'Suck it and see' medication

It is no secret that medication for OCD is at best, imprecise, and at worst, arbitrary.

This is due to the fact that there is, as yet, no medication designed specifically for OCD. I am not suggesting that current medication support for OCD is unhelpful but I am suggesting that it isn’t an accurate science. In my 18 years of assessing clients for psychotherapy, despite medication-specific research, no one medication has resulted in general positive results or feedback from those that matter – our clients with OCD.

As psychotherapists we are unable to advise regarding medication but we do know that the current anti-depressant, anti-anxiety, sedative and neuroleptic (anti-psychotic) options can offer, at best, symptomatic relief. The fact that OCD medication isn’t tackling the core problem isn’t always made clear to patients. This adds to the confusion and unrealistic expectations. We exist in a society where immediate medical solutions are often possible & it can be unsettling for those with OCD to realise that their medication isn’t precise. In the UK we are relatively medication-averse so even arriving at the point where a person with OCD will consider this path can take time and fortitude. Additionally, there are many OCD subtypes where the fear of medication is symptomatic and pathological – they are terrified of the impact of medication.

Since returning from work in the United States, I have for some years been recommending that medicated clients look at the possibility of pharmacogenomics testing. It is an emerging field which promises, for the first time, meaningful and precise pharmaceutical data. Pharmacogenomics is the study of how your body will respond to particular medicines based upon your DNA. It looks for genetic variants that are associated with variable responses to specific medications. It may be able to eliminate the ‘suck it and see’ approach that reflects OCD medication. In other words, when your doctor prescribes a new medication for your OCD and there are adverse side effects or very little effect (more common) they will try another and the process starts all over again. In our practice, clients who have tried 10 different medications is not unusual. In contrast, pharmacogenetics offers doctors the opportunity to individualise drug therapy for patients based on their genetic make-up and get the dosage right from the start. The testing will cover most currently available medicines and the results will give an indication of a normal, adverse or little effect together with dosage suggestions. Naturally, for OCD, the psychiatry category of results are most relevant but it is helpful for all health-related conditions as we age and have to make health-related decisions in conjunction with our doctors.

The UK National Health Service (NHS) considers pharmacogenomics testing so important that they have undertaken to be the first national health system globally to roll out genomic testing as part of routine care.* Sadly, COVID may well have delayed the implementation and it is likely be offered first to those with rare diseases and life-threatening diseases such as cancer, particularly children. It might be some time before it is offered to mental health patients. Until such times, anyone who is considering going it alone may find it tough to get tested. In Europe, pharmacogenomics testing is mostly available via practitioners. It can also be expensive but in time, should become more cost-effective.

In summary, until such times that an OCD-specific medication is trialled and offered to the public, pharmacogenomics testing may represent an important opportunity for more precise and useful data when prescribing for OCD. Moreover, it can also inform doctors when there is a medication for OCD. To bridge this gap, we are therefore going to be offering reasonably priced pharmacogenomics testing via our Nutritional Therapist at OCD Excellence in the very near future. Please check our website for updates. Here’s to a clearer pharmaceutical future for us all!

Please note that as from April 2022, OCD Excellence will be offering full panel pharmacogenomic testing via our Nutritional Therapist. Please email for details.

*https://www.england.nhs.uk/genomics/nhs-genomic-med-service/