Coping with Treatment-Resistant OCD

Multi-ethnic couple at therapy session
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Although there are many effective treatments for obsessive-compulsive disorder, up to a third of people with OCD have what is called treatment-resistant OCD, which means they do not respond to standard treatments like medication and psychotherapy. If you or a loved one are dealing with treatment-resistant OCD, here are some options to consider, along with links to more information.

Explore Reasons Your Medication May Not Be Working

Although there are many FDA-approved medications available for the treatment of OCD, medications don't seem to be effective for one-third of people’s OCD symptoms. This can happen because of genetics, body chemistry, other medications you're on, skipping doses, as well as whether or not you use alcohol and/or drugs. Sometimes, it can take a lot of time and experimenting with dosage and medication types to find the right one for you.

Consider Augmentation Treatment Strategies

Augmentation therapy treats OCD symptoms with more than one medication. This strategy improves the odds of relieving symptoms by using combinations of drugs, rather than a single drug. Augmentation antidepressant treatment may be helpful for people who do not achieve remission with just one medication.

Adding antipsychotic drugs to an antidepressant is one way of augmenting treatment that has been shown to be effective.

Explore Reasons Psychotherapy May Not Be Helping

Although psychological treatments have come to the forefront in the treatment of OCD, they are not always effective. There are multiple reasons why psychotherapy for OCD may not be working for you, including not being ready for therapy, receiving the wrong type of therapy for OCD, an insufficient relationship with your therapist, lacking social support, financial difficulties and not having the social or family support you need.

Investigate Intensive Treatment Programs

While there are many effective medical and psychological treatments available for OCD, not all treatments work for everybody. Unfortunately, for some people, nothing seems to be effective. This has led to the development of a number of intensive residential OCD treatment programs.

Consider Taking Part in a Clinical Trial

Clinical trials often offer free, cutting-edge treatments that are not yet widely available to the public that can be helpful for treatment-resistant OCD. A clinical trial can also help you understand your disorder better while serving to help others with OCD receive more effective treatments in the future.

Explore Psychosurgery and Deep Brain Stimulation

A very small minority of individuals with OCD have symptoms severe enough to consider brain surgery. Surgical procedures for OCD involve inactivating certain brain regions that are responsible for the symptoms associated with OCD. In most cases, approximately 50% to 70% of people who have these procedures see a significant improvement in symptoms. One of these neurosurgical procedures is deep brain stimulation, which appears promising, although it is still in the experimental stage and often considered a last resort.

Transcranial magnetic stimulation (TMS), a type of noninvasive deep brain stimulation often used to treat migraines headaches and major depression, is another consideration. It was approved by the FDA for the treatment of OCD in 2018.

2 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhou D-D, Wang W, Wang G-M, Li D-Q, Kuang L. An updated meta-analysis: Short-term therapeutic effects of repeated transcranial magnetic stimulation in treating obsessive-compulsive disorderJournal of Affective Disorders. 2017;215:187-196. doi:10.1016/j.jad.2017.03.033

  2. Food and Drug Administration (FDA). FDA permits marketing of transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder.

By Owen Kelly, PhD
Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders.