OCD and Depression — How to Combat Both

Having obsessive-compulsive disorder (OCD) can put you at a higher risk for developing other forms of mental illnesses — this includes OCD and depression.

The combination can make it feel like your symptoms are endless, and someone who has OCD might present their symptoms a little differently from someone who may only be diagnosed with depression.

As we continue to learn, we’re realizing that mental health conditions are more nuanced than we think. The way we see one condition today is totally different from how we’ve seen it in the past. For example, OCD was once classified as an anxiety disorder because people with OCD would often present signs of severe anxiety. 

Let’s take a deeper look into OCD and then explore what OCD and depression look like and how to treat them.

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by obsessions and compulsions that interfere with daily life.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), OCD was moved to its own disorder class of “Obsessive-Compulsive and Related Disorders.” Some related conditions in this class include body-dysmorphic disorder, hoarding disorder, and trichotillomania.

A person with OCD can experience distress that oftentimes has a theme associated with it (obsessions). This can lead to behaviors and thought patterns such as:

• Fear of contamination or dirt
• Doubting and having difficulty tolerating uncertainty
• Needing things orderly and symmetrical
• Aggressive or horrific thoughts about losing control and harming yourself or others
• Unwanted thoughts, including aggression or sexual or religious subjects
• Doubts that you’ve locked the door or turned off the stove
• Intense stress when objects aren’t orderly or facing a certain way
• Images of driving your car into a crowd of people
• Thoughts about shouting obscenities or acting inappropriately in public
• Unpleasant sexual images
• Avoidance of situations that can trigger obsessions, such as shaking hands

With these thoughts and obsessions, someone with OCD might react compulsively in a variety of ways, perhaps without even realizing it. For example, if someone fears contamination by dirt, they may constantly be washing and cleaning. If they fear seeing objects appear a certain way, they might go back and check to make sure an object is set in the right place. 

Someone who is obsessed with making sure they are certain with everything may follow a strict routine. They might repeat things to themselves or have a pattern to how they complete their tasks each day.

Like many other mental illnesses, OCD can range in severity. It begins in adolescence, though it could begin as early as childhood, and the symptoms can increase or change in severity over time.

Symptoms of OCD can be anything from mild/moderate to so severe and time-consuming that it can become disabling. 

A Quick Note About OCD Terminology

We talk a lot about how language and culture influence how we look at mental health. Something we hear people say often is, “Why are you being so OCD about this?” or “I’m so OCD about how I drink my coffee.” 

We need to be aware of how we so loosely throw these terms around. OCD is a real condition that affects real people — we don’t need to use it as a joke or jab. The more we diminish OCD to something as arbitrary as a joke or insult, the less we can take these conditions seriously and give people the right treatment.

OCD and Depression 

Now that we know more about what OCD is, let’s talk about OCD and depression — what happens when you’re experiencing the two?

Studies have shown 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/compulsive behaviors to chemical imbalances in the brain that can alter moods and behaviors.

The International OCD Foundation estimates that between 25–50% of those with OCD will also experience depression. Most people experience the symptoms of OCD first, but for a small percentage, the two conditions begin at the same time. It’s rare for depression symptoms to precede OCD.

What Does It Look Like to Have Both?

Let’s look at an example of someone who is experiencing both OCD and depression.

Let’s say this person is a new parent and they experience unwanted thoughts of hurting their baby. These thoughts are scary, even if the baby is not in any real danger. 

This person may feel like something is wrong with them, and the more there are intrusive thoughts like these, the more this person may begin feeling depressed. It can make them feel like they’re out of control, which can feel frightening and debilitating.

People with OCD and depression may experience symptoms at the same time. For example, they could experience compulsions and debilitating fears, such as that they have run over someone while driving, yet may also feel a sense of hopelessness (a feeling a person with depression generally experiences).

That hopelessness can keep a person from feeling assured that they did not actually run someone over. 

Depressed people also experience high levels of anxious symptoms such as agitation, apprehension, and worry. Studies show that anxiety is commonly found in reactive depression but is infrequently observed in the more severe psychotic or bipolar forms of depression. It is in the more severe forms of depression that obsessions and compulsions are seen.

Interestingly enough, when I was a young kid, I remember having intrusive thoughts. I wasn’t diagnosed with major depressive disorder, but I did feel discomfort with these intrusive, repetitive, extreme thoughts — even though it didn’t necessarily put me or anyone else in danger.

Later, I was diagnosed with major depressive disorder. I am curious to see if there are any mild OCD symptoms that have been underlying in my diagnosis throughout my life.

Of course, like anyone, it’s important to get a medical diagnosis from a health care professional — the more information you have, the better you can set yourself up for a treatment plan, whether that’s for OCD, depression, or OCD and depression simultaneously.

Treatments for OCD and Depression

Thankfully, OCD is generally a highly treatable disorder (and so is major depressive disorder). OCD can be treated in a few different ways, including with cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP). 

ERP is a great option for OCD and depression because it exposes the person to their OCD-specific fears in a safe environment. Doing so can help resist their urge to turn to their compulsions.

However, for someone with both OCD and depression, ERP might be a little more difficult to do. The symptoms of depression might combat the symptoms of OCD. 

Someone with severe depression may feel hopeless and not even want to try changing their habits or approaches including ERP. It could take some time for someone to eventually feel motivated to participate in these therapies, which could delay progress and treatment. 

Additionally, symptoms of depression such as fatigue may make it feel almost impossible to go to therapy appointments, keep a regular schedule, or uphold their end of the inner work they have to do outside of therapy sessions.

This can make the process feel frustrating. But remember, you are not alone.

It’s important to remember that each individual is different, so the process for treatment might be different. For example, a person’s most distressing symptoms might be their depressive symptoms like hopelessness.

A healthcare professional may want to treat these symptoms first to provide some relief before going on to help treat the OCD symptoms. (This is known as a hierarchy of mental health disorders, stipulating that depression should be dealt with before treating any anxiety-based conditions). 

In addition to a few different kinds of therapies, medications can help regulate mood and offset some of the severe symptoms of depression. 

For example, selective serotonin reuptake inhibitors (SSRIs) are used to treat symptoms for anxiety, depression, and OCD. This could help lower levels of distress and provide some relief as part of the treatment process. Other medications include serotonin-norepinephrine reuptake inhibitors (SNRIs) which focus more on depression and anxiety. 

I invite you to share your own personal story of experiencing both OCD and depression. Have you found that certain treatments worked better for you than others? Do you feel that your OCD is more intense than your depression? Let me know in the comments.