While the cause of obsessive-compulsive disorder is not actually known, many professionals and lay people often attribute the disorder to a chemical imbalance. SSRIs, which are medications that affect serotonin, are known to reduce symptoms in a good number of people with OCD. So it is reasonable to deduce that serotonin levels in those with OCD must be out of whack, right?
Well, not necessarily. That explanation is way too easy, and certainly has never been proven. Drugs often help people with all types of illnesses, but how and why they help is not always clear. And I’m not just talking about medications for brain disorders. There are a number of cholesterol medications, blood pressure medications, anxiety-reducing medications, rheumatoid arthritis medications – just to name a few – that work to reduce symptoms. Different drugs work for different people, and we don’t always know why. Why does acetaminophen help my husband’s headache but only ibuprofen works for me?
But really, what’s the big deal if we just use an easy explanation of “chemical imbalance” when discussing the cause of OCD, even if it’s just a theory?
Well, for one thing, if those with obsessive-compulsive disorder, or their loved ones, believe their OCD is caused by a chemical imbalance, how will they feel if medication fails to correct this supposed imbalance? Depressed? Confused? Hopeless?
And if we believe that treating OCD is as easy as raising our serotonin levels, we might just be lured into the many scams out there promising a quick fix for OCD. Raise your serotonin levels and be free of OCD ! Ah, if only it were that easy!
As imaging technology advances (PET Scans for example) and more research is conducted, we are discovering that nothing is simple when it comes to OCD. Studies have shown that those with OCD have elevated brain activity in parts of the frontal lobes (particularly the orbital cortex) and the basal ganglia. This is important information that, on the one hand, brings us closer to understanding OCD and its causes, and on the other hand, raises even more questions. Throw in the fact that genetics and environment have been shown to play a big role in the development of OCD, and it is now easier to see how we can’t just attribute the disorder to a chemical imbalance.
So where does that leave us? Well, thankfully, we do not have to fully understand the cause of obsessive-compulsive disorder to treat it effectively. Exposure and response prevention (ERP) therapy, the evidence-based Cognitive Behavioral Therapy used to treat OCD, works. It literally saved my son’s life. So while the experts are busy at work trying to decipher what actually causes OCD, those who live with the disorder can commit themselves wholeheartedly to ERP therapy. Because one thing we do know is that OCD, no matter how severe, is treatable and can be beaten.
ocdtalk 
Absolutely agree. OCD can be treated. I did not believe this once, but i was wrong. I am not free of it, but it can be significantly improved.
Thanks for sharing, Paul, and I’m so glad you are doing well! Hope to hear from you again.
On the other hand, I feel like “medication” sometimes gets a bad rap. I suffered from severe OCD (mostly harming obsessions) and panic disorder, and I was put on Fluoxetine back in the day when it was still being tested for its effectiveness in treating OCD. That was nearly 30 years ago, and it saved my life. I often find myself feeling guilty every time I read another article favoring ERP over medication because I feel it implies that I’ve somehow taken the easy path by relying on medication. However, the fact is that medication does work for some of us, and I am proof of that. Would ERP do just as well? I don’t know. Does it really matter in my case? Do I want to start all over again with ERP and see if that is just as effective? Is there something “wrong” with relying on medication? Trust me, getting used to the initial effects of Fluoxetine was no “easy fix”, and I do not consider my lifelong dependence on it an “easy fix”.
I also feel like there is much more research on ERP with respect to actual compulsions and rituals, rather than with pure obsessions, which often do not result in any obvious outward activities. That, combined with the lack of qualified professionals who offer ERP (at least here in the U.S.) is another reason why medication might often be the best choice for many of us. I think I would like to see more written on the availability of all options, both medication and ERP, rather than negative bias against medication.
Hi Laura, Thank you so much for sharing your story and I’m glad you have found medication helpful. I’m sorry if you felt this post was “anti-meds” as that was not my intent. No judgement here. My stance has always been that meds help some people, but not all, and everyone should make the right choices for themselves without having to feel badly about it.
As far as I understand it, for most people, medication alone is not enough to keep OCD at bay, which is why the combination of ERP and medication is typically recommended. Then there are some people who are helped a lot by meds (you!) and some who are not helped at all (my son).
For those who prefer not to remain on medication indefinitely, OCD often returns once the medication is stopped, so ERP is helpful in these cases as well.
I totally agree we are lacking in qualified ERP therapists. However, with a good therapist, ERP is successful for those with Pure O (mental rituals). You might find this guest post by Dr. Seth Gillihan interesting: https://ocdtalk.wordpress.com/2012/09/14/mental-rituals-ocd-and-erp/.
I wish you all the best and am truly pleased you have found what works for you!