Depression and OCD

Dr Costas PapageorgiouConsultant Clinical Psychologist

OCD Treatment ProgrammePriory Hospital Altrincham

www.costaspapageorgiou.com

Overview of Presentation

• Impact of OCD on life and functioning• Overlap between OCD and depression• Diagnostic criteria for depression• Assessment of OCD and depression• Treatment of OCD and depression

- Behavioural activation- Cognitive therapy- Metacognitive therapy- Anti-depressant medication

The Impact of OCD

• OCD can affect people’s quality of life and their daily functioning

• The impact of OCD can lead to many people also experiencing sadness, symptoms of depression or clinical depression

• Differences and similarities between sadness, symptoms of depression and clinical depression

Exercise 1

• To what extent has OCD impaired…- Your ability to work or study?- Your home management skills?- Your ability to enjoy social leisure?- Your ability to enjoy private leisure?- Your general relationships?- Your sexual relationship?• What impact has OCD had on your life and mood?

Overlap between OCD and Depression• OCD often co-exists with other problems

• The most common additional problem with OCD is depression

• About one-third of individuals with OCD suffer from depression

• 11% of individuals with depression develop OCD

What is Clinical Depression?• Depressed mood

• Loss of interest or pleasure in nearly all activities

• Changes in appetite

• Sleep problems

• Change in psychomotor activity

What is Clinical Depression?• Decreased energy, tiredness and fatigue

• Sense of worthlessness or guilt

• Difficulties concentrating or making decisions

• Thoughts of death or suicide

Exercise 2

• Given the list of symptoms of depression, can you get an idea of whether or not you or someone you care about is suffering from depression?

• What steps have you considered in seeking help?

Overlap between OCD and Depression• Depression nearly always starts after OCD, which

suggests that it is the result of having OCD

• Depression can often lead to hopelessness as well as pessimism about recovering, which can affect people’s ability and efforts to overcome OCD

• Depression can make OCD last longer, seemingly “confirming” people’s fear that OCD will never disappear

Dealing with OCD and Depression• Addressing problems of OCD with co-existing

depression can be challenging but is necessary

• When OCD co-exists with depression, it is vital to be able to provide comprehensive assessments of the problems together with integrated or combined treatments

Assessment of OCD and Depression• Key goals are to determine if there are any co-

existing problems such as depression

• To be able to formally assess the severity of depression including suicide risk

• Assess person’s living situation and supports from family and significant others that could be used in treatment

Treatment of OCD and Depression• For treatment of OCD with depression to be

effective, three forms of care must be offered:(1) Parallel care: Give equal consideration to the co-existing problem(2) Sequential care: Prioritise all care issues so do not wait for OCD problems to improve to see if depression lifts(3) Integrated care: Allow all team members to participate in the care of the individual

Treatment of OCD and Depression• CBT - Behavioural activation:

- Changing behaviour- Monitoring daily activity- Avoidance vs. activities- Scheduling daily activities- Reduce inertia and activities- ACTION is needed

Treatment of OCD and Depression• ACTION stands for:

- Assess if avoidance is present- Choose to avoid and be depressed or to do a different activity- Try the activity chosen- Integrate new behaviours into a routine- Observe the results- Never give up

Treatment of OCD and Depression• CBT - Cognitive Therapy:

- Learning that thinking leads to emotions- Negative thoughts contribute to low mood- Identifying negative thoughts is a starting point- Recognising thinking errors in negative thoughts- Seeing thinking corrections in negative thoughts- Challenging and testing negative thoughts

Treatment of OCD and Depression• Metacognitive therapy for depressive rumination

(Adrian Wells and Costas Papageorgiou, 2004):- Recognising and identifying rumination- Using similar strategies for dealing with OCD intrusions and ruminations- Learning that rumination is not uncontrollable- Leaning to stop the factors that start and keep rumination going

Treatment of OCD and Depression• Anti-depressant medication:

- Consider for moderate to severe depression- Selective Serotonin Reuptake Inhibitors (SSRIs)- Most sides effects resolve within days- Improvements are usually within 4-6 weeks- Anti-depressants also help to carry out some of the tasks involved in treatment for OCD

Discussion

• Questions

• Case studies

• Advice and recommendations

• There really is a light at the end of the tunnel, but it is not a train coming towards you!