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OCD symptoms may begin anytime but usually start between late childhood and young adulthood. Most people with OCD are diagnosed as young adults. 

The symptoms of OCD may start slowly and can go away for a while or worsen as time passes. During times of stress, the symptoms often get worse. A person’s obsessions and compulsions also may change over time. 

People with OCD might avoid situations that trigger their symptoms or use drugs or alcohol to cope. Many adults with OCD recognize that their compulsive behaviors do not make sense. However, children may not realize that their behavior is out of the ordinary and often fear that something terrible will happen if they do not perform certain compulsive rituals. Parents or teachers typically recognize OCD symptoms in children. Recognizing OCD: How to know if your symptoms are OCD
Everyone rethinks or double-checks things sometimes. Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions. However, people with OCD generally:

 ● Can’t control their obsessions or compulsions, even when they know 

they’re excessive.

 ● Spend more than 1 hour a day on their obsessions or compulsions. ● Don’t get pleasure from their compulsions but may feel temporary 

relief from their anxiety. 

 ● Experience significant problems in daily life due to these thoughts 

or behaviors. 

Some people with OCD also have a tic disorder involving repetitive movements or sounds. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Vocal tics include things like repetitive throat- clearing, sniffing, or grunting sounds. It is common for people with OCD to also have a diagnosed mood disorder or anxiety disorder.
If you think you or your child may have OCD, talk to a health care provider. If left untreated, OCD symptoms can become severe and interfere with daily life.

What are the risk factors for OCD?

Although the exact causes of OCD are unknown, various risk factors increase the chances of developing the disorder.

 ● Genetics: Studies have shown that having a first-degree relative (parent or sibling) with OCD is associated with an increased chance of developing the disorder. Scientists have not identified any one gene or set of genes that definitively leads to OCD, but studies exploring the connection between genetics and OCD are ongoing.
● Biology: Brain imaging studies have shown that people with OCD often have differences in the frontal cortex and subcortical structures of the brain, areas of the brain that impact the ability to control behavior and emotional responses. Researchers also have found that several brain areas, brain networks, and biological processes play a key role in obsessive thoughts, compulsive behavior, and associated fear and anxiety. Research is underway to better understand the connection between OCD symptoms and parts of the brain. This knowledge can help researchers develop and adapt treatments targeted to specific brain locations. ● Temperament: Some research has found that people who exhibit more 

reserved behaviors, experience negative emotions, and show symptoms of anxiety and depression as children are more likely to develop OCD.
reserved behaviors, experience negative emotions, and show symptoms of anxiety and depression as children are more likely to develop OCD.

 ● Childhood trauma: Some studies have reported an association between childhood trauma and obsessive-compulsive symptoms. More research is needed to understand this relationship.

Children who suddenly develop OCD symptoms or experience a worsening of OCD symptoms after a streptococcal infection may be diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). You can learn more about PANDAS at www.nimh.nih.gov/pandas.

How is OCD diagnosed?

Diagnosing OCD can be difficult because symptoms such as worry, anxiety, and low mood—which are often people’s most distressing concerns—can be similar to those of other mental illnesses. Also, people with OCD may not tell their health care provider about their obsessions and compulsions out of fear of judgment.
If you are experiencing symptoms, the first thing you should do is speak with a health care provider. They will examine you and ask about your health history to ensure other illnesses or conditions are not causing your symptoms. A health care provider may refer you to a mental health professional for further evaluation or treatment.

How is OCD treated?

Treatment helps many people, even those with the most severe forms of OCD. Mental health professionals treat OCD with medications, psychotherapy, or a combination of treatments. A mental health professional can help you decide which treatment option is best for you and explain the benefits and risks of each. 

Following your treatment plan is important because psychotherapy and medication can take some time to work. Although there is no cure for OCD, treatments help people manage their symptoms, engage in day-to-day activities, and lead full, active lives.
Find tips for talking with a health care provider to improve your care and get the most out of your visit at www.nimh.nih.gov/talkingtips. Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavioral therapy and other related therapies, can be as effective as medication for many people. For others, psychotherapy may be most effective when combined with medication.
● Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that helps people recognize harmful or untrue ways of thinking so they can more clearly view and respond to challenging situations. CBT helps people learn to question these negative thoughts, determine how they impact their feelings and actions, and change self-defeating behavior patterns. CBT has been well studied and is considered the “gold standard” of psychotherapy for many people. CBT works best when customized to treat the unique characteristics of specific mental disorders, including OCD.
● Exposure and response prevention therapy (ERP): Research shows that ERP, a specific type of CBT, effectively reduces compulsive behaviors, even for people who do not respond well to medication. With ERP, people spend time in a safe environment that gradually exposes them to situations that trigger their obsession (such as touching dirty objects) and prevent them from engaging in their typical compulsive behavior (such as handwashing). Although this approach may initially cause anxiety, creating a risk of dropping out of treatment prematurely, compulsions decrease for most people as they continue treatment.

