Feeling Hesitant About Starting OCD Medication?
If you’re living with Obsessive Compulsive Disorder (OCD) and considering the possibility of starting medication, it’s extremely common to experience feelings of hesitancy and uncertainty- after all, OCD isn’t known as the “doubting disease” for nothing! Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL reviews some common concerns that arise in patients considering medication for OCD, and some tips for making an informed decision that’s driven by choice rather than fear.
This post is provided for educational purposes only, and is not intended as a substitute for professional medical advice. If you have questions, always reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
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Intrusive Thoughts Surrounding OCD Medications
Whether you’ve only recently begun to consider whether you may be experiencing OCD, have been formally diagnosed and are considering treatment options, or have been in treatment for some time and are are now faced with the possibility of making changes to your current medications, it’s very common for the topic of medications to trigger intrusive thoughts.
As a quick review, intrusive thoughts are unwanted, unwelcome, involuntary thoughts. These thoughts may not be aligned with our values and beliefs, and can be upsetting. It’s important to note that everyone experiences intrusive thoughts from time to time. We can think of them as kind of like junk mail: "Your traffic ticket is overdue- pay $10,000 immediately, or a warrant will be issued for your arrest!” While they may appear important, threatening, and urgent when taken at face value, the reality is that they are quite the opposite- just junk, of no real meaning or value at all. For those who don’t experience OCD, it may be easy to immediately disregard and move on from these intrusive thoughts, sending them to the proverbial spam folder with no major impact on one’s day. In OCD, however, intrusive thoughts can be “stickier” and harder to let go of, as if they were marked with a “high importance” or “urgent” flag. When intrusive thoughts are persistent, repetitive, and distressing, we think of them as obsessions.
The types of intrusive thoughts experienced by people living with OCD are vast, with significant variations from one person to the next. While it would be impossible to list every type of intrusive thought that can come up surrounding medications, here are a few common ones:
Stigma
If I take medication for OCD, what does that mean about me as a person?
Are my symptoms really severe enough to warrant medication? Is there something really wrong with me?
If I take medication, does it mean I was too weak to “beat” OCD on my own? That I’m not trying hard enough in therapy?
Is taking medication “cheating?”
Side Effects/ Impact on Health
What if I experience side effects?
What if I experience side effects that haven’t been discovered yet/unknown to my doctors?
What if I experience a life-threatening allergic reaction? What if it doesn’t happen until I’ve been taking it for years?
What if it interacts with my other medications or supplements?
What if I experience suicidal thoughts, and act on them?
What if I die?
What if it changes my personality?
What if it doesn’t work?
What if I become addicted to the medication? What if I become dependent on the medication and it gets discontinued, or I can’t afford it?
Medication Accuracy/ Contamination Concerns
What if the doctor prescribes the wrong medication, or the wrong dose?
What if the pharmacist put the wrong medication in the bottle?
What if the medication has been tampered with? What if there are germs on it?
What if the medication is expired, or counterfeit?
What if the pharmacist gives me a generic medication from a different manufacturer, and they’re not actually equivalent?
As you can see, we can divide these types of intrusive thoughts up into different categories based on the specific content, but we can also see that they have a similar underlying theme- when it comes to starting a new medication, there is always going to be an element of uncertainty, and that can be very challenging to sit with!
Common Compulsions Surrounding OCD Medications
As we saw above, the topic of medications can trigger many different intrusive thoughts for people living with OCD, and these can cause significant distress and anxiety. In an attempt to reduce this discomfort and find some temporary relief, one may find themselves engaging in compulsions, or repetitive physical or mental behaviors aimed at relieving the distress.
Compulsions can be sneaky in that you may not even be aware that you are doing it. Here’s a few common examples of compulsions that may show up in response to distressing intrusive thoughts about medications:
Asking loved ones for reassurance- whether the medication is right for you, whether they think it will work, whether they think the physical sensation you’re noticing is a side effect, etc.
Excessive googling/research about the medication
Excessively chatting with AI chatbots about the medication
Excessively reaching out to your doctor or therapist about possible side effects
Body scanning for changes in physical sensations that may be suggestive of a side effect or allergic reaction
Repeatedly checking the label to confirm that you are taking the correct dosage
Repeatedly comparing the medication in the bottle to photos of the medication online for confirmation
Repeatedly checking for any recent safety recalls of the medication
More on Side Effect Concerns
Unfortunately, all medications carry a risk of side effects, and if you’ve seen any commercials lately, the list can be lengthy and quite off-putting! Medication manufacturers, as well as your doctor, share this detailed information about potential side effects with you not to cause fear or anxiety, but because it’s important for you to be able to make an informed decision about whether or not the medication is right for you, and that means understanding the risks as well as the benefits. Some side effects may be common, while others may be extremely rare, and a discussion with your doctor can help you to get a better sense of this. Everyone’s tolerance for risk, and what they consider to be acceptable vs. unacceptable, is different, and thus the decision about whether or not to take a medication is an ultimately a personal one. It can be helpful to keep in mind that doctors take an oath to do no harm, which means that if your doctor believed that the risks of the medication greatly outweighed the potential benefits, it’s unlikely that they’d be offering it to you as an option in the first place.
