Both obsessive-compulsive disorder (OCD) and depression are common mental health conditions, and they often occur together. OCD symptoms can contribute to isolation, loneliness and withdrawal—leading to depression; however, both conditions can be treated by a trained mental health professional.
Dealing with obsessive-compulsive disorder (OCD) can feel exhausting, isolating, and hopeless at times. Intrusive thoughts, or obsessions, typically trigger feelings of intense distress—and can make it hard to focus on anything else. Compulsions are often time-consuming, and can make it hard to socialize with others. When obsessions re-emerge, it’s common to feel hopeless.
If these feelings of exhaustion, isolation, and hopelessness sound similar to depression, that’s because it’s not uncommon to experience both conditions at once. Studies have shown that around 25-50% of people who have OCD also meet the diagnostic criteria for a major depressive episode. OCD can cause depression—and depression can make it difficult to manage OCD symptoms.
If you think you may be navigating both OCD and depression, you’re not alone—and there are ways to get help. Read on to learn more about the differences between OCD and depression, how these conditions interact, and the best strategies for finding relief.
What is OCD?
OCD is a complex, but treatable, mental health condition characterized by two main symptoms: obsessions and compulsions. Obsessions are intrusive thoughts, sensations, images, feelings, or urges that are persistent and cause distress, or anxiety. Obsessions are typically ego-dystonic—meaning they go against your core values, beliefs, and desires; this is a key part of why they can feel so deeply distressing.
In response to obsessions, people with OCD perform compulsions—physical or mental acts meant to relieve anxiety or distress. However, compulsions only provide temporary relief, ultimately prolonging the OCD cycle.
What is depression?
One of the most common mood disorders, depression is classified as a persistent feeling of sadness and loss of interest in things previously found enjoyable. If you have depression, you don’t just feel sad; you’re likely to experience prolonged daily symptoms that inhibit your ability to engage in normal daily activities. According to Tracie Ibrahim, LMFT, CST, and Chief Compliance Officer, depression “can cause changes in eating and sleeping patterns, loss of energy and motivation, and reduced ability to experience pleasure, among other symptoms.”
Symptoms of depression may include:
- Trouble sleeping, or excessive sleeping
- Extreme lethargy
- Loss of interest or pleasure in most activities
- Feelings of worthlessness, hopelessness or emptiness
- Loss of appetite or binge eating
- Brain fog, lack of concentration, and/or inability to make decisions
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How OCD and depression interact
People with OCD are more likely to develop other mental health conditions, and depression is no exception. In fact, it’s the mental health condition most commonly experienced by people dealing with OCD. Both conditions are characterized by imbalances in serotonin, increasing the likelihood that someone dealing with OCD may also struggle with depression, and vice versa.
OCD can also drive symptoms of depression. Obsessions and compulsions are often exhausting, and may impact interpersonal relationships and daily functioning. This can lead to feelings of overwhelm and hopelessness, if untreated. “If your OCD is focusing on something, you have now potentially lost interest or pleasure in that thing because of the OCD,” says Dr. Patrick McGrath, chief clinical officer at NOCD. “That will often lead you to feel down or depressed.”
Let’s imagine that your obsessions center on concerns about contamination, germs, and accidentally getting other people sick. In response, you compulsively clean your surfaces and groceries, and avoid public spaces. Once enjoyable experiences, like large group gatherings, travel, hosting dinners, or shopping at stores might begin to feel impossibly distressing. As a result, you might spend more time alone at home, worrying about the health and safety of those around you. In this way, OCD can strip joy from your life, and induce feelings of isolation, hopelessness, and despair—exacerbating or causing depression.
This hopelessness can, in turn, make OCD symptoms worse, or prevent people from seeking treatment. “If you’re depressed, it’s hard to fight anything. It’s just easier to give in,” says Dr. McGrath. “If you think you’re not worth anything, why not just do everything that OCD says?” He points out that OCD offers the allure of promising that by performing just one more compulsive behavior, you’ll feel less distress. But, these are false promises that only fuel the OCD cycle. The best approach is to seek support from a mental health professional.
