OCD and Depression: Are They Related?

OCD is a common mental illness affecting up to 2% of the world’s population. What many people don’t know, is that it is not unusual to live with OCD and other related disorders simultaneously.  OCD and depression are two mental health conditions that often go hand in hand.

When living with comorbid conditions such as these, a sufferer may find themselves wondering which caused the other. What started it all? 

They may also find themselves questioning how they could be so unlucky to have both.

It can leave them feeling isolated and feed into their belief that somehow, there is something wrong with them (two conditions at one-time offers ‘proof’ of this in their mind).

However, studies have shown that anywhere between 67-92% of those with OCD are likely to also be living with another related disorder.

Comorbid definition: existing simultaneously with and usually independently of another medical condition. When we talk about comorbid conditions (or comorbidities), we are simply describing two mental health conditions that co-exist at the same time. In this case, we are discussing OCD and depression, for example.

What is OCD? A Recap

Let’s have a basic recap of what OCD is so we can understand the difference between this mental health condition and depression.

Obsessive-compulsive disorder is a common psychiatric disorder whereby the sufferer fixates on horrifying, repulsive, uncomfortable, or unwanted thoughts, feelings, images, urges, or sensations (obsessions).

The reason we obsess over these triggers is because of the overwhelming feeling of uncertainty and anxiety. An egodystonic disorder, the obsessions in OCD often feel so disturbing to the sufferer precisely because they go against who they are and what they believe.

NOTE: These obsessions are not just feelings of uncertainty or anxiety. Sometimes they can include other emotions, sensations, or urges like in the case of Just Right OCD whereby the sufferer repeats their ritualistic behaviors until things feel ‘as they should be’.

Following these obsessions, comes an influx of anxiety and distress.

OCD is known as the ‘doubting’ or ‘uncertainty disorder’. It is precisely because we do not feel as though we are in control, or have 100% certainty about the obsessions, that we become engulfed with these feelings of uneasiness.

In order to find relief, we engage in compulsions. 

Compulsions are ritualistic and repetitive behaviors that we do to offer us temporary relief. 

Mental compulsions and physical compulsions are as equally distressing as one another and both can negatively impact the quality of someone’s life in equal measure.

It is by engaging in these compulsions (in the hope ease the feelings of anxiety and find some comfort from the obsessions) that we keep the OCD cycle in motion. 

Signs and Symptoms

Although OCD varies from person to person depending on their specific theme, the content, and their own personal experiences, there are certain signs we can look out for.

There are two main features that signify OCD: obsessions and compulsions.

Signs of one or the other may show up in your life in the following ways:

• Thoughts that stick in your head or feel like a broken record
• Thoughts that scare you
• ‘What if’ intrusive thoughts that you cannot shake
• Fear of what you ‘might’ do
• Fear of what ‘might’ happen to someone else
• Fear that you did or said something wrong
• A feeling of excruciating unease when things don’t feel ‘quite right’
• The constant need to seek reassurance about what you’ve said or done
• An excessive need to keep checking
• An overwhelming urge to clean/count/pray/check/avoid
• Constantly seeking quick relief from unmanageable anxiety by doing something that makes you feel better
• Repetitive physical or mental behaviors that are negatively impacting your life

It is important to note that we all experience doubt and worry. We also all have our coping mechanisms. 

However, the difference for those with OCD is that these obsessions and compulsions become all-consuming and begin to affect their day-to-day life.

Doing seemingly normal, everyday things can feel like a massive challenge when you’re interrupted by intrusive thoughts and feel compelled to perform compulsions just so you can carry on with your day.

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What is Depression?

As described by the Mayo Clinic, depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder (mdd) or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. 

Depression is far more than a temporary feeling of sadness. It’s the heavy and ongoing feeling of doom and dread. 

Those living with depression may find themselves wondering whether life is worth living.

Thinking thoughts like, what’s the point?

People with this particular mood disorder can feel miserable, discontent, and hopeless without even really knowing why.

Similar to people with OCD, it can leave them wondering what is ‘wrong’ with them and how they can be ‘fixed’. But just like those with OCD, having depression does not mean you are broken. It is more common than you think with up to 5% of the world’s population suffering from it globally.

And just like OCD, there are effective treatments available.

Signs and Symptoms

As mentioned above, we all go through periods of sadness and feeling low.

Life circumstances typically contribute to this. However, depression is 10 notches higher in intensity than circumstantial sadness. 