Another point to keep in mind when weighing the risks versus the benefits of taking a medication is to make sure we are also considering the risks of not taking the medication. When we think about side effects in isolation, it may feel like a simple decision- why would I choose to take the risk of experiencing some nausea when I could just not? The scales may tip in a different direction if you instead frame the question as whether you would rather take the medication and risk experiencing some nausea, or not take the medication and risk experiencing no changes in the distressing obsessions and compulsions that consume hours of your day. Consider making a chart listing out the pros and cons of starting the medication vs. continuing things as is.
When you are starting a new medication, or making changes to an existing one, it’s natural to wonder whether you will experience the side effects you’ve heard about. For some people, this can lead to an increase in their attention towards, and thus heightened awareness of, one’s bodily sensations. People may engage in body scanning behaviors, or closely and intensely monitoring oneself for any noticeable changes in physical sensations, or for the presence of new physical symptoms. They may be hypervigilant and “on the lookout” for sensations that may otherwise pass by unnoticed, or perceive symptoms that they may otherwise have chalked up to be minor to be more bothersome.
To give an example, our heart rate varies naturally throughout the day- it may rise when we are physically active, or slow down when we are resting. Most people don’t actively monitor their heart rate, so it’s unlikely that they would be aware of, nor bothered by, these changes. If one is concerned, however, that the medication that they are starting has the potential to cause an increase in heart rate, they may find themselves paying very close attention to their heart rate. They may check their pulse, find it to be somewhat higher than it was earlier, and reach the conclusion that it must be due to the medication, when it may in fact be entirely unrelated.
To give another example, perhaps you are experiencing some indigestion after taking a medication that carries a risk of this side effect. You may quickly draw the conclusion that it must be due to the medication, disregarding that you just got back from a pizza party where you enjoyed multiple slices along with some cake and soda.
It’s also important to keep in mind that anxiety itself can also cause many different physical symptoms, such as racing heart, nausea, diarrhea, increased sweating, or muscle tension. As we mentioned earlier, there can be a lot of uncertainty when starting a new medication, so it’s not uncommon to experience an increase in anxiety- consider whether this may also be a reasonable explanation for the symptoms you’re experiencing.
So, how do you know whether it’s a side effect to be concerned about? Have a discussion with your doctor! They can help you to understand if there are any side effects you need to be actively monitoring for, and provide guidance on steps to take if you feel you may be experiencing them. Sometimes, some minor side effects may actually be expected when first starting a medication, typically resolving within a few days without any cause for concern- they can provide anticipatory guidance so that they don’t come as such a surprise if they do occur (a temporary, unwelcome, expected guest rather than an unknown intruder).
If you’re very concerned about the potential for side effects, either one in particular, or as a whole, don’t hesitate to let your doctor know! They can take your preferences and concerns into account to provide you with options that may carry a lower risk of side effects, or discuss possible adjustments to the dosing schedule that may help to reduce the risk of certain side effects.
Working Through Doubt and Uncertainty
If you’re struggling with feelings of doubt and uncertainty in the face of all of the unknowns surrounding starting a medication, please know that you are absolutely not alone- as we’ve discussed, this is extremely common for people living with OCD.
We are fortunate to have multiple evidence-based treatment options available for OCD, so while medication is an option (and a life-changing one for many!), it certainly isn’t the only one. Many people opt not to pursue medication, and are able to achieve lasting success via evidence-based therapy, such as Exposure Response Prevention (ERP), alone. With that said, the decision about whether or not to take medication for OCD should be just that- a choice. Above all, you are worthy and deserving of effective treatment, whatever that may look like for you.
If you feel like uncertainty and doubt may be holding you back, or creating undue influence over your decision, speak with your doctor and let them know what you’re going through. They can help to troubleshoot using some of the strategies discussed above, and can also consider whether there may be a role for Exposure Response Prevention (ERP) Therapy aimed specifically at working through overcoming medication related obsessions and compulsions to help you get to a point where your decision isn’t driven by your OCD symptoms.
Remember also that while the decision about whether or not to start medications can feel like a heavy one, it isn’t a permanent, irreversible commitment! Starting a medication doesn’t mean that you are committing to taking it for the rest of your life. If at any point you decide that it’s not for you, there is always the option to stop taking it. With that said, always reach out to your provider if you are considering adjusting or stopping your medication- they can help you to understand the risks and benefits of doing so, and provide guidance about how to do so safely should you prefer to go that route.
Finding Treatment for OCD
If you’re interested in learning more about the role of medications in treating OCD, and whether they may be an option for you, reach out to a board-certified psychiatrist.
To locate a psychiatrist near you, check out these free online directories from leading professional organizations:
Located in Florida? Dr. Holly Betterly is a Board-Certified Psychiatrist who is dedicated to treating OCD. She offers telehealth appointments for patients across Florida, as well as in-person appointments in Weston, FL. Request an appointment to start your journey to better mental health.
