My DH's medication for his OCD is not working, how can I help him?

[StormyLovesOdd]

My DH has had contamination OCD for years and the treatment has never really worked, he had has one course of CBT in the past and he also takes medication but nothing has really seemed to help very much.

DH is progressivly getting worse, he agrees he is getting worse but as he hates talking about the OCD he wont speak to our GP and just carries on with the same medication.

I love DH and try to support him with his treatment but I am at the end of my tether with all this and really worried how bad he will be in another few years if the OCD keeps getting worse. I don't want to leave him but I am starting to think that for the sake of myself and our young daughter if things don't improve soon I may have to as the OCD is starting to take over all our lives.

How do I deal with this? Will our GP speak to me about my DH's medication and treatment? I don't know where to turn but we need some help before things get any worse.

Very unlikely your DH GP will engage in a two way discussion with you due to confidentiality. If you could persuade DH to go tongs with you accompanying him that would be different of course.

I think you have no choice but to sit him down and simply explain that whilst you love him and wish to continue to helping him in as far as you can, you feel that you may soon have no choice but to leave in order to protect your DC for the effect of the OCD.

I am afraid that when in a family, a parent does have a responsibility to try to be as well as they can be and sometimes this involves seeking treatment, when you may feel anxious, angry, or reluctant at the prospect of trying to change things ( therefore exposing yourself to dis comfort or fear in the process)

Contamination OCD can be really successfully treated, I think maybe if you can persuade him to the hap it would be worth asking for a referral to the local Mh team as they will be able to provide more intensive and longer term therapy as well,as looking carefully at the medication as well.

He needs to look at getting desensitisation treatment. Its hard work and easy to give up as it means doing things which are uncomfortable.

There's ocd action either you or he can join.

Good luck.

Yeah, that's what I thought re the GP. I will wait for him to have a good day and try again to talk him about speaking to the GP again. He does tend to go for the easiest route every time and I think that's why the CBT didn't work for him last time, he says all the right things but then never seems to confront it, it's just so frustrating.

That could be why the treatment failed, or he may not have had the best therapist, or some combination of the two.

Exposure and response prevention can fail if you don't deliberately confront the things you fear (building up to the things you fear most), stay with the fear without doing any rituals (including covert mental ones such as telling yourself it is only OCD and not really a threat), and prevent yourself from doing any rituals afterwards. Exposures should be done frequently/last long enough.

Re. drugs, if your husband is on an SSRI he probably needs to try a different one. Citalopram cannot now be used with great effect for OCD since the therapeutic dose (60mg) is no longer regarded as safe for the heart. A safer dose of 20mg would not be likely to help him. The big guns drug for OCD is Clomipramine (not an SSRI, it is a tricyclic antidepressant) - but it has worse side effects so often doctors prefer to try at least two different SSRIs first, usually with at least 12 weeks at the highest dose.

Medication alone is not likely to be enough if his OCD is very bad, it should be combined with CBT (inc. ERP). In fact it is best for ERP effectiveness if the drug does leave him with some anxiety, otherwise he will not be confronting his fear and long term will be more dependent on the drug.

It is interesting you say he tends to take the easiest route. Living with OCD is very difficult, and I think that because treatment is so hard, people tend to be motivated to do it when the effects of the OCD are so horrific that they are prepared to try such a difficult treatment. Normally, suffering the disorder is enough! But maybe you should tell him that in time you may have to leave if he doesn't get any better - everything he has in the list of 'things OCD will definitely take from me' can balance against the perceived risks of treatment, and losing his family would be a big one.

Temporary - thank you, you really sound like you have been here too.

We had a very difficult conversation last night and I laid it all on the line, how I feel about our future, the lot. DH asked if I would give him time to try and battle it himself and if he was no better in a month he will go back to the GP. I think this is more avoidance but I agreed as I don't want to push him back to the therapy if he's not ready.

He takes fluoxetine and has done for about 5 years now. Really doesn't seem to help.

Well done for having that conversation. It might take a bit of time for the message to sink in but hopefully it is percolating now!

Just a couple of suggestions. Since your DH's mind is partly ruled by OCD, the OCD might interfere with unhelpful 'suggestions' of how to battle it that are actually just more rituals. To help him, it might be good if he would use a self-help book. There are loads and I don't know what is best, but the following are in line with NHS treatment ideas I think -

www.amazon.co.uk/Overcoming-Obsessive-Compulsive-Disorder-David/dp/1849010722/ref=sr_1_7?ie=UTF8&qid=1406749299&sr=8-7&keywords=ocd

www.amazon.co.uk/The-Ocd-Workbook-Obsessive-Compulsive/dp/1572249218/ref=sr_1_8?ie=UTF8&qid=1406749299&sr=8-8&keywords=ocd

www.amazon.co.uk/Freedom-Obsessive-Compulsive-Disorder-Personalized/dp/042519955X/ref=sr_1_1?ie=UTF8&qid=1406749340&sr=8-1&keywords=ocd+grayson

I agree it is probably partly more avoidance, though you never know, he might do it. Anything the GP will do will take a while to happen though so he could go now and still have the month. However, I know this might not work because he wants to avoid talking to the GP, but there are good reasons to agree to him tackling it alone for a bit whilst going to the GP first -

1. The GP will have to refer him to the community mental health team if he thinks the case needs their input. If so the wait is usually at least a few weeks, then after assessment he'll have to wait longer to begin CBT. So, he will still have more than a month to tackle it alone! I don't know if he could be persuaded to get on the waiting list, he needn't actually commit to going since at the end of his trial of self management he probably still won't have an appointment anyway for the assessment anyway.

1. It sounds like a change of drug (at least dose but probably after five years drug) would be good. It takes several weeks to work anyway so he could get started, and the GP might be able to do this, or he might want to wait for the mental health team to advise. If the latter he might want to start bringing down the current drug.

Temporary - I will have a look at the links, thank you so much for your advice. Getting DH to talk about it at all is really difficult so I am going to leave him to think it all through for a while.

I am not going to live my life like this, it's a constant battle.

Yes, that is fair enough to feel that way. Your last sentence is the way you need your DH to feel too - that any treatment has to be better than the consequences of living life like this. It won't cure him to feel that, but it will make him engage with recovery. Good luck, keep us posted if you have any breakthroughs!

Great advice from Temporary, who clearly knows her / his stuff. Best wishes for it all, OP.