Signs and symptoms to be aware of:

• Intense feelings of guilt or shame
• Feelings of low self-worth
• Thoughts about whether life is worth living
• Lack of concentration
• Feelings of disinterest in things that used to bring you joy
• Lack of pleasure
• Feelings of low energy or exhausted
• Lack of appetite
• Sudden weight loss or weight gain
• Disrupted sleep
• Feelings of hopelessness about the future
• Suicidal thoughts

During a depressive episode, you may feel as though it is impossible to get out of it. You may feel like this is permanent and can’t be changed, or that there isn’t a ‘light at the end of the tunnel’. Life can appear incredibly bleak for an ongoing period of time.

Comparatively, periods of sadness tend to ebb and flow, often offering moments of uplift.

This is what really distinguishes depression from occasionally feeling low; it feels heavy and relentless, and it holds on.

If you notice any of the above are beginning to negatively impact your life, please speak to a qualified mental health professional. And know that it can be treated.

The main differences between OCD and depression

Below we have broken down the main differences between OCD and depression.

	OCD	Depression
Disorder Type	Anxiety disorder	Mood disorder
Characteristics	Intrusive thoughts, unwanted images, feelings, sensations, and urges that cause intense feelings of anxiety and uncertainty	Intense thoughts and feelings of doom, loss of hope for the future, lack of energy
Causes	Unknown (Studies have shown there is a possible hereditary component but it is also highly likely that OCD is triggered by biological and environmental factors combined.	Varied (Depression can be caused by a series of stressful and traumatic life events, poor lifestyle management, addictive tendencies, etc. There could also be a genetic factor involved)
Prevalence	Up to 2% of the world’s population	Up to 5% of the world’s population
Treatment	Cognitive behavioral therapy and exposure response prevention (with medication if appropriate)	CBT, talking therapy, and/or medication (if appropriate)

A common question about OCD is whether or not is a form of anxiety or depression. 

As you can see from the chart above, OCD and depression are two very different mental health conditions that very often overlap but are categorized very differently in the DSM-5. 

OCD is a type of anxiety disorder and does not come under the depression umbrella.

The severe and uncontrollable anxiety that arises from the obsessions distinguishes it from the emptiness, and hopelessness of depression. 

What percentage of people with OCD have depression?

Anywhere between 25% and 50% of those living with OCD will also experience a depressive episode within the same time period, according to IOCDF.

When you stop and think about it, those statistics are not overly surprising.

Many people with OCD have stated that their OCD symptoms began before their depressive symptoms. Meaning that OCD typically comes first. For anyone who has experienced OCD, this probably isn’t particularly shocking.

OCD is an incredibly debilitating disorder.

Day in and day out you are trying to navigate alarming intrusive thoughts and obsessions that make you question and doubt everything about yourself.

Obsessions arise and you get caught in a loop of worrisome thoughts;

What does this mean about me?

Does this make me a bad person?

How can I fix this?

Did I check already?

Should I check again, just in case?

Did I say the right thing?

Did I do the right thing?

How can I avoid X outcome?

What if the worst possible scenario happens?

What if it is my fault?

And to find just a moment’s peace from the doubt, anxiety, uncertainty, and discomfort you perform compulsions.

Except these compulsions interrupt your everyday life. 

Suddenly doing simple things like meeting your friends for lunch, spending time with your children, going on a date night with your partner, going to the theatre, driving around the block, or even making coffee seem like an unachievable tasks.

A prolonged sense of hopelessness is a defining characteristic of depression. When you really step back and imagine what it is like to live with OCD day to day, it is depressing in and of itself.

Does OCD cause depression?

The short answer is yes, it can.

As mentioned above, the personal stress of living with a condition like OCD can cause depression.  However, typically the opposite is rarely true.

It is not often the case that depression causes OCD. This signifies that it is likely the experience of trying to manage OCD symptoms and the difficulties of those obsessions and compulsions that contribute to depressive tendencies.

For example, if you had sexual obsessions, imagine that you experience the groinal response as an unwanted sensation.

It may appear in times when you would consider it inappropriate, such as when you are around a parent. Intrusive thoughts suddenly pop up making you wonder what this must mean. 

Am I attracted to my parent?

What if I’m aroused by them?

What does that mean about me?

And so wherever you can you engage in compulsions to mitigate those doubts. You might avoid your parent at all costs, leaving the room whenever they enter. You may constantly check your genital area for any signs of that groinal response.

Left unchecked, you find yourself living a life of fear and avoidance.

You constantly doubt who you are as a person and why you’re having these ‘twisted’ feelings of arousal toward a parent. And now, you avoid them by any means necessary which pains you because you wish you didn’t have to.

Day-to-day life can become incredibly difficult for those living with OCD.

