OCD Related Conditions The Link Between OCD and Major Depressive Disorder Challenges in Managing the Dual Diagnosis of OCD and Depression By Owen Kelly, PhD Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. Learn about our editorial process Updated on September 22, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print Tetra Images / Getty Images Table of Contents View All Table of Contents Major Depressive Disorder OCD and Depression Managing a Dual Diagnosis People with obsessive-compulsive disorder (OCD) are at a greater risk of developing other forms of mental illness. One of the most common is major depressive disorder (MDD). In fact, research suggests that as many as two-thirds of people living with OCD will experience a major depressive episode sometime during the course of their illness. The causes can be varied, ranging from reactive stress to obsessive or compulsive behaviors to biochemical changes in the brain that can alter moods and behavior. Depression can be especially serious in people with OCD as it can affect their ability to adhere to the treatment of their OCD symptoms. Understanding Major Depressive Disorder Major depressive disorder is about more than just feeling sad. To be diagnosed with MDD, you need to experience a depressed mood and lose interest in things that used to be enjoyable to you for at least 2 weeks. In addition, four of the following symptoms must be present nearly every day during the same 2-week period: Difficulty thinking or concentratingEating too much or too littleFeeling either slowed down or noticeably fidgetyFeelings of worthlessness or inappropriate guiltLow energyRecurrent thoughts of death or suicideSleeping too much or too little If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Typically speaking, these symptoms will be severe enough to cause trouble at home or work. Link Between OCD and Depression Depression in people with OCD most often occurs after the onset of OCD symptoms; the inverse is not true. What this suggests is that depression may be related to the personal stress of living with OCD or troubles that have developed at home or work as the result of the disease. However, secure attachment seems to be protective against depression. Scientists also believe there may be biochemical factors that contribute to depression. We know, for example, that OCD and MDD are both characterized by changes in the production and activity of serotonin, a chemical that relays signals between nerve cells. With these biochemical changes can come associative behavioral ones, some of which are shared in people with OCD and MDD. As such, OCD may perpetuate MDD simply by enhancing an underlying biochemical imbalance. Most evidence also suggests that symptoms of depression are more actively linked to disturbing obsessions (negative thoughts you can't get rid of) rather than compulsions (repetitive behaviors you can't control). Managing a Dual Diagnosis On their own, OCD and MDD require specific care and treatment delivered over the long term. When they both occur together, they may complication therapy. But this is really only the tip of the problem. By its very nature, major depression tends to affect a person's ability to maintain adherence to drug therapy, not only those related to OCD but any chronic medication that requires daily drug-taking. Oftentimes, feelings of persistent hopelessness can lead people to ask "what's the point?" If this happens, the person will usually be less interested in taking their drugs, grooming, eating properly, or interacting with others. This can be seriously problematic for those undergoing OCD treatment. Insofar as many psychotropic drugs require high levels of adherence to achieve the desired effect, any gap in treatment can take back the gains a person may have made. To mitigate this concern, the therapist will often need to treat the depression first before addressing the OCD. On the other hand, the use of selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, is also known to be effective in managing many of the symptoms of OCD. In the end, if you have been diagnosed with OCD and believe you have depression, do not wait for the feelings of sadness to pass. Speak with your doctor or mental health provider. Treatment plans can be adjusted to meet your needs and prevent the worsening of symptoms. 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. Tibi L, Van oppen P, Van balkom AJLM, et al. The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample. Eur Psychiatry. 2017;44:76-82. doi:10.1016/j.eurpsy.2017.03.009 Pallanti S, Grassi G, Sarrecchia ED, Cantisani A, Pellegrini M. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Front Psychiatry. 2011;2:70. doi:10.3389/fpsyt.2011.00070 Additional Reading Remijnse PL, Van den heuvel OA, Nielen MM, et al. Cognitive inflexibility in obsessive-compulsive disorder and major depression is associated with distinct neural correlates. PLoS ONE. 2013;8(4):e59600. doi:10.1371/journal.pone.0059600 By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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