OCD and depression
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and/or repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. These thoughts and behaviors can be time-consuming and difficult to control. A diagnosis of OCD is considered when they occupy a significant part of the day, are hard to suppress, and seriously interfere with daily functioning.
OCD can affect social life, work, and family relationships. Everyday tasks may take excessive time and energy, as they must be checked repeatedly or carried out in a very specific way. The constant tension associated with OCD can also lead to fatigue, concentration difficulties, and feelings of shame or guilt. OCD can be diagnosed and treated by mental health professionals, such as psychologists and psychiatrists.
Neurological
In OCD, brain networks involved in anxiety, control, and error detection can become overactive, causing obsessive thoughts and compulsive behaviors to persist and repeat.
Treatable
Many people improve with specialized therapy, sometimes in combination with medication. If this is not sufficient, additional treatment options are available.
Comorbid
OCD often co-occurs with depression, anxiety, or perfectionism. Symptoms often emerge in childhood or adolescence, but treatment may not be sought until years later.
DSM-5 Criteria for Obsessive-Compulsive Disorder
In obsessive-compulsive disorder (OCD), obsessions and/or compulsions are present that are time-consuming (taking more than one hour per day) and cause significant impairment in personal, occupational, or social functioning.
The symptoms are not attributable to the effects of substances, medication, or another medical condition, and are not better explained by another mental disorder.
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and that cause marked anxiety or distress in most individuals. The person attempts to ignore, suppress, or neutralize these thoughts, urges, or images, often by performing a compulsion.
Compulsions consist of repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules. These behaviors are aimed at reducing anxiety or preventing a feared event, but they are either not realistically connected to what they are intended to prevent or are clearly excessive.
Many people with OCD hold dysfunctional beliefs, such as an inflated sense of responsibility, a tendency to overestimate threat, perfectionism, and intolerance of uncertainty. They may attach excessive importance to thoughts and feel a strong need to control them.
Approximately half of individuals with OCD experience suicidal thoughts at some point. Up to one quarter report a suicide attempt. The presence of a comorbid depressive disorder increases this risk.
Important
If you are experiencing suicidal thoughts or planning to harm yourself, seek immediate help. Call 113 Suicide Prevention (in the Netherlands), contact the crisis service, or go to the nearest emergency department.
Obsessions
Unwanted, recurring thoughts, images, or urges that are intrusive and difficult to ignore.
Fear of contamination
A strong fear of germs or illness that can lead someone to avoid certain places, objects, or situations.
Doubt and checking
Ongoing uncertainty about having completed tasks properly, leading to repeated checking behaviors (e.g., doors, appliances).
Symmetry and Order
A persistent need for things to feel perfectly aligned, symmetrical, or arranged in a precise way.
Intrusive thoughts
Unwanted thoughts that feel shocking or upsetting, often involving sexual, violent, or religious content.
Compulsions
Repeated actions or mental routines that reduce anxiety, but only for a short time.
Washing and Cleaning
Excessive handwashing, showering, or cleaning, often to the point of skin irritation or damage.
Repeated checking
Repetitive checking of locks, appliances, or other objects, often performed many times to reduce anxiety.
Counting and repeating
Mental Rituals
Internal actions like silently praying, repeating words in your mind, or trying to cancel out unwanted thoughts.
How does the brain function in people with OCD?
Disrupted communication between brain regions
In OCD, there is a disruption in communication between different brain regions responsible for thoughts, emotions, and behavior. The orbitofrontal cortex, which helps process uncertainty and make decisions, is often overactive. This can lead to obsessive thoughts, such as excessive worry about certain actions or situations. At the same time, the caudate nucleus, which plays a role in regulating habits and filtering out unnecessary actions, tends to function less effectively, making it difficult for the brain to distinguish between important and unimportant signals. The amygdala, involved in processing emotions like fear, is also often hyperactive, further intensifying anxiety and obsessive thoughts.
Brain chemistry and reduced self-control
Reduced activity in the prefrontal cortex, responsible for self-control and decision-making, makes it harder to suppress obsessive thoughts and stop compulsive behaviors. An imbalance in serotonin contributes to repetitive thoughts and actions, while dopamine dysregulation may fuel compulsive behavior. Together, these factors create a vicious cycle of obsessions and compulsions that is difficult to break.
How OCD affects daily life
OCD can significantly disrupt daily life. Individuals may spend hours each day engaged in rituals, which can affect work, school, and social relationships. The constant anxiety and compulsions are mentally exhausting and may lead to depression and social isolation.
Personal life
Your self-image may come under pressure. You may feel that you are “not normal” or that you cannot trust yourself. Feelings of shame and self-criticism are common.
Work and study
Obsessions lead to persistent doubt and interfere with concentration. Checking and repetitions increase the time and mental effort required to complete everyday tasks.
Physical health
Prolonged tension and stress can manifest as physical symptoms, such as fatigue, headaches, sleep disturbances, or a constant sense of physical restlessness.
Social contact
Compulsions can put pressure on relationships. You may begin to avoid certain situations, and fear of judgment can lead to withdrawal or feelings of loneliness.
Emotions and energy
The constant struggle with thoughts and rituals is exhausting. Anxiety, restlessness, and doubt can dominate, making it difficult to relax or experience pleasure.
Control and certainty
OCD often revolves around the need for absolute certainty. Doubt becomes difficult to tolerate, leading to repeated checking, repeating behaviors, or overthinking.
Causes of OCD
In the brain, OCD is associated with disrupted communication between several regions, particularly the prefrontal cortex, the basal ganglia, and the amygdala. These areas are involved in cognitive control, threat detection, and the ability to stop or regulate behavior. In OCD, these inhibitory and control systems function less effectively, causing thoughts and impulses to become “stuck” or difficult to disengage from.
Neurotransmitters such as serotonin also play a role in regulating anxiety and compulsive behavior. An imbalance in these systems may contribute to the development of symptoms. Genetic factors increase vulnerability to OCD, meaning that individuals with a family history may have a higher risk.
Psychological traits, such as perfectionism, a strong need for control, or difficulty tolerating uncertainty, can further intensify symptoms. Stressful or significant life events may also act as triggers, particularly in individuals who are already vulnerable.
OCD is therefore not a matter of personality or willpower, but the result of a dysregulated interaction between brain function, behavior, and environmental factors.
When OCD and depression reinforce each other
Living with persistent obsessions and compulsions is mentally exhausting and can lead to feelings of fatigue, hopelessness, and low mood. At the same time, depression can worsen OCD symptoms, as reduced motivation, resilience, and emotional regulation make it harder to resist compulsions.
This interaction can create a cycle in which both conditions reinforce one another. For this reason, effective treatment should take both disorders and their interaction into account.
When do we treat OCD with rTMS?
At rTMS International, we deliberately use rTMS for obsessive-compulsive disorder only when it is accompanied by treatment-resistant depression.
Based on scientific evidence and clinical experience, we have found that rTMS is most meaningful and effective in this combination. When OCD co-occurs with depression that has not responded adequately to previous treatments such as medication and psychotherapy, broader disruptions in brain activity are often present. In this context, rTMS can help restore balance in affected neural networks, which may lead to improvement in both mood and obsessive-compulsive symptoms.
In cases of OCD without a depressive component, the effectiveness of rTMS is currently less well established. For this reason, we carefully assess whether your specific symptom profile fits this indication. This ensures that you receive a treatment that aligns with your individual situation and with what current scientific evidence and clinical practice support.
Take a step towards recovery
There is a treatment that works, even when previous therapies have not helped enough. Discover rTMS or ask a question.