Obsessive compulsive disorder (OCD) and depression are mental health conditions that share overlapping symptoms, such as struggling with intrusive thoughts, poor self-esteem, and loneliness. Due to these similar experiences, those with OCD may also develop depression at some point in their life. Despite this association, these disorders are two very different diagnoses.
What Is Depression?
Depression is a common mental health disorder that includes symptoms such as a loss of energy, disinterest in normal activities, hopelessness, and increased irritability.1 Someone with depression may also experience less observable behavioral changes, making it difficult for others to recognize signs of the condition.
According to the DSM-5TR, there is a difference in diagnosable depression and general sadness. Whereas sadness is a normal human experience, depression is sadness that has persisted for at least two weeks.2
Common symptoms of depression include:
- Irritability or changes in mood
- Changes in sleep or inability to sleep
- Loss of appetite
- Low self-esteem and poor feelings of self-worth
- Difficulty concentrating, making decisions or performing daily routines (like proper hygiene)
- Hopelessness, intense sadness or melancholy and poor thoughts about the present or future
- Frequent thoughts about death, dying or even suicide
What Is Obsessive Compulsive Disorder (OCD)?
Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by obsessions and compulsions. Compulsions are thoughts or behaviors that are created as a response to unwanted, intrusive thoughts (obsessions). The DSM-5TR describes compulsions as being repetitive or ritualistic, and are performed to “neutralize” or soothe anxiety.2
Is There a Link Between Depression & OCD?
Due to the potentially distressing nature of OCD, it is common for depressive symptoms to also occur and impact one’s functioning.3 Seeing as avoidance, anxiety, and fear are characteristic emotional traits of OCD, it is understandable that one may become sad about the quality of their life.
Certain negative or pessimistic views of oneself can easily translate into negative thoughts or hopelessness about the future.3 Therefore, it is likely that a person with OCD may develop a co-occurring depressive disorder. The comorbidity rate of these two disorders is quite high, as about half of those with diagnosable OCD also meet criteria for major depression.4
Can OCD Cause Depression?
OCD is not a direct cause of depression, but it can play a role in the development and persistence of depressive symptoms. For instance, when someone experiences frequent, intrusive thoughts that take up a significant amount of their time, they may lose out on opportunities that maintain a healthy mindset, such as social or physical activities.
Additionally, someone with OCD can have “bouts” of triggers followed by response behaviors, similar to the experience of “bouts” of depression. When these strike unexpectedly, the development of depressive symptoms can follow, especially if the OCD is triggered by trauma, stress, or abuse.5
A person’s subjective level of distress experienced when having intrusive thoughts may lead to extremely poor self-esteem or disgust with oneself. It is common for those with OCD to feel angry about having their obsessions, wishing the thoughts would simply end. A person’s level of insight into the legitimacy of these obsessions may also play a role in their subjective expression of distress.
For example, one may understand and recognize that their OCD obsessions are extreme and irrational. Another person might truly believe they are causing harm to others by not performing their ritualized behavior to stop something bad from happening. This level of anxiety and worry about harm to themselves or others can induce intense feelings of guilt and shame. In turn, depressive symptoms may develop.
Compulsions can look like repetitive hand washing, putting things in a specific order, or repeated checking.2 They can also include thought-based or mental acts such as praying, counting, or repeating words to oneself silently.2
Like with unhealthy levels of perfectionism, those with OCD may apply rigid rules to themselves and their behaviors. By going above and beyond to put their world back in order, they might believe they can prevent something bad from happening. As having any control over many circumstances is not guaranteed, it is common for a person with OCD to become depressed or hopeless about the future.
Impacts on Relationships
OCD affects a person’s life in many ways, but the potential loss of relationships can be so anxiety-provoking for some that they start to shut down and internalize these fears. For those with OCD, it can be difficult to ask for help or engage with other people, especially if social engagement is at the root of their fears. For example, those who obsessively worry about contamination are likely going to avoid others.
Disorders like OCD are highly treatable. However, if this condition is not addressed, anxiety symptoms can manifest and lead to other issues like depression. Untreated anxiety can have major, long-term effects on the brain and impact areas of memory, attention, and executive functioning.6 Additionally, guilt commonly associated with anxiety disorders can result in the development of depressive symptoms, such as low self-worth and poor self-esteem.7
Similarities Between OCD & Depression
Both OCD and depression can include a fixation on unhelpful, negative thoughts that are often about the future or one’s inability to control the present.8 From a biological perspective, the amygdala–the part of the brain responsible for emotional processing–responds to overactive levels of distress.9 For those with depression or OCD, this can produce similar symptom exhibition as one experiences intense worry or anxiety.
