Dealing with Relapses
Even with thoughtful preparation for anticipated changes and stressful times, relapses — defined as the return of OCD symptoms previously in remission — are normal and to be expected. The biggest mistake you or your child can make is to attach any great significance or negative emotions to an OCD symptom relapse. Instead, view the arrival or return of symptoms as an indicator, much like a yellow light at an intersection. This indicator is pointing your attention to some factor that's triggering your child's anxiety. Perhaps the problem is too much stress from schoolwork. There may be an overload of extracurricular activities, or part-time work. Is there a change of school, or are friends causing the anxiety? With the tools of CBT therapy and exposure exercises, your child can handle any relapse either alone, with your help, or with the help of a therapist.
When medications are stopped for whatever reason, there is a greater likelihood of a relapse of symptoms in the child or adult with OCD (as well as any other anxiety disorder or depression). For this reason, cessation of medication should be done in close consultation with your prescribing doctor.
There are also special issues when OCD is comorbid with other disorders involving medications and relapse. Leading childhood OCD clinical researcher from Massachusetts General Hospital Dr. Daniel Geller did a 2003 study comparing the effects on children and adolescents who had OCD alone and those with comorbid OCD, focusing on both the degree of efficacy while on the medication (Paxil), and the effect of going off the medication on relapse rates. Dr. Geller summarized his results as follows:
At entry, 193 of 335 patients had at least one psychiatric disorder in addition to OCD, and 102 of 335 had multiple other disorders. Although the response rate to paroxetine in the overall population was high (71 percent), the response rates in patients with comorbid attention deficit hyperactivity disorder, tic disorder, or oppositional defiant disorder (56 percent, 53 percent, and 39 percent, respectively) were significantly less than in patients with OCD only (75 percent). Psychiatric comorbidity was associated with a greater rate of relapse in the total patient population; 46 percent for one or more comorbid disorders. The results of these post hoc analyses show that comorbid illness adversely impacted response to pharmacotherapy with paroxetine in pediatric OCD and significantly increased risk of relapse following withdrawal from treatment. Continued paroxetine treatment reduced the relapse rates in all groups compared with placebo, including those with comorbid illness.
The question of how long an adolescent with OCD must remain on medication for his condition is one that must be revisited on a regular basis. There are many cases where medication is phased out without a major relapse of OCD symptoms. This is usually when the individual has augmented his medication with a commitment to CBT treatment.
