OCD Medication Explained — SSRIs, What Works & What Doesn’t | Dr. Steven Poskar

In this episode of The OCD Confessional, we’re joined by Steven Poskar, MD, psychiatrist, Clinical Director of OCD NYC, member of the Scientific and Clinical Advisory Board of the International OCD Foundation, and one of the country’s leading experts in the treatment of OCD and related disorders. 

This conversation focuses on one of the most debated and misunderstood topics in OCD treatment: medication.

Dr. Poskar breaks down what medications for OCD actually do, why SSRIs are used differently in OCD than in depression, and the most common misconceptions patients have when starting treatment. We also discuss why medication alone is often not enough — and how it works best alongside evidence-based therapies like Exposure and Response Prevention (ERP) and CBT. 

We also explore the growing interest around:
 • Psilocybin and OCD
 • MDMA-assisted therapy
 • Glutamate-targeting medications
 • Why some medications fail
 • How to think critically about “gut health” and alternative treatment claims

This episode is educational, nuanced, and grounded in real clinical experience — whether you’re considering medication, currently taking it, or simply trying to better understand OCD treatment.

Transcript

SPEAKER_01 0:00

I'm Alicia. And I'm Liam. We both have OCD, and instead of spiraling alone, we decided to turn our symptoms into a podcast. You're welcome.

SPEAKER_00 0:10

Here we overshare real stories, laugh through the anxiety, and talk to actual experts who can explain why your brain keeps asking, What if I accidentally marry my cousin?

SPEAKER_01 0:20

Whether your thing is hand washing, mental rituals, or just silently panicking during normal conversations, congrats. You have found your people.

SPEAKER_00 0:28

This is a safe place, unless you're an intrusive thought. In which case, get in line, buddy. We're booked.

SPEAKER_01 0:34

So grab a weighted blanket, cancel your plans for the fifth time, and let's dive in. This is the OCD Confessional.

SPEAKER_00 0:42

And yes, we did check this recording four times before uploading it.

SPEAKER_01 0:48

Today on the OCD Confessional, we are honored to welcome Dr. Stephen Poscar. Dr. Posgar is a leading psychiatrist specializing in the treatment of OCD and related disorders. His work focuses on helping individuals struggling with OCD, body dysmorphic disorder, trichotillemonia, hoarding disorder, and skin picking disorder. He is the director of OCD NYC, a specialized treatment center serving patients across Connecticut, New York, New Jersey, Florida, Virginia, and Washington. We are so grateful to have him here to share his expertise, insight, and compassion with our community. So, Dr. Poskar, thanks so much for being on the OCD Confessional.

SPEAKER_04 1:28

Thank you guys so much for having me. I really, really am looking forward to it.

SPEAKER_00 1:32

Thanks for being here. We're going to jump right in. Should someone with moderate to severe OCD be on medication?

SPEAKER_04 1:41

So that's a great question. And I think it's it's always kind of hard when we say should, right? You know, as we know, there are there are some people, even with moderate to severe OCD, that can do the standard therapy, which in OCD is exposure and response prevention, and get really good results. And so, you know, typically when I see somebody with moderate to severe OCD, often I'm thinking that it's more likely than not that medication would be helpful for them. And, you know, and then I really talk to patients about patient preference, right? And so some of this is also about like urgency and timeline, right? So if somebody comes to me, even if they have moderate to severe OCD, but they say, like, I'm willing to do therapy alone, I want to try it and give it some time, and then if it's not moving in the right direction, I'll do medicine, which is fine. On the other hand, if somebody comes to me really severe and either they're just really suffering or not functioning, then in that case, usually I want to start them on medicine, you know, and and again, you know, therapy is always the most important piece, right? And and the best thing the medicine can do is often kind of lower symptoms down enough to allow people to be able to do the therapy. And I think I always go back to with patients, right, that the nice thing about medicine is it's not surgery, right? It's not something we can't undo. So to me, trying medicine is sometimes worthwhile because you'll see. Is it is it helpful to you? If it's not, we stop it. If you're getting side effects and you're not worth it, we stop it. But often people can see it's helpful for them. And then sometimes if people are doing therapy for a while, sometimes we can lower and even stop the medicine and they keep their gain. So again, sometimes medicine's a long-term thing, but sometimes it's just a thing that we need sometimes to get people to be able to kind of take those kind of steps and end their therapy.

