Depression and OCD
“I keep on feeling like I can’t do anything (because I experience depression) but my OCD is like “You HAVE to do something.” But depression paralyzes me. I get stuck. The thoughts get me, like the intrusive thoughts that my friends won’t like me. I care so much. If it seems like my friends are pulling away, I get so sad. That sadness can feel like a pain in my chest. It is a very deep loneliness. OCD piggybacks off the depression and that makes me even more anxious about doing my compulsions. I get stuck in “just right” cycles with my art, instead of enjoying it. The depression feels very irrational. It's so dysfunctional.”
A, Age 16
“As a father who is emotional, I tend to get depressed when my daughter is depressed. When she is hopeless, I go into hopelessness. I revert into safety mode. The first time my daughter experienced suicidal ideation was one of the hardest months of my life. I wish I had more therapists, peers (parents), resources telling me: this is likely a cycle that you need to get through. It feels like forever that we were keeping her safe and hoping she comes back. I didn’t believe that she could become functional again.
During her depressive episodes, I see how deeply the OCD has gotten its claws in her. I feel parental helplessness. I’m a “solver dad.” I had to watch my 9 year old in horrible distress. I had to see what was going on with her brain and not be able to do anything about that. I would just yell at her OCD, but not be able to solve any aspect of it.
I asked myself, is she sentenced to this level of a grind for the rest of her life?”
JS, OCD Parent
Within a child’s psyche, diagnosed with OCD, the arrival of depression becomes an unwelcome squatter in an already overcrowded home. Unlike OCD, which often carries an air of urgency, depression in children can be a far quieter, insidious counterweight. In such instances, depression should not signal the cessation of OCD treatment but a strategic pivot in the approach.
When depression hijacks the narrative, the child's world is also conquered. Exposure and Response Prevention (ERP) may feel impossible. The sense of hopelessness can take away any motivation to push themselves into distress.
During this time, it is even more important to have active channels for communication between clinicians, caregivers, and the child. While we continue the crucial work of ERP, safety from suicidality needs to be a priority. Safety plans should be drafted with the child's input, their own strategies to fight back in the darkest moments.
The lifeline during depression is the consistency in therapy, the familiar faces of support, and the unwavering existence of a structured treatment plan. Many children want to drop out of treatment during a depressive cycle, but the truth is that depression can often be navigated through the persistence of treatment. The aim is not to overpower depression but to outlast it.
For parents, their job is to remain the beacon of hope. Even if they are highly empathetic and emotionally attuned to their children, I ask them to adopt a calming and consistent demeanor. Even if parents struggle with depression themselves, I ask that they become an emotional buoy for their child. Unquestionably, it is challenging. It demands patience, stoicism, and resilience. For our children with OCD and Depression, parents and therapists alike must maintain hope and therefore anchor our children. As Rilke aptly put it, a depressed individual is lost "in the uncommon vastness of their sorrow." Parents must stand close by and resolute, and insist that treatment goes on.
