OCD and depression: How are they related?

While obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) are distinct mental health conditions that can occur and the relationship between them can be complicated. Both can involve negative thoughts that can affect your daily quality of life, and symptoms of OCD can sometimes lead to depression.

If you or someone you care about is experiencing one or both (which is fairly common) you may have questions about the differences between them and how they relate to each other. We’re here to help you understand a little more about these mental health disorders.  

What is OCD?

OCD, or obsessive-compulsive disorder, is a long-lasting disorder that features a pattern of unwanted, uncontrollable, and recurring thoughts and fears known as obsessions. These obsessions lead to repetitive behaviors, called compulsions. For example, if someone is obsessed with germs and cleanliness, they may repeatedly wash their hands as relief from the distress that comes from these thoughts.

Many people with OCD experience a cycle of obsessions and compulsions, though it’s also possible to experience only obsession symptoms or only compulsion symptoms. For those living with OCD, these obsessions and compulsions get in the way of daily activities and can cause a significant amount of distress.

Common obsession symptoms include:  

• Fear of germs or contamination
• Fear of forgetting, losing, or misplacing something
• Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
• Desire to have things symmetrical or in perfect order

Common compulsion symptoms include:  

• Excessive cleaning or hand washing
• Repeatedly checking things, like that the door is locked or the oven is off
• Praying or repeating words silently
• Ordering or arranging items in a particular, precise way

What is depression?  

Major depressive disorder (MDD) is a common mood disorder that can affect how a person feels, thinks, and handles daily activities. While everyone experiences feelings of sadness once in a while, people with MDD experience  depressive episodes of persistent sadness that typically last longer than two weeks or longer.  

The most 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
• Thoughts of death or suicide  

To learn about symptoms in more detail, check out: What does depression feel like

What’s the difference between OCD and depression?  

While there are some similarities between OCD and depression—including a fixation on unhelpful, negative thoughts that may be about the future or your inability to control the present—these are two distinct mental health conditions.  

The main differences between depression and OCD include:  

• The type of thoughts: When you have depression you can  get stuck on pessimistic beliefs and negative thoughts, usually in response to a personal problem you’re dealing with. But when you have OCD, you end up obsessing over something without knowing why or how. These unwanted thoughts are intrusive and the nature of them can vary.  
• The presence of compulsions: If you’re dealing with depression and trying to find relief from negative thoughts, you typically won’t react to them with compulsions the way people with OCD do.  
• OCD-related disorders: Body dysmorphic disorder, hoarding disorder, hair-pulling disorder (trichotillomania), and skin-picking (excoriation) disorder are related to OCD, but are not as commonly present in those with depression.  

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Can you have both?  

People can have OCD and depression at the same time (meaning they can share comorbidity). In fact, according to the International OCD Foundation, somewhere between 25 and 50% of those with OCD will also experience depression at some point in their lives.  

In most cases, people experience OCD symptoms first, though it’s possible to develop symptoms of both OCD and depression simultaneously. Research has found that it is rare for people to experience depression symptoms before the onset of OCD—which is why it's common for depression to be considered a part of OCD, but OCD is not necessarily a part of depression. More on that next.

Related article: What’s the difference between OCD and ADHD?

Is there a link between OCD and depression?

Mental health professionals often associate OCD with depression because of the negative effect that OCD might have on someone’s interpersonal relationships, general functioning, and overall satisfaction with life.  There's also a link between OCD and anxiety.

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Can depression cause OCD?  

While we still don’t know for sure what causes OCD, there is no evidence that suggests that depression causes OCD. There are, however, a few risk factors that can make a diagnosis of OCD more likely. These include:  

• Genetics  
• Structural differences in certain regions of the brain  
• Childhood trauma
• Streptococcal infections, a bacterial infection that can affect the skin and throat  

Can OCD cause major depression?  

While OCD does not directly cause major depressive disorder, it can play a role in the development and persistence of depressive symptoms. OCD patients usually experience depression , researchers believe that the difficulties of living with OCD can lead to depression symptoms.  

If you’re living with OCD, you might develop depression due to:  

• The kind of compulsive thoughts you have  
• Difficulties that arise because of your compulsive actions  
• Problems OCD might cause in your life and relationships

Here’s a little more detail about how this might occur.

Obsessions and depression  

The obsessive thoughts that characterize OCD are unwanted and usually upsetting. The nature and content of these thoughts alone is often enough to cause feelings or symptoms of depression.  

These feelings can be frightening and can cause intense shame, which can trigger feelings of depression. If you’re experiencing these distressing thoughts, over time you may feel like you’re no longer in control of your own mind. This can leave you feeling depressed, hopeless, and debilitated.  

Compulsions and depression  

In response to obsessive thoughts, people with OCD will enact compulsive behaviors even when they know the compulsions can't make the thoughts go away or prevent something bad from happening. They feel absolutely driven to do the compulsions anyway and often can't resist doing the compulsion. Other people don't understand the compulsions or why a person with OCD must do the compulsions, often leaving the person feeling more alone/guilty/ashamed which worsens depression.  

If you have OCD, you might find that you’re a relentless perfectionist, believing that you must complete your compulsions flawlessly every single time. It’s hard to meet such a high standard, and that might make you feel depressed as well.  

Treatment for OCD and/or depression

Like many mental health conditions, OCD and depression can be treated with talk therapy, medication, or a combination.  Effective treatment for both include antidepressants like SSRIs (selective serotonin reuptake inhibitors) and cognitive behavioral therapy (CBT). OCD treatment typically includes a specific kind of CBT called exposure and response prevention therapy (ERP).

When someone has two distinct disorders, doctors will usually try to treat the most prevalent condition first. In the case of OCD and depression, studies suggest that for most people treating OCD symptoms first can help alleviate symptoms associated with both conditions. This is because improving OCD symptoms often improves depression (because of the connections we discussed above) but not the other way around.  

That said, treatment is unique since people can experience mental health conditions differently. If you think you have symptoms of OCD or depression, the first step is speaking to an expert, like a psychiatrist. They can help determine whether you either condition or if something else might be the cause. If you’re not sure where to start, take Talkiatry’s free online assessment. We’re a national psychiatry practice that provides virtual care. We’ll match you with a doctor who can help you understand your symptoms and provide a personalized treatment plan.

FAQs

Here’s what else to know about major depression and OCD.

Can depression cause OCD?

While the cause of OCD is still uncertain, there is no evidence that depression can cause OCD.  

Can OCD cause depression?

Because the intrusive thoughts and compulsions associated with OCD can feel distressing and disruptive to those living with the condition, it’s possible and not uncommon for those with OCD to develop depression.  

What are other mental health conditions?

OCD and depression are just two of a number of mental health disorders, which also include, anxiety disorders, bipolar disorder, dissociative disorders, and eating disorders.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.