SPEAKER_01 3:41

We can speak to this a little bit. I think the research shows that the best results come from some combination, right, of medication and therapy, obviously depending on the patient and the circumstances. But overall, I think that's what the literature says. You can correct me if I'm wrong on that. But I did want to ask how you got into this field. How did you get to OCD NYC and why the focus on OCD for you?

SPEAKER_04 4:04

Yeah. So first on the research, so this is a this is a contentious issue. Uh some research that that, you know, and when we were writing kind of um, you know, so I wrote the the biological treatment guidelines for the OCD Foundation. And when we were writing them, we got pushback from a lot of people, which is great. I mean, people have questions and things. And so depending on like how you look at things, there are some people that would say, I don't know. There are a bunch of studies that show that Sarah Kes just as well as medicine and therapy. Others, not so much. And then it's a question of what's the difference if it's moderate to severe versus more mild? What's the difference between if somebody has comorbid depression with it? So it's it's it's it's it's a debated subject. Um, for me, I got into this because I had a couple of family members with OCD. Um, I actually never planned on being a doctor ever. Um, you know, I didn't go back to school to do even pre-med till I was 28. And I started when I was 30. Um, but I went in and did all this because I realized that I wanted to help people with OCD. And so I really went to medical school knowing this was what I was gonna do. I I went to medical school for for that reason.

SPEAKER_01 5:20

As it relates to the research on the combination of medication and therapy, um where does heroin fit into that?

SPEAKER_00 5:31

Where does what? What'd you say?

SPEAKER_01 5:33

Where does heroin fit into that?

SPEAKER_00 5:38

Sorry, you'll have to excuse my friend. He he had a rough night last night.

SPEAKER_04 5:43

Uh yeah, that that that is beyond, I think, the re what the research has has delved into.

SPEAKER_01 5:50

Uh on a more serious note, a lot of people wonder um, they're newly diagnosed with OCD. So I'll give you a little bit of my experience. And Alicia's experience on this was kind of similar, where I was super reluctant to do medication. Um I actually became kind of obsessed with the thought of the side effects and wanted to avoid those at all costs. And thought if I take those very black and white thinking, then this is going to happen. I'm going to have these side effects. My life is actually going to get worse. And so I was really opposed to it. How do you talk to someone who's in that position? They're they're newly diagnosed, they know they need help, but they're just so reluctant to take medication, almost to a point where it is its own obsession.

SPEAKER_04 6:37

Well, it's I I love that you ended on that, right? Like almost like good if it's own this obsession. Because I think you want to see, you know, there's there's normal being afraid of medicine and things like that. And that's a certain conversation. But I also think we have to see when this is just in part of an OCD symptom, right? That you're that no matter how much we tell you, no matter how much, you keep researching and researching, and you never feel certain, right? Because I think at that point, then right, we, you know, part of it is informational, right? Like so when somebody asks a question about medicine or they're nervous, I want to give them information. And and but at some point, when they've asked me the same question four or five times, when, you know, and it goes back, then I do want to identify with them and if they're working with a therapist to their therapist, is this something we actually have to address also from an OCD perspective, right? And and not looking things up and things like that. But again, I think I go back to, you know, what I kind of said a little earlier, which is one of the things I really drive home with people, you know, that have your situation that either want to be with is it's not surgery. There, there, there is kind of it is there's nothing we start that we can't stop. And and we start things gradually and slowly. And, you know, and and part of it's also just being with people. I think one place where this stuff fails is when the doctor doesn't see the patient frequently enough at the beginning if they have medicine anxiety. I think sometimes you need to help them get through that at the beginning when they have some side effects, right? Typically, side, you know, the problem is side effects tend to come early with medicine and then go away if it's a while to accrue. So it's hard, right? Because at the beginning you might be getting side effects and no benefit. Yeah. And so, you know, I think educating them on what the timelines are, educating them on what the side effects are, right? Because if people don't want to take medicine because of certain side effects, I want to make sure these are actually true side effects, right? So people will come in and they'll say, I I don't want to be on Prozac because I'm worried about my kidneys. Prozac has will not does not get dealt with by your kidneys. It doesn't do anything for your kidneys. So I want to also make sure I want to hear their concerns because some of them just aren't true. And then others do have validity, and then it's going over kind of and explaining those.

SPEAKER_00 9:02

How do you decide what to prescribe?

SPEAKER_04 9:06

So, you know, when OCD typically writes, the standard of care is SSRIs. And those are selective serotonin reuptake inhibitors, and those are Zolof, Prozac, Lexapro, Selexa, Luvac, and Paxel.

