Understanding The Connection Between Depression and OCD

The relationship between obsessive-compulsive disorder (OCD) and depression is deep and complex.

Understanding why these two conditions often co-occur — and perhaps more important, how to think about treatment when you have both — may help you develop better mental and physical health. Here are some good things to know.

How OCD and depression are related

People often have OCD and depression at the same time. The International OCD Foundation estimates that between 25 and 50 percent of those with OCD will also experience depression. Most people experience the symptoms of OCD first, but for a small percentage, the two conditions begin at the same time. It’s rare for depression symptoms to precede OCD.

For that reason, researchers often say that depression is part of OCD, but OCD is not necessarily part of depression.

Can depression cause OCD?

Although it isn’t clear exactly what causes OCD, no research suggests depression causes OCD. According to the National Institute of Mental Health, OCD can be caused by:

  • genetics
  • differences in the frontal cortex and subcortical regions of the brain
  • childhood trauma
  • streptococcal infection

Can OCD cause depression?

The short answer is yes. Because depression often begins after OCD symptoms develop, researchers think the difficulties of living with OCD can lead to depression symptoms.

Depression can develop because of:

  • the nature of your compulsive thoughts
  • difficulties caused by compulsive actions
  • the problems OCD causes in your life and relationships
Obsessions and depression

OCD sparks repetitive, unwanted, and upsetting thoughts. For many people, the very nature of the thoughts is enough to cause shock, fear, and eventually depression. Here’s an example of how that progression can work.

A new parent might have sudden, unwanted thoughts of harming the baby. About half of all parents (fathers and mothers) have intrusive thoughts exactly like these.

The thoughts can be frightening and cause enormous shame, even though the baby may never be in any actual danger. A parent who doesn’t realize how common these thoughts are might feel that something is wrong with them.

OCD causes intrusive thoughts like these and others. Not all intrusive thoughts involve violent imagery, but most are disturbing or unsettling.

Still, intrusive thoughts do not automatically indicate an increased risk of harm. But that risk may increase if the thoughts occur along with anxiety, depression, and OCD.

Distressing thoughts can also lead to depression over time because an individual having intrusive thoughts may feel out of control of their mind, which can be quite depressing and debilitating.

Studies from 2018 also show that ruminating — thinking the same worrisome, depressing, or negative thoughts over and over — is a key contributor to depression and OCD.

In a 2017 study, researchers asked people with OCD and depression questions to determine whether they were prone to anxious or depressing thoughts. Researchers found that having anxious and depressing thoughts was common in people with these two disorders.

In an older study, researchers found that people with OCD experienced fewer depression symptoms when they showed three common patterns:

  • thought their actions could change an outcome
  • thought themselves capable of taking those actions
  • thought they had control in a given situation, so they could take the necessary action
Compulsions and depression

In response to intrusive thoughts, people with OCD usually perform specific actions in the mistaken belief that their behaviors will either make the thoughts go away or prevent something bad from happening.

These compulsive behaviors must be performed flawlessly every time — a standard that is hard to meet.

Researchers say this kind of relentless perfectionism, the hallmark of OCD, is also a key factor in depression.

Functioning and depression

OCD and depression can adversely impact your ability to function in a healthy way. Obsessions affect your state of mind. Compulsions can interfere with your schedule.

When your relationships, social life, therapy, and performance on the job or in school are affected, you may begin to experience symptoms of depression. Researchers have found that the more severe obsessions and compulsions are, the more they impact your daily functioning, worsening depression symptoms.

What about anxiety?

Anxiety is a key component of OCD. People with OCD may feel anxiety for many reasons, including:

  • distressed by the content of the thoughts that intrude on them
  • are anxious to keep the thoughts from happening again
  • feel anxiety until they perform a compulsive behavior
  • feel anxiety about whether they’ve performed the behavior correctly
  • feel anxiety over what other people think of them
  • feel anxiety in response to how other people treat them because of their condition
  • are anxious about other practical and emotional effects of OCD on their lives

Anxiety is also common among people with depression. The National Alliance on Mental Illness estimates that 60 percent of people with anxiety also have depression and vice versa.