OCD and depression share many overlapping symptoms including:
- Frequently experiencing fear, worry, or hopelessness
- Feelings of failure
- Negative self-talk or negative beliefs about one’s self
- Catastrophic thinking
- Increased agitation, apprehension, or nervousness
- Feeling lonely or wanting to isolate, despite increase in loneliness
- Overall poor life-satisfaction
- Increased anger and low mood
Differences Between OCD & Depression
Although similar, the two disorders are distinct as OCD is ritualistic, repetitive, and patterned whereas depression is more generalized. While intrusive, ruminating thoughts are a hallmark trait of both OCD and depression, those with OCD will experience these at an excessive, extreme frequency compared to those with depression.8
Some differences between OCD and depression include:
- Frequency and intrusiveness of thoughts: While those with depression experience thoughts that are common to them, a person with OCD experiences repetitive thoughts until something is done about them.
- The presence of compulsions in OCD: While someone with depression may say their negative thoughts don’t let up, they don’t believe their behaviors or routines in response to the thoughts have impact like those with OCD do.
- OCD-related disorders: The DSM-V suggests that body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder are OCD-related disorders (not caused by OCD).
- OCD can be a predictor of depression: Again, there is a high chance someone with OCD might experience depression but depression itself cannot “cause” OCD.
How Are OCD & Depression Treated?
Treatment for depression may include cognitive behavioral therapy (CBT) in which one’s thoughts, feelings, and behaviors are confronted in order to make healthy changes. With OCD, some components of CBT can be helpful. However, directly confronting an OCD thought is not enough. Rather, specialized treatments for OCD often focus on utilizing exposure therapy methods instead. In some cases, medications may also be prescribed as a part of someone’s treatment plan.
If you are wondering “Do I need therapy?,” the answer is probably yes. An OCD therapist receives specialized training that not every provider may have. Unlike with depression, OCD requires a very specific kind of treatment that is not as generalizable.
Most commonly, exposure therapy for OCD is recommended in these cases. CBT includes thought-stopping techniques that may not be as beneficial for those with OCD as they are for other disorders.10 In exposure therapy, a person is slowly taught how to respond to and overcome their fears. Exposures may be “in vivo”, meaning in real life, or “imagined.”
If you think you have OCD, finding the right therapist is the first step. You should consider one who has the knowledge and skills to assess, diagnose, and treat OCD. You do not have to have a referral from a doctor to start therapy and can easily look for therapists in your area through an online therapist directory.
In addition to seeking therapy, medications may be helpful in the management of symptoms. However, medications will not simply stop obsessive thoughts and compulsive behaviors. It is important to discuss all benefits and risks of a prescription with a medical healthcare provider.
Some medications for OCD, like SSRIs, are also designed to target symptoms of depression. Seeking a consultation with a doctor will ensure that you are recommended the best options based on your personal experiences, pre-existing conditions, and genetic factors.
*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.
How to Cope With OCD & Depression
Just like you would do when you have a cold or the flu, spend time finding things that help heal your mental health. Making certain lifestyle changes can improve your symptoms, such as focusing on controlling what you can. While these changes alone are not enough, they can support you throughout treatment.
Here are some tips for coping with OCD and depression:
- Seek support: Seek professional support and support from friends, family, or loved ones who you trust. Building a team of allies goes a long way, even if you choose to focus on your relationship with a therapist first.
- Practice meditation: Meditation for depression or meditation for OCD can help you build a healthier connection with your thoughts, emotions, and behaviors.
- Try journaling: Journaling can be a helpful tool to utilize when you are hesitant to share your symptoms with others.
- Determine your priorities: Determine areas of your life that need the most attention or are in urgent need of addressing. This is something that can be done with your therapist or on your own.
- List your fears: For individuals with OCD, it is important to identify, list, and arrange your fears from greatest to least worrisome. This is an important component of exposure therapy, but writing them down on your own can also be insightful.
- Be patient with yourself: As with any major life change, starting therapy and addressing your mental health can be tiring, even frustrating at times. Be patient with and forgiving of yourself as you make this journey.
- Set reminders: Remind yourself of the progress that has been made, whether this looks like starting treatment or feeling motivated to make necessary changes.
OCD and depression are difficult to deal with, but there are effective treatments available. If you have OCD, make sure your provider asks the right questions to determine if you also have depression, as you may require treatment for both. Change is possible when you reach out for help. Allow yourself to trust in the process of breaking down what aspects of your life have been contributing to your challenges.