Understanding OCD
Obsessive-compulsive disorder (OCD) is characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts performed to reduce distress (compulsions). OCD affects 2–3% of the population and is often underdiagnosed or misdiagnosed. Common obsession themes include contamination, harm, symmetry, taboo thoughts, and religion. Compulsions — checking, washing, counting, reassurance-seeking — provide temporary relief but maintain the disorder.
Signs & Symptoms
- Persistent, unwanted intrusive thoughts or images
- Compulsive behaviors performed to reduce anxiety
- Excessive time spent on rituals (1+ hour per day)
- Significant distress or functional impairment
- Recognition that obsessions/compulsions are excessive (though insight varies)
- Common themes: contamination, harm, symmetry, forbidden thoughts
How Dr. Agresti Treats This Condition
The gold-standard treatment for OCD is Exposure and Response Prevention (ERP) — a specialized form of CBT that involves gradual, structured exposure to feared situations without engaging in compulsions. This is combined with medication management, typically high-dose SSRIs. OCD often requires higher SSRI doses than depression or anxiety. Dr. Agresti has expertise in OCD pharmacology and can coordinate with an ERP-trained therapist.
Medication Options
- SSRIs (high dose): Prozac (fluoxetine) up to 80mg, Zoloft (sertraline) up to 200mg, Luvox (fluvoxamine)
- Anafranil (clomipramine) — tricyclic with strong OCD evidence
- Augmentation: atypical antipsychotics (Risperdal, Abilify) for treatment-resistant OCD
- Note: OCD requires higher doses and longer treatment duration than depression
The Concierge Advantage
With Dr. Agresti's concierge model, medication adjustments happen quickly when you need them — not at your next appointment weeks away. Text him directly if symptoms worsen. Get same-day refills. Reach him directly when you're having a difficult day. This level of access makes a meaningful difference in psychiatric treatment outcomes.
Frequently Asked Questions
Clinical OCD involves obsessions and compulsions that cause significant distress and consume substantial time (1+ hours daily). Preferring organization or cleanliness is not OCD. OCD involves unwanted, intrusive thoughts that the person typically recognizes as irrational — and compulsions that they feel driven to perform despite wanting to stop.
The mechanism underlying OCD appears to require more robust serotonin reuptake inhibition than depression or anxiety. Doses that help depression (e.g., Prozac 20mg) may be ineffective for OCD; doses of 60–80mg may be needed. This is well-established in OCD treatment guidelines.
ERP (Exposure and Response Prevention) has the strongest evidence base. Other approaches including Acceptance and Commitment Therapy (ACT) show promise. Deep brain stimulation is a last resort for severe, treatment-resistant OCD. Most patients respond well to a combination of ERP and appropriate medication.
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