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People with obsessive compulsive disorder have a higher risk of becoming depressed — and if they do, they can also expect their OCD symptoms to get worse. How does a depression diagnosis work, and what are your treatment options?

Obsessive compulsive disorder is a serious and debilitating mental illness on its own. Marked by both "obsessions" and "compulsions", some of the symptoms of OCD can include:

  • On the obsessive side, invasive thoughts and urges may involve a serious fear of dirt and germs, intrusive worries of impending doom, thoughts of aggression and harming others or self, and a need to have things in "exactly the right place". 
  • On the compulsive side, needing to count and check things constantly, needing to have things in perfect order, and spending hours cleaning and engaging in specific "rituals" are part of OCD. 

People of all ages, genders, and ethnic groups all over the world suffer from OCD. A significant percentage — according to one study, 67.5 percent — of people living with obsessive compulsive disorder will also suffer at least one major depressive episode during their lives, with nearly a third of those diagnosed with OCD living with depression at any given time. 

OCD sufferers with more intense symptoms are at a higher risk of becoming depressed, research shows, but being depressed also intensifies the number and severity of obsessive compulsive symptoms. People with both obsessive compulsive disorder and depression have worse treatment outcomes than people with OCD alone, as well — so prompt diagnosis and treatment are really important. 

How is depression diagnosed in people with obsessive compulsive disorder?

Some other mental health diagnoses that are strongly associated with a higher risk of depression, like anxiety and bipolar personality disorder, have significant overlapping symptoms, making diagnosis trickier. This is, thankfully, not really the case with obsessive compulsive disorder. Should you have OCD, are pretty sure you're clinically depressed, and approach your doctor about it, they can simply examine whether you meet the diagnostic criteria. Let's take a look at those. 

The symptoms of major depressive disorder recognized by the current version of the diagnostic and statistical manual of mental disorders (DSM-5) are:

  • Having a depressed mood the majority of the time — this can be marked by feelings of pervasive sadness, emptiness, hopelessness, and numbness. 
  • A reduced interest in most daily activities, including those you used to find meaningful — even the smallest task takes a lot out of you. 
  • Involuntary weight gain or loss, as a result of gaining or losing appetite. 
  • Suffering from insomnia or oversleeping. 
  • A physical speeding up (agitated physical behavior) or slowing down. 
  • A lack of energy or fatigue.
  • Excessive or inappropriate feelings of guilt or worthlessness. 
  • Loss of ability to focus, and having a hard time making decisions. 
  • Finally, suicidal thoughts or feelings that may or may not lead to concrete plans or attempts to commit suicide. 

Other important things you need to know:

  • You need to experience at least one of the first two symptoms on the list to get a diagnosis of major depressive disorder. 
  • You should have a minimum of five of the symptoms. 
  • Symptoms need to be present for at least two weeks. 
  • To get a diagnosis of depression, your symptoms shouldn't be better explained by another mental or physical health condition, or occur as a side effect of medications you may be taking. 

Your doctor will be well aware that depression is more common in OCD sufferers, as well, and will be able to make a diagnosis after assessing whether you meet the diagnostic criteria.

How is combined OCD and depression treated?

If you have a dual diagnosis, your doctor will consider which condition is currently more of a threat — and they will then focus on triage before making a more long-term treatment plan together with you. If you were receiving behavioral treatment for obsessive compulsive disorder before you were diagnosed with depression, this may mean that you will take a break from that until your depression is under control. 

On the other hand, where depression is caused more directly by OCD symptoms, treating obsessive compulsive disorder may simultaneously liberate a person from depression. It is up to the treating doctor(s) to figure this out, then, with your help.

People with both obsessive compulsive disorder can be prescribed antidepressants, commonly of the SSRI or SNRI variety. They may be less effective in alleviating depression than they would be in someone who didn't have OCD, but on the other hand, antidepressants may also reduce some of the symptoms of obsessive compulsive disorder. 

Cognitive behavioral therapy is a kind of talk therapy that is really quite effective in helping people with major depressive disorder, and that can also help with obsessive compulsive disorder. Talk therapy can, therefore, help you on two fronts, which is good, because it means you don't have to put your goal to manage your OCD on hold completely while you are in treatment for depression. 

In conclusion

Though the true prevalence of major depressive disorder in people with obsessive compulsive disorder remains unknown, with available data simply being estimates, it is beyond clear that many OCD sufferers become depressed at some point. Depression can make your OCD symptoms worse while OCD makes you more depressed, so starting treatment as soon as possible is essential. Together, your doctor and you will come up with the best plan for you. 

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