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Getting help for OCD and depression
Although common, a dual diagnosis of OCD and depression can be difficult to manage—but, with the right approaches, it is treatable. OCD may be a root cause of your depression, while being in a depressive episode may affect your ability to adhere to your OCD treatment. If you’re navigating both OCD and depression, Dr. McGrath recommends focusing first on depression: “You’ve got to find that motivation again. Otherwise, you’re stuck. Once the depression no longer has such a hold on your life, we then switch gears.”
Addressing depression first is especially important because the most effective treatment for OCD, requires energy and full participation. ERP therapy is highly effective, but it can be difficult to embark on while navigating depression. You may find yourself struggling to make it to therapy appointments and complete assignments, or wondering whether the process is even worth it. ERP isn’t easy—even though the results are worth it—and depression can make any action, let alone a purposefully challenging one, feel impossible.
“If the depression is severe and the person is having a hard time getting out of bed or completing work or school tasks, then they likely don’t have the motivation to do ERP,” says April Kilduff, MA, LCPC. “We’d ask them to stabilize the depression first.”
Completing treatment for depression can help you regain the energy and motivation to begin work on your OCD symptoms. Dr. McGrath says it can also give people a sense of achievement that can be helpful for tackling ERP therapy: “They see, ‘I was able to overcome this depression. I might be able to overcome this OCD, too.’”
Treating depression
The recommended treatment for depression is behavioral activation (BA); Ibrahim says it’s the evidence-based treatment she uses for all her patients with depressive disorders. BA is a form of cognitive therapy that helps you gradually re-engage in meaningful activities that once brought you joy—such as exercise, gardening, or book clubs. By starting small and working your way up, you can minimize feelings of overwhelm, and remind yourself of the small joys that make life feel worthwhile.
It can also be helpful to prioritize physical exercise or engage in mindfulness exercises. Medication can also support recovery, so you may want to ask your provider about selective serotonin reuptake inhibitors (SSRIs)—which can sometimes improve OCD symptoms, as well.
Treating OCD
OCD is a highly treatable disorder, and ERP therapy is a highly effective, evidence-based treatment that is specialized for the condition. ERP works by gradually exposing you to situations that trigger your fears, while helping you resist the urge to engage in compulsions. For example, if you’re navigating fears about contamination, an ERP therapist might work with you to imagine a worst case scenario, and sit with any emotions that arise—rather than turning to compulsions, like cleaning or isolating. In time, you might be encouraged to gradually reduce the time you spend sanitizing your groceries, or to slowly begin re-entering public spaces.
Dr. McGrath says ERP therapy is all about becoming comfortable with being uncomfortable, and that taking action is the first step to getting there. “How do you overcome the fear of an elevator, without getting in an elevator?” asks Dr. McGrath. “You have to do it, and in doing it, learn that you can handle it.”
By helping you slowly face your fears—and teaching you to sit with feelings of discomfort, rather than immediately react—ERP therapy can help you build resilience, and find relief from obsessions and compulsions.
Bottom Line
If you’re navigating depression and OCD, know that you’re not alone. It’s common to deal with these conditions together, and it’s also possible to find relief. OCD can make life feel hopeless, and depression can make it difficult to find the motivation to seek treatment, but with time—and the support of a specialized therapist—you can reconnect with activities that bring you joy and reclaim your time from obsessions and compulsions.
Key Takeaways
- OCD and depression are both common mental health conditions, and often co-occur.
- Both mental health conditions can be caused by imbalances in serotonin, and OCD can trigger feelings of exhaustion, isolation, and hopelessness—that may lead to or exacerbate depression.
- Both OCD and depression are treatable, but it’s important to tackle depression first, as it can inhibit motivation for ERP—the most effective form of therapy for OCD.
- In time, you can find relief from both OCD and depression.