Children with OCD may need additional help from family members and health care providers to recognize and manage their OCD symptoms. Mental health professionals can work with young children to identify strategies for managing stress and increasing support so they can control their OCD symptoms.
You can learn more about psychotherapies, including CBT, at www.nimh.nih. gov/psychotherapies. 

Medication

Health care providers may prescribe medication to help treat OCD. The most common medications prescribed for OCD are antidepressants that target serotonin, a chemical transmitter in the brain involved in depression and OCD. The largest category of antidepressants is called selective serotonin reuptake inhibitors.
Antidepressant treatment can take 8–12 weeks before symptoms begin to improve, and treatment for OCD may require higher doses than are typically used to treat depression. For some people, these medications may cause side effects such as headaches, nausea, or difficulty sleeping. Most people with OCD find that medication, often in combination with psychotherapy, can help them manage their symptoms. Your health care provider can adjust medication doses over time to minimize side effects or withdrawal symptoms. Do not stop taking your medication without first talking to your health care provider. They can work with you to monitor your health and adjust your treatment plan safely and effectively.

The most up-to-date information on medications, side effects, and warnings is available on the U.S. Food and Drug Administration (FDA) website at www.fda.gov/drugsatfda.

Other treatments
The most up-to-date information on medications, side effects, and warnings is available on the U.S. Food and Drug Administration (FDA) website at www.fda.gov/drugsatfda.

Other treatments

In 2018, the FDA approved using a deep form of repetitive transcranial magnetic stimulation (rTMS)—along with medication, psychotherapy, or a combination of both—to treat people with severe OCD who did not respond to other treatments. In 2022, this approval was extended to standard TMS devices.

Most commonly used to treat depression, rTMS is a noninvasive therapy that uses a magnet to deliver repeated low-intensity pulses to stimulate a particular part of the brain. Unlike most treatments, rTMS can target specific brain areas associated with OCD.
Deep brain stimulation (DBS) is a surgical procedure that uses electricity to directly stimulate sites in the brain. Health care providers may use DBS to treat people with severe OCD when other treatments have not worked. However, this therapy is considered experimental. 

Although DBS has received FDA approval to treat certain neurological disorders such as Parkinson’s disease, its effectiveness for treating mental disorders is still being actively researched. The FDA has approved using DBS to treat severe cases of OCD under a Humanitarian Device Exemption. This exemption allows the use of a medical device, such as DBS, for rare diseases or conditions that affect a relatively small number of people, making it challenging to gather enough evidence to establish the device’s effectiveness.
You can learn more about brain stimulation therapies, including rTMS and DBS, at www.nimh.nih.gov/braintherapies. Visit www.fda.gov/medical-devices for the latest information and guidance on brain stimulation devices. 

Effective strategies for managing stress and anxiety 

You can do several things to manage the stress and anxiety associated with OCD. 

 ● Create a consistent sleep schedule. ● Make regular exercise a part of your routine. ● Eat a healthy, balanced diet. ● Seek support from trusted family and friends. How can I find help?

If you’re unsure where to get help, a health care provider is an excellent place to start. They can refer you to a qualified mental health professional who has experience treating OCD and can evaluate your symptoms.
You can learn more about getting help and finding a health care provider on the NIMH website at www.nimh.nih.gov/findhelp. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool at https:// findtreatment.gov to help you find mental health services in your area.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

What are clinical trials and why are they important? 

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. These studies help researchers determine if a new treatment is safe and effective in people. The main purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
People volunteer for clinical trials for many reasons. Some people join clinical trials to help doctors and researchers learn more about a disease and improve health care. Other people, such as those with health conditions, join to try new or advanced treatments that aren’t widely available.

NIMH supports clinical trials at the National Institutes of Health campus in Bethesda, Maryland, and across the United States. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit www.nimh.nih.gov/clinicaltrials. Reprints 

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content at www.nimh.nih.gov/copyright. 

Where can I learn more?
Where can I learn more? 

