I’ve previously written about how complicated the topic of OCD and medication can be. I’ve talked about stigma and the process of “trial & error.” I’ve discussed how there are those who feel weak for deciding to take medication, and still others who feel empowered by this decision. I’ve talked about how there is not one specific drug for obsessive-compulsive disorder, and what works for one person might not work for another. Some people find medication to be helpful, and others never derive any benefits from them, no matter how many meds they try. There are those who are plagued by intolerable, and often dangerous, side-effects, and others who say medication saved their lives.
To say the subject of medication and OCD is an individual thing is an understatement.
There is one aspect of medication in relation to OCD that I have yet to touch upon, and that is attitude. Specifically, does one’s beliefs about medication influence its effectiveness?
Most of us are familiar with the placebo effect, which in the case of medication, involves beneficial effects produced by the patient’s beliefs in the “drug” (typically nothing more than starch and sugar) they are taking. Not as well known, but equally powerful, is the nocebo effect, which is associated with harmful effects due to the person’s negative beliefs about the “drug” they are taking.
Dr. Brogan quotes from the New England Journal of Medicine:
Placebo effects rely on complex neurobiologic mechanisms involving neurotransmitters (e.g., endorphins, cannabinoids, and dopamine) and activation of specific, quantifiable, and relevant areas of the brain (e.g., prefrontal cortex, anterior insula, rostral anterior cingulate cortex, and amygdala in placebo analgesia).
In other words, the placebo and nocebo effects are real, and have been recognized as such by the medical community.
It is interesting to note that the placebo and nocebo effects are not limited to medication. As an example, Dr. Brogan highlights a study which produced data that focused on outcomes of belief. She says:
…One of my favorite studies took 84 hotel attendants with cleaning responsibilities and told half of them that their daily work satisfied the Surgeon General’s recommendations for an active lifestyle as exercise. They told the other half nothing.
As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.
So interesting! But what does all this mean for those with OCD? I’m no expert, but I’d guess that if someone is forced to take medication for their OCD when they really don’t want to, and when they believe it won’t help, there is a good chance it won’t benefit them. Conversely, if someone is gung-ho about meds and can’t wait to take them because they’re convinced they’ll quell their OCD, chances are they’ll experience at least some relief.
Of course, there is more to these medications than just believing or not believing they will work. But attitude is a piece of the complicated OCD puzzle. Also, it’s not difficult to see how attitude and beliefs are likely to affect exposure and response prevention (ERP) therapy as well. Hmm, sounds like a good topic for another post!