Ayurvedic Management of Drug Resistant Obsessive Compulsive Disorder

Abstract

Obsessive compulsive disorder (OCD) is a debilitating neuropsychiatric disorder  with a lifetime prevalence of 2 to 3 percent. Selective serotonin reuptake inhibitors  (SSRIs) and Clomipramine are the established pharmacologic first-line treatments  for OCD, and Exposure Response Prevention (ERP) is recommended as the  first-line behavioral intervention, with Cognitive Behavioral Therapy (CBT)  as an alternative. About 40-60% of patients show no or just partial symptom  improvement from drug treatment, and long-term management results in  significant adverse effects. Drug-resistant OCD is defined as individuals who have  persisting symptoms after being exposed to at least two trials (6 months) of SSRIs. Psychiatric illness is dealt with as one of the 8 specialties of Ayurveda named  Bhutavidya. According to the presentation and severity of symptoms, OCD can  be diagnosed as Unmada. According to the evolved dosha status and severity of  the symptoms, the management can be done with sodhana, samana, and rasayana  chikitsa. Studies suggest that the add-on effect of Yoga can also be beneficial in  OCD. A 40-year-old female presented with recurrent, persistent thoughts about  contamination followed by increased cleaning rituals such as excessive hand  washing, increased time taken for bathing, and washing clothes. This condition  was diagnosed as OCD, and she had been on SSRIs for more than 3 years, but no  relief in symptoms was found. She underwent various treatments, and the total  duration of intervention was 45 days. The Yale-Brown Obsessive Compulsive  Disorder (Y-BOCS) score was 38 upon admission, which reduced to 19 after  intervention.