Benefit of cognitive-behavior therapy alongside pharmacotherapy in treating obsessive-compulsive disorder with depression: a case report and review of the literature

Abstract

Obsessive compulsive disorder (OCD) is characterized by unwanted, persistent, and intrusive thoughts and has lifetime prevalence estimated at 1 to 3%. OCD is often associated with a high degree of psychiatric comorbidities (like depression), disability, and relatively poor long-term outcome. Cognitive-behavior therapy (CBT) has proven to be an effective treatment regiment for OCD. Yet, it is being underused used in acute care facilities for the treatment of patients with OCD and associated psychiatric comorbidities. We present a challenging case highlighting the benefit of CBT alongside medication adjustments in a mental health unit. A 20-year-old male patient presented to our mental health unit with previously diagnosed OCD and severe depression. In addition, he also had social anxiety, insomnia, and suicidal ideation. Patient history revealed that he had been prescribed fluvoxamine, 200 mg per day, five months back but his symptoms had gotten worse. He has had one previous hospitalization. His Global Assessment of Functioning (GAF) at admission was in the range of 21-30. The fluvoxamine that had been previously prescribed was kept at 200 mg per day. In addition, he was also prescribed lorazepam 1 mg every four hours (anxiety), and zolpidem 10 mg per day (insomnia). During his inpatient stay, the patient also underwent CBT with counselors and a social worker. At discharge which was 6 days post admission, the fluvoxamine was increased to 250 mg per day. He had mild depression; GAF had improved; was very sociable; slept 8 hours a day; and had no suicidal ideation. CBT that focuses primarily on exposure and response prevention may be better at treating co-occurring depression. This case illustrates the importance of considering CBT alongside proper pharmacotherapy in the treatment of OCD with depression in acute care facilities.