SPEAKER_02 9:21

Uh-huh.

SPEAKER_04 9:22

And, you know, typically in OCD, we often need higher dosages than are used for things like depression or anxiety. There's not a shred of evidence anywhere to show that any SSRI is better than any other for OCD or for anything for that matter.

SPEAKER_00 9:40

Wait, can I interrupt you really quick? Is there evidence to show that OCD is a low serotonin issue? Because I think that No, no.

SPEAKER_04 9:48

So let's talk about that.

SPEAKER_00 9:49

Okay. Sorry, I if I don't get it out right away, then I forget.

SPEAKER_04 9:52

That's a good question. So we think I think there's thinking that just people don't have not thought out, right? So you we can say that people have OCD and we give them an SSRI. And an SSRI, you know, can cause increased serotonin in the synapse. And therefore, if it works, it must be because they have low serotonin.

unknown 10:13

Right?

SPEAKER_04 10:14

False. It really doesn't make any sense, right? So I always I always tell people, you know, imagine you're an alien or you're coming to Earth and you become a human and you don't know anything.

SPEAKER_00 10:22

We don't have to imagine, Doc.

SPEAKER_01 10:24

I imagine that every day I basically am an alien.

SPEAKER_04 10:28

And you only sleep for four hours, but you don't know what causes tiredness. And next day you wake up tired and I give you coffee and you feel less tired. Were you caffeine? Did you have low caffeine? No. Just because something helps doesn't mean it's the cause, right? You know, when you have a headache and you take a Tylenol, you didn't have a headache because you were low on Tylenol. And so, you know, the assumption that that is a mechanism, and when you actually look, people with OCD don't appear to have lower levels of serotonin, nor do nor do people in depression.

SPEAKER_00 11:02

So why are we giving them more?

SPEAKER_04 11:04

So so again, we're we're starting a chain reaction, right? Where we're and we're doing something pretty specific, right? Because not all medicines that increase serotonin work for OCD, right? There are other medicines like Remaron is an antidepressant anti-anxiety. It increases serotonin. It doesn't treat OCD, right? That OCD seems not to just be treated in particular by things that affect the serotonin reuptake pump. But remember, your body and your brain, these are all interjoining neural circuits. So serotonin is going to affect dopamine and affect glutamate, and glutamate's going to affect this and that, and it's going to go downstream and do a million other things, right? And we kind of all we can say is we know that this starts some cascade of reactions that eventually lead to improvement in OCD symptoms.

SPEAKER_01 11:55

We don't really know the mechanism then, right? We just know that the research shows that people who take this tend to do better. And Alicia and I are, I think you're okay with me saying this, right? Alicia, we're both on them.

SPEAKER_00 12:05

Um, Liam at this point.

SPEAKER_01 12:08

At this point, we've we've really said that. Yeah, we've we've shared we've shared a heck of a lot on this podcast, which is good. Um we're both on them. We both have seen improvement as a result of them, but it sounds like even the experts, you, don't really know why. Is that the case?

SPEAKER_04 12:28

Well, we have theories. I mean, a couple of things we we kind of have a sense of, right? Which is, you know, one of the things we see in people with OCD is kind of a what we call a hyperactive brain circuit, right? And and an OCD, and and you know, this there will not be a test on this, but in OCD, these are what we know we'll call cortico, striatal, thalamic, cortical loops. And and an OCD in particular, the areas in like the cortex are usually like we see hyperactivity in the orbital front frontal cortex and the anterior cingulate, and then it goes to an area called the striatum, and then to your thalamus and back. And in people with OCD, it looks like these areas are hyperactive. Interestingly, when we treat people with medicine and they get better, often we can see that actually these loops have slowed down. So we kind of know that there's possibly an endpoint of where it's doing things, but exactly how we don't know. And there are theories, um, but nobody knows for sure. Um, the interesting thing is when we do therapy and it works, those loops also slow down. And that's important for people to remember. Some people assume, well, if I have a brain or biological illness, I need medicine. But tons of things change your biology. Learning changes your biology, and therapy changes your biology. So it is not in that way, while you're not taking a biologic medicine, it is absolutely changing your biology.

SPEAKER_00 13:59

I would say for me, my my experience with it is it's allowed me to I I used to get very anxious very quickly, and now it slows, it's has slown that down, right? So I don't go into these OCD spirals as fast. I'm able to rationally think things through without being uh so anxious through the process. And I haven't had a depression episode since I've started. So whether it's helping with depression or anxiety, whatever it's doing, it's allowing my body to have a um uh a calmer response.

