OCD and depression: starting on a new path

Is this one step forward and two steps back?

That’s what I was thinking as I left my therapist’s office yesterday evening.

Today I considered the possibility that it was a leap to a new path.

I will be starting a new course of therapy tomorrow, one that will focus not on obsessive-compulsive disorder, but on another problem that has accompanied me for most of my life: depression.

I have written about my battle with depression before, but in my therapy and my own work with exposures, I’ve been focusing on improving my OCD symptoms. The OCD is getting in the way of my living a full life.

But depression is getting in the way of the OCD therapy.

My therapist is very perceptive. I wrote about how he called me out on my avoidance of the paper pile.

Yesterday, he cut to the heart of things again.

He always begins a session by asking me an open question like, “So, how are things going?”

I talked about what I had done and hadn’t done and how overwhelmed I felt. The words kept coming. And then I started crying.

He reminded me of our discussion in the past where he said other things like anxiety and “stuffed” anger and emotions can feed OCD.

He believes it’s chronic depression that is feeding the OCD, and as long as I don’t deal with that, I won’t get very far with the OCD therapy.

I knew he was right. I knew intuitively, right away, that he was right.

Chronic depression, especially when it’s early-onset, which mine was, is particularly hard to treat. Medication has helped me tremendously, but some people have drug-resistant depression. I am, my therapist said, one of those people.

Though I was never diagnosed as a child, I probably suffered from dysthymia, which Medline Plus defines as “a chronic type of depression in which a person’s moods are regularly low.”

My therapist said in those with chronic depression, the more severe depression episodes improve only so much—to that same low level.

He said the best therapy for chronic depression is called Cognitive Behavioral Analysis System of Psychotherapy, or CBASP.

He wrote it out for me, and I focused on one word: psychotherapy.

I’ve been through talk therapy before, and it was helpful, but it was also a meandering, nebulous experience with no end in sight.

But my therapist said CBASP is a very active and practical type of therapy. The treatment usually lasts approximately 26 weeks, but it could go faster for me, he said.

CBASP can put people into remission from their depression.

I’ll always be on medication, but the medicine provides a floor for me, he said, that enables me to do other therapy more effectively.

I’ll still work on the OCD, but we won’t spend time in our therapy sessions on it while I’m doing the CBASP.

I feel like I’m starting over. I’m almost 49 years old, and I still have to work on depression. But I could also experience remission for the first time in my life.

Those are the thoughts I’ve been having today and the hope I’m clinging to. Remission. An ebbing away of the depression that causes me to feel hopeless, helpless, fatigued and irritable. Hopeless and helpless.

I imagine the depression as a dark knot down inside me, surrounded by the more visible OCD and anxiety. Getting that knot to come loose and work itself through the OCD and anxiety is my goal.

Here I go: another therapy, another path, a new hope.