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Medication helps too. Antidepressants such as Prozac and other selective serotonin reuptake inhibitors (SSRIs) can help dial down the anxiety enough that patients can get started with ERP and, significantly, stay with it. When patients are children, practitioners are more reluctant to prescribe medication, but they are careful not to stay too long with ERP alone if it's not producing results. "The longer a child struggles with an illness, the more impact it's going to have," says Dr. John Piacentini, director of UCLA's child OCD clinic. Still, there are some people--kids and adults--whose OCD is so acute that more extreme methods are needed, such as hospitalization, more intensive exposure therapy and other medications.
Coric, of Yale, is among the growing group of investigators experimenting with drugs targeting the glutamate problem. The best medication so far, riluzole, was originally developed for Lou Gehrig's disease and works simply by turning down the glutamate spigot, reducing the amount that's available in the brain. In Coric's admittedly small studies and clinical observations, half of about 50 subjects experienced at least a 35% remission, and almost all the rest improved at least a little.
Much more invasively, investigators are looking into deep-brain stimulation (DBS), in which electrodes are implanted in the brain and connected by wires embedded in the skin to a pacemaker-like device in the chest. Low doses of current can then be applied as needed to calm the turmoil in the regions of the brain that cause OCD. The procedure sounds extreme--and it is--but it's already been used in about 35,000 people worldwide to treat Parkinson's disease, and FDA approval to use DBS for OCD as well is pending. "Many of our OCD patients are able to re-engage in life rather than being stuck at home," says neurosurgeon Ali Rezai of the Cleveland Clinic, who performs DBS surgery for Parkinson's and has researched it for OCD.
For the vast majority of people, the treatment never needs to go so far. OCD, for all the suffering it inflicts, is nothing more than the brain doing something it's supposed to do--warning you of danger--but doing it very badly. Living in the world means living with risks: real ones, imagined ones, exaggerated ones. That's not an easy lesson, but it's a powerful lesson--one that, once learned, can offer a paradoxical state of peace.