SPEAKER_04 14:36

And that and that's when people ask me, you know, what you know, what what am I gonna feel, right? Like what's what's the response feel like? And I I kind of always talk about it almost of a lowering of the volume, right? It's not that the OCD goes away. No. But it's the volumes lower. Sometimes I tell people it's like the difference between me poking you in the arm with a pin and then you rolling a sweatshirt down and me poking you. You feel it, but it's not as strong, right? People say, yeah, sometimes the thoughts are less. Sometimes the thoughts just don't have the same emotional heft, right? They're just easier for me kind of to kind of let be there and walk past. It's easier for me not to give in to compulsions. And and again, I think that's what also just allows people that ability now to really engage in the therapy, because they have a little bit of everything's a little calmer, because sometimes it's just so overwhelming that it's hard to even hear what the therapist is saying.

SPEAKER_00 15:32

So that's why the ERP with it is so helpful. You have to.

SPEAKER_01 15:37

Yeah, I like thinking about it that way, that that scaffolding, that's nice. You you mentioned that typically the dosages are higher for someone with OCD than with an anxiety disorder or depression. Why is that?

SPEAKER_04 15:50

So we don't know again, you know, we don't know exactly why. We know just from you know doing this and studying it that people seem to require higher dosages. And it's just remember that, you know, we're we're probably kind of targeting and hitting different brain areas. And and, you know, just like just by like in the same way, you know, on your skin, right? Yeah, I can kind of touch some of the skin on parts of your body and you barely feel it. And I can touch areas that are really sensitive. And so there are probably going to be areas of the brain that are more sensitive that you need a lower dosage to get a response, and other areas that are not as sensitive in that way that that require a higher dosage. And again, we see this in OCD, and we also see the same thing in one of the other OCD-related disorders, body dysmorphic disorder, where we also tend to kind of need the same kind of OCD dosages.

SPEAKER_00 16:39

I imagine it gets pretty hard to figure out what's best for someone who is who has been battling severe OCD for a long time because they don't even know who they are outside of the OCD. And then you medicate them and they're trying to figure out how they should be showing up in situations and respond the numbing versus symptom relief. You know what I mean? Because sometimes you're like, well, I feel really numb, but it's better than feeling bad, but I should feel good. At what point do you say, okay, maybe we need to increase your dose or maybe try something different? How long? I know it's a loaded question. I'm all over the place. Good question.

SPEAKER_04 17:15

It's a great question. So, you know, look, you know, it's first, you know, it's always first you want to kind of try to figure things out, right? So one thing is sometimes when people have been, you know, a certain way for a while, anything different feels wrong. Right. And and so they don't know, like, well, I don't know. It doesn't feel right, but it it doesn't not feel right because it's not your normal, and everything that's not your normal might feel weird. Um, and especially like when people, you know, and again, like when people are, you know, one of the things you'll hear, right, is is patients say, I can't cry anymore. Right? Like, you know, when I'm I can't cry anymore. When I watch sad movies and they're kind of like, And all I do is cry. Like I'd like to I'd like to cry every now and then. Um again, so one thing is like thinking, like, you know, have you overshot the mark, right? We don't want them crying all the time. Um, and you know, we talk about this kind of what some people would call an apathy syndrome, right? From SSRIs and as dosages get higher, and you know, as dosages get higher, it looks like there's kind of becomes this misbalance between you know between serotonin and things like dopamine and norepinephrine. And you know, sometimes as serotonin gets higher, it can kind of actually impact levels of those things and inhibit them. So when people do have it, and and we we do think this is you know be caused by the medicine, one of the most common medicines we use is well butrin. And well butrin is an antidepressant. Uh it is one of the antidepressants that is not good for OCD.

SPEAKER_00 18:49

It doesn't affect I started off with that. Also prescribed that to me, and it was horrible. My intrusive thoughts were through the roof. I didn't know why. I told Liam, I'm like, this is you warned me though, didn't you, Liam? You said I did start with that. And I was like, well, I'm trusting the doctor.

SPEAKER_04 19:11

Well, well, so you know, I talked about this when I lecture a lot, right? There's it it gets confusing because of the language, right? You know, because we used SSI, often things get a name for what we use them for first. And so SSRIs we started using for depression originally. So people just started calling them antidepressants. And then people just like, well, antidepressants work for OCD. But not all SSRIs are antidepressants, not all antidepressants are SSRIs. And so I think people just sometimes go, oh, well, it's it's it's an antidepressant. But again, the only antidepressants that help OCD are, as far as we know, are things that block the serotonin reuptake pump, things that are serotonin reuptake inhibitors. Well, butrin is not. Well, butin actually inhibits the reuptake of dopamine and norepinephrine. And so it's good for depression, doesn't help with anxiety. Sometimes it actually in some people can kind of cause an uptick in anxiety.