And so it is no wonder that those depressive thoughts and feelings of despair and low self-worth may creep in.

IMPORTANT NOTE: Although OCD can cause depression, it doesn’t mean it will for everyone. The statistics have shown that while up to 50% of OCD sufferers experience depression at some point, that leaves 50% who don’t. Having OCD does not guarantee that you will develop depression. If you have any concerns about either disorder, please speak to a qualified mental health professional as this article is not a replacement for diagnosis or medical advice.

How is a dual diagnosis treated?

The reason why it is important to understand the differences between OCD and depression is that when it comes to OCD treatment, depression can make things a little tricky.

The most effective form of treatment for OCD is Cognitive Behavioral Therapy (CBT) with Exposure Response Prevention (ERP). For both of these modalities to work effectively, the OCD sufferer must be A) open to the possibility that recovery is possible for them and B) willing to challenge themselves so they can get better.

In CBT, the client is guided through a process of allowing and accepting their intrusive thoughts, and changing their relationship with them. The second component is then allowing anxiety and uncertainty to arise while resisting the urge to do compulsions (tackling the behavioral response).

As you can imagine, this can be an uncomfortable process.

The client is being asked to purposefully place themselves in anxiety-inducing scenarios so that they can learn that they are capable of managing them without the need for compulsive behaviors to provide relief.

So this is tricky enough when dealing with OCD alone.

Once you add depression into the mix, there’s an added hurdle to overcome.

The reason for this is that when you’re having thoughts such as:

This is pointless.

I’ll never get over this.

I’m broken and can’t be fixed.

Things will never get better for me.

…you are not in a receptive state for OCD treatment to be effective.

With that in mind, we recommend working with a qualified professional who is highly trained in both OCD and depression. 

These mental health conditions require different approaches. And in order for OCD treatment to yield the best results, depression needs to be addressed first so the client can make the most of their treatment.

Treatment for OCD & Depression

So, as we have discussed, when we have a dual diagnosis such as this it’s important to seek appropriate support.

Treating a client with one of these conditions is quite different from treating someone with comorbid conditions.

The two most important considerations for OCD and depression treatment are as follows:

1. Private Therapy

Whilst it is entirely possible to navigate these mental health conditions alone, we highly recommend working with licensed, highly skilled clinicians who can guide you along the most effective path toward recovery.

CBT and ERP are the gold standard treatment for OCD. Likewise, CBT can be incredibly effective in helping with depression. 

As we have discussed, when someone has both disorders it is important that treatment is approached with care and consideration for both (not just one or the other). 

If you are based in California, we have a team of highly qualified mental health professionals who work under the supervision of top OCD specialist, Kimberley Quinlan.

Our team here is trained to the highest standard and is able to help you navigate both disorders effectively. If you would like to find out more information about our clinicians and who would be the best fit for your needs, please submit an inquiry here.

You can also find local support groups of like-minded individuals who truly understand what you’re going through and can offer peer support.

Medication for OCD and Depression

There are several medication options for treating depression including; SSRIs (Selective serotonin reuptake inhibitors), SNRIs (Selective serotonin & norepinephrine inhibitors), NaSSAS (noradrenergic and specific serotonergic antidepressants), and more.

The most commonly used medication for OCD is SSRIs.

Although it is not entirely clear as to why SSRIs are effective for OCD treatment, they impact the level of serotonin in the brain and typically act as mood stabilizers affecting attention, behavior, and body temperature.

Every individual is different and medication should only be taken if your doctor or mental health practitioner advises you to do so. Even then, you always have a choice. And you must remember that if you choose to try medication and they don’t sit well with you then you have every right to stop.

Both OCD and depression are not solely caused by chemical imbalances in the brain which means that medication is not always the most appropriate option for either. Please do not take any medication without consulting a professional first.

IMPORTANT NOTE: This is not a substitute for medical advice. Please speak to your nearest doctor or mental health specialist who will walk you through the proper diagnostic procedures and determine whether medication may be a worthwhile option for you, or not. There is no shame in taking medication. It helps a lot of people manage the day-to-day distress of these conditions. However, you should only take them under professional guidance and supervision.

Best advice for sufferers of OCD and Depression

The best advice we can offer for sufferers of OCD and depression is to seek professional medical or mental health assistance.

Managing one of these disorders alone can be difficult enough, managing two is another story entirely.

Both conditions must be taken seriously and as noted above, the severity of your depression may impact the success of your OCD recovery. It’s important to understand that both can be treated, and both can be managed.

You want to be in the safe hands of a trained clinician who can navigate both in the appropriate and most effective way possible.