Depression and OCD
Dr Costas Papageorgiou
Consultant Clinical Psychologist
OCD Treatment Programme
Priory 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!