SPEAKER_01 20:11

It caused one for me.

SPEAKER_04 20:13

You know, and it's it's sometimes good for some people with ADHD, um, often ones who can't tolerate stimulants or other other medications.

SPEAKER_00 20:23

Yeah, but you most people who have OCD also have ADHD. So how do you treat both? Liam and I both have OCD. Well, I'm gonna we're gonna it's less than most, but a lot.

SPEAKER_04 20:32

But we'll talk about it.

SPEAKER_00 20:32

Yeah. Okay.

SPEAKER_04 20:34

But again, I think so. Well butrine can often help because again, some of this apathy seems like it's due to kind of an imbalance with the serotonin, dopamine, and norepinephrine. So if you give somebody well butrin and increase the dopamine and norepinephrine, we can often see improvements in that. Uh and it happens to some people. But I also think that sometimes patients come in, especially artists, and they really worry. They really worry about uh what if uh if I can't feel sad or I can't feel this, I can't do my art. Or even being medicated, period. They're like, if it's gonna make me anybody different than who I am, I I can't do that. This is my you know, and and and what most people find is it does quite the opposite. It tends to make you better artists and and better.

SPEAKER_00 21:20

They're like, then why are we why are you here then? You know, like what what what is it that's wrong? If you like the ups and downs, then we have nothing to talk about.

SPEAKER_04 21:29

Yeah, but like you said, it they like some of it and not others, right? People are ambivalent. They're they they you know, and and that's always what you do with patients is working on kind of ambivalence.

SPEAKER_01 21:40

You talk about how with some of these medications, uh uh, probably with all of them, you have to give them time to understand whether or not they're working for you because those first few weeks, the side effects can be higher and the benefits are not quite delivered yet. So Alicia and I both had our experience with Well Butrin. She gave it a while. I gave it a while. It was not good. I I moved on to something else. I forget what it was even called, but it wasn't an SSRI. And I'll be completely honest, just because this is the way this podcast is, it's the confessional. I was super worried about erectile dysfunction with SSRI. You know, I like that I was I just became obsessed with the idea that that was going to happen to me. And so that was a big part of it.

SPEAKER_02 22:29

Dr. Pascar doesn't have any idea why you just said that.

SPEAKER_00 22:34

Man, OCD got a hold of him and thought he had Peyroney's disease. So he went to the doctor to make sure that his Yeah. Okay, sorry.

SPEAKER_01 22:42

I had to do that. Oh my God. Health OCD has been one of my subtypes, Dr. Poscar, as you might be able to tell already. And and I became obsessed that I was going to get Peyroni's disease because I had seen a I'd seen it pop up in a TV show and uh it was like, oh my god, what if I have that? It was the whole thing. Uh oh, right. So you can get the sense that for SSRI, the erectile dysfunction risk really concerned me. And as you say, it's not surgery. I could have just, if that ended up being a problem, I could have just stopped taking it, but OCD wouldn't let me believe that.

SPEAKER_04 23:16

Um I do want to say like this is a point that we talked about earlier about educating, right? So so one of the common things SSRIs cause are sexual side effects. Erectile dysfunction is not common, right, with SSRIs. What's common with SSRIs, right? The most common sexual side effect, both for men and women, is anorgasmia, right? A delayed orgasm phase, it takes a really long time. And the second behind that is lowering libido and sexual interest. Erectile dysfunction happens, but it's not common with, you know, it's not a super common thing. And again, that goes back to like making sure you educate the patient on like, no, there are side effects, and and but these are the more common ones. These are kind of less common.

SPEAKER_01 24:03

Yeah, it was just like for me, if it was a 1% chance, even I I was I was uh locked into that. But um uh ultimately I decided, you know what, my life is in horrible shape, even if I end up with ED, I'm gonna do this. So I did, and and then I my first two weeks were tough with fortunately with not those side effects, but just headaches, sleeplessness, you know, some muscle cramping. Um but I waited it out. And about six weeks in, I had this kind of light bulb moment of one day where I was like, wow, everything's a little quieter in here. Um how long do you recommend typically people give it to see that impact before you're willing to say, all right, let's move to something else?