How are OCD and depression similar?

These two disorders share many overlapping symptoms, including:

  • They can affect your mood, relationships, and ability to function well.
  • Both are associated with negative beliefs about yourself.
  • They can cause thinking patterns that worsen symptoms.
  • Both can usually be improved with a combination of psychotherapy and medication – especially selective serotonin reuptake inhibitors (SSRIs).

How are OCD and depression different?

Although OCD and depression share many symptoms, there are some critical distinctions.

  • OCD causes you to feel compelled to repeat certain behaviors to reduce anxiety, but depression does not usually involve repeating compulsive behaviors such as turning off and on light switches – though it is important to note that depression can be associated with compulsive use of alcohol, drugs, and sex.
  • OCD can cause tic disorders to develop, but there isn’t any research to suggest that tic disorders arise from depression.
  • Depression is classified as a mood disorder in the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)”. In older versions of the DSM, OCD was classified as an anxiety disorder. In the DSM-5, OCD has been separated from both anxiety and mood disorders.

What you can do if you have OCD and depression

OCD and depression can be treated with psychotherapy, medication, or both. In addition to these research-tested treatments, you can also reduce your symptoms with other therapies such as mindfulness, yoga, and healthy doses of physical activity.

Focus first on your OCD symptoms

Studies suggest that, for most people, it may be better to focus on treating OCD symptoms first because reducing OCD symptoms often improves depression – but not the other way around. Treating depression doesn’t necessarily reduce OCD symptoms.

Consider therapy

Cognitive behavioral therapy, which aims to identify and reshape unhealthy thinking patterns, has proven particularly helpful to people with OCD and depression.

It’s vital to target ruminations as part of your therapy because reducing these entrenched thought patterns can help with depression once you’ve begun to see improvement in your OCD symptoms.

Connect when you feel like isolating

This means if you are a family member or friend to someone with OCD, take heart. Though you may feel helpless in the face of the symptoms affecting someone you care about, there is something powerful you can do. Show up. Show love. Strong human connections have a protective effect against the depression that can seep in when dealing with OCD.

Work toward more movement in your life

When you’re experiencing depression, finding the energy to exercise can sometimes feel impossible. Take some small steps in the right direction. Many studies have confirmed that physical activity in conjunction with therapy can reduce OCD and depression symptoms.

What’s the outlook for people with OCD and depression?

Though OCD and depression can’t be “cured,” many people with symptoms of OCD and depression do respond well to treatment. Studies show that around half of people with OCD (especially those with less severe symptoms) experience remission of their symptoms in time. It’s worth noting that when OCD symptoms improved, so did depression symptoms.

In a 2013 study involving 591 participants, researchers tracked OCD symptoms over 30 years and found that roughly 60 percent of those with OCD went into remission. Some of those in remission had not received any treatment.

In general, several factors contribute to better outcomes for people with OCD:

  • early onset (symptoms that start in early or middle childhood)
  • early diagnosis
  • intensive intervention with CBT and SSRIs
  • less severe symptoms
  • family support

Having depression at the same time as OCD can lead to outcomes that are not as good. This may be because depression can make it harder to stick with treatment plans.

Conventional treatments won’t work very well for some people diagnosed with these two disorders. It’s possible that some newer treatments, especially brain stimulation techniques, could be helpful in these cases, but more research needs to be done.

The takeaway

Depression and OCD often go hand in hand. Most of the time, OCD begins first and depression follows, suggesting that it’s living with OCD that leads to depression.

Though these two mental health conditions can be long lasting, they are both treatable. First-line treatments such as medication and psychotherapy can make a big difference in the severity of OCD and depression symptoms.

If you are experiencing both OCD and depression, you will probably fare better if you focus on treating OCD symptoms first. When those symptoms are better managed, you may find the depression gets better, too.

OCD and depression together are a lot to contend with. Though these conditions can make you feel isolated, you are not alone in dealing with them. Your symptoms, daily functioning, and quality of life can all improve with treatment and support.

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