Many of these side effects can contribute to new symptoms, entirely new problems and more stress. However, for may people, medications are effective and a welcome solution. Psychological and behavioral therapy requires significant commitment whereas treatment of OCD with medication requires less effort. Use of medication will typically requires a life long reliance on medication. Psychotherapy is almost always the first treatment of choice except in cases where OCD is so severe that relief as soon as possible is necessary to restore functioning and to prevent severe consequences.
Medication is usually the second choice after a comprehensive and competent trial of psychotherapy.
Combined use of medications and psychotherapy at the onset of treatment may in some cases confound the evaluation of treatment effectiveness and the observed source of change. It is harder for a psychotherapist involved in a combined medication and therapy approach to know which approach is or is not helping and how much it is helping. Psychotherapy, or the psychotherapist, can generally be considered ineffective if a trial of 3 months has not produced a measurable and noticeable improvement. A decision to change therapists or to start a medication may be necessary at this point. Keep in mind that a failed attempt that is the result of working with an inexperienced or incompetent psychotherapist can lead to discouragement, self-blame and an increasing sense of helplessness and hopelessness.