NIMH website www.nimh.nih.gov www.nimh.nih.gov/espanol (en español) 

MedlinePlus (National Library of Medicine) https://medlineplus.gov https://medlineplus.gov/spanish (en español) 

ClinicalTrials.gov www.clinicaltrials.gov https://salud.nih.gov/investigacion-clinica (en español) 

National Institute of Mental Health Office of Science Policy, Planning, and Communications 6001 Executive Boulevard, MSC 9663 Bethesda, MD 20892-9663 Toll-free: 1-866-615-6464 Email: nimhinfo@nih.gov Website: www.nimh.nih.gov 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 23-MH-4676 Revised 2023
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Depression

National Institute of Mental Health What is depression?

Everyone feels sad or low sometimes, but these feelings usually pass. Depression (also called major depression, major depressive disorder, or clinical depression) is different. It can cause severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working. Depression can affect anyone regardless of age, sex, race or ethnicity, income, culture, or education. Research suggests that genetic, biological, environmental, and psychological factors play a role in the disorder.

Women are diagnosed with depression more often than men, but men can also be depressed. Because men may be less likely to recognize, talk about, and seek help for their negative feelings, they are at greater risk of their depression symptoms being undiagnosed and undertreated.
In addition, depression can co-occur with other mental disorders or chronic illnesses, such as diabetes, cancer, heart disease, and chronic pain. Depression can make these conditions worse and vice versa. Sometimes, medications taken for an illness cause side effects that contribute to depression symptoms as well.

What are the different types of depression?

There are two common types of depression. ● Major depression includes symptoms of depressed mood or loss of interest, most of

the time for at least 2 weeks, that interfere with daily activities.

● Persistent depressive disorder (also called dysthymia or dysthymic disorder) consists of less severe depression symptoms that last much longer, usually for at least 2 years.

Other types of depression include the following. ● Seasonal affective disorder comes and goes with the seasons, with symptoms
Other types of depression include the following. ● Seasonal affective disorder comes and goes with the seasons, with symptoms

typically starting in the late fall and early winter and going away during the spring and summer. For more information, visit www.nimh.nih.gov/SAD.

● Depression with symptoms of psychosis is a severe form of depression in which a person experiences psychosis symptoms, such as delusions or hallucinations. For more information, visit www.nimh.nih.gov/psychosis.

● Bipolar disorder involves depressive episodes, as well as manic episodes (or less severe hypomanic episodes) with unusually elevated mood, greater irritability, or increased activity level. For more information, visit www.nimh.nih.gov/bipolardisorder.
Additional types of depression can occur at specific points in a woman’s life. Pregnancy, the postpartum period, the menstrual cycle, and menopause are associated with physical and hormonal changes that can bring on a depressive episode in some people. ● Premenstrual dysphoric disorder is a more severe form of premenstrual

syndrome, or PMS, that occurs in the weeks before menstruation.

● Perinatal depression occurs during pregnancy or after childbirth. It is more than

the “baby blues” many new moms experience after giving birth. For more information, visit www.nimh.nih.gov/perinataldepression.

● Perimenopausal depression affects some women during the transition to

menopause. Women may experience feelings of intense irritability, anxiety, sadness, or loss of enjoyment. What are the signs and symptoms of depression?
menopause. Women may experience feelings of intense irritability, anxiety, sadness, or loss of enjoyment. What are the signs and symptoms of depression?

Common signs and symptoms of depression include: ● Persistent sad, anxious, or “empty” mood ● Feelings of hopelessness or pessimism ● Feelings of irritability, frustration‚ or restlessness ● Feelings of guilt, worthlessness, or helplessness ● Loss of interest or pleasure in hobbies and activities ● Fatigue, lack of energy, or feeling slowed down ● Difficulty concentrating, remembering, or making decisions ● Difficulty sleeping, waking too early in the morning, or oversleeping ● Changes in appetite or unplanned weight changes ● Physical aches or pains, headaches, cramps, or digestive problems without a clear

physical cause that do not go away with treatment ● Thoughts of death or suicide or suicide attempts
physical cause that do not go away with treatment ● Thoughts of death or suicide or suicide attempts

Depression can also involve other changes in mood or behavior that include: ● Increased anger or irritability ● Feeling restless or on edge ● Becoming withdrawn, negative, or detached ● Increased engagement in high-risk activities ● Greater impulsivity ● Increased use of alcohol or drugs ● Isolating from family and friends ● Inability to meet responsibilities or ignoring other important roles ● Problems with sexual desire and performance

Not everyone who is depressed shows all these symptoms. Some people experience only a few symptoms, while others experience many. Depression symptoms interfere with day-to-day functioning and cause significant distress for the person experiencing them.
If you show signs or symptoms of depression and they persist or do not go away, talk to a health care provider. If you see signs of depression in someone you know, encourage them to seek help from a mental health professional.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life- threatening situations, call 911. How is depression diagnosed?

To be diagnosed with depression, a person must have symptoms most of the day, nearly every day, for at least 2 weeks. One of the symptoms must be a depressed mood or a loss of interest or pleasure in most activities. Children and adolescents may be irritable rather than sad.

Although several persistent symptoms, in addition to low mood, are required for a depression diagnosis, people with only a few symptoms may benefit from treatment. The severity and frequency of symptoms and how long they last vary depending on the person.
If you think you may have depression, talk to a health care provider, such as a primary care doctor, psychologist, or psychiatrist. During the visit, the provider may ask when your symptoms began, how long they have lasted, how often they occur, and if they keep you from going out or doing your usual activities. It may help to take some notes about your symptoms before the visit. 

Certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression. A provider can rule out these possibilities by doing a physical exam, interview, and lab tests.

Does depression look the same in everyone?

Depression can affect people differently depending on their age. ● Children may be anxious or cranky, pretend to be sick, refuse to go to school, cling to

a parent, or worry that a parent may die.
Depression can affect people differently depending on their age. ● Children may be anxious or cranky, pretend to be sick, refuse to go to school, cling to

a parent, or worry that a parent may die.

● Older children and teens may get into trouble at school, sulk, be easily frustrated‚ feel restless, or have low self-esteem. They may have other disorders, such as anxiety, an eating disorder, attention-deficit/hyperactivity disorder, or substance use disorder. Older children and teens are also more likely to experience excessive sleepiness (called hypersomnia) and increased appetite (called hyperphagia).

● Young adults are more likely to be irritable, complain of weight gain and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalized anxiety disorder, social phobia, panic disorder, or substance use disorder.

● Middle-aged adults may have more depressive episodes, decreased libido, middle-
● Middle-aged adults may have more depressive episodes, decreased libido, middle-

of-the-night insomnia, or early morning waking. They often report stomach problems, such as diarrhea or constipation.

● Older adults often feel sadness, grief, or other less obvious symptoms. They may

report a lack of emotions rather than a depressed mood. Older adults are also more likely to have other medical conditions or pain that can cause or contribute to depression. Memory and thinking problems (called pseudodementia) may be prominent in severe cases.

Depression can also look different in men versus women, such as the symptoms they show and the behaviors they use to cope with them. For instance, men (as well as women) may show symptoms other than sadness, instead seeming angry or irritable.
For some people, symptoms manifest as physical problems (for example, a racing heart, tightened chest, chronic headaches, or digestive issues). Many men are more likely to see a health care provider about these physical symptoms than their emotional ones. While increased use of alcohol or drugs can be a sign of depression in any person, men are also more likely to use these substances as a coping strategy. How is depression treated?

Depression treatment typically involves psychotherapy (in person or virtual), medication, or both. If these treatments do not reduce symptoms sufficiently, brain stimulation therapy may be another option. 

Choosing the right treatment plan is based on a person’s needs, preferences, and medical situation and in consultation with a mental health professional or a health care provider. Finding the best treatment may take trial and error.
For milder forms of depression, psychotherapy is often tried first, with medication added later if the therapy alone does not produce a good response. People with moderate or severe depression usually are prescribed medication as part of the initial treatment plan.

Psychotherapy Psychotherapy (also called talk therapy or counseling) can help people with depression by teaching them new ways of thinking and behaving and helping them change habits that contribute to depression. Psychotherapy occurs under the care of a licensed, trained mental health professional in one-on-one sessions or with others in a group setting. 

Psychotherapy can be effective when delivered in person or virtually via telehealth. A provider may support or supplement therapy using digital or mobile technology, like apps or other tools.
Psychotherapy can be effective when delivered in person or virtually via telehealth. A provider may support or supplement therapy using digital or mobile technology, like apps or other tools.

Evidence-based therapies to treat depression include cognitive behavioral therapy and interpersonal therapy. Using other forms of psychotherapy, such as psychodynamic therapy, for a limited time also may help some people with depression. ●	 Cognitive behavioral therapy (CBT): With CBT, people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings. Recent advances in CBT include adding mindfulness principles and specializing the therapy to target specific symptoms like insomnia.