SPEAKER_04 24:50

So it's a great question. So remember, you know, we don't know what your dosage is going to be ahead of time, right? So, you know, we know kind of estimates of typical dosages that work for OCD. So when you get to a dosage that you think is a high enough dosage that it could work for OCD, you know, you usually want to give it four to six weeks at that dosage, right? That the the getting there doesn't count, right? It's it's at that dosage. After four to six weeks, I usually want to see something, right? Not everything, not not whatever, but you're telling me that something's different. If something's different after four to six weeks, then I usually keep my hands off of it, even if it's small, because we often see these grow over time. If at four to six weeks I don't see anything and they're tolerating it well, then I'm gonna go to a higher dose, right? And so you want to kind of get them to a decent dose. And if you still see nothing at a at a fairly high dose, you know, and or they're getting side effects because of dosage, then you might want to switch to another agent. You know, but one of the problems we typically see, right, um, you know, when you do this specifically is patients come to me and they say, I've been on Prozac and I've been on Zolof and I've been on whatever. And then I say, how long were you on them? And at what dosage, and and for how long, because often they haven't been on very high dosages. They either haven't been on OCD dosages or maybe they're in the low end of what could be OCD dosages. And so it's making sure that you're actually using kind of, again, those kind of upper dosages, you know, before you give up on a drug.

SPEAKER_00 26:27

We're gonna pause for a moment because this part of the conversation is brought to you by our partners, No C D.

SPEAKER_01 26:32

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SPEAKER_00 28:38

How do you decide when it's time for someone to wean off? And do you recommend that at some point if they are doing therapy with uh medication? When do you know it's time to maybe Tula?

SPEAKER_04 28:49

There are a lot of people with OCD that stay on SSRIs for their life. And because they just do well on them, and we know that when we stop them, there's a high relapse rate. Um I think there's this group of people where we start them on SSRIs and then they really push the therapy and they're doing well. And it's hard to know what's doing what. Do they just do they need the SSRI? And then if you're gonna lower an SSRI, you do it incredibly slowly, right? Because I want to catch it if it gets a little worse, right? So I might lower, you know, a Prozac if somebody's on 80 milligrams of Prozac, I'm gonna lower it to 70 for two months. Because I don't see the effect, just like it takes a while for the drum to work, it doesn't unwork right away, right? And so I want to see to see what you really look like on 70, I want a couple months. If you're doing okay, I'll drop it. And I just keep dropping it until either you're off of it or you might get to a point where we drop it and you're good, and you drop it and we're good, and then we drop it beyond the third point and you go, I don't feel so great. In which case we got you to a lower dose. But I also think, you know, the when when people are deciding whether to be on something or not, right? It's what's the upside, what's the downside. So, you know, it's gonna be much more likely that someone's gonna want to lower or their dosages that they might say, like, hey, you know, look, it's been working for me, but I've been pushing real hard in therapy. But like I've gained 15 pounds and and I'm having sexual functioning issues. Can we try to get off this? There are other people that say, I tolerate this really well. I feel good with the combination. You know, there's no there's no data to support that it's harmful in any way. And, you know, we have a decent amount of data now because Prozac's been out, you know, for 40 plus years. Um, and and so, you know, and so it's it's it's everybody's different. And again, you could always do a trial and you just do a trial of lowering slowly, and then you see.

SPEAKER_01 30:47

I did want to ask about the long-term effects because, you know, I've wondered myself, am I gonna be on this the rest of my life? Is there some point at which maybe it makes sense to wean? Um I haven't looked at the research myself, but what does the research say about possible long-term effects of high doses of SSRIs?

SPEAKER_04 31:08

So, you know, I don't think we know as much about long-term effects of high doses of SSRIs, right? Just because I don't think it's studied very much for very long. But there's nothing in what we've seen, and we have been doing it for a while in the high doses or regular doses of SSRIs that appear to be kind of long-term problematic side effects that lead to, you know, people dying any sooner, being sicker, any any kind of disease process. And I think something to remember is, you know, there are things that actually really get in the way of your health. Anybody who does this stuff or anything will tell you that stress, cortisol, all of those things aren't good for us. So, you know, not only is it doesn't it appear to be harmful, but I think in a lot of cases we might find, again, that it's actually helpful, right? That that it's decreasing stress, you know, it's decreasing anxiety, it's decreasing things that actually we do know for sure are destructive for your health. Remember, we've had people on Prozac now for 40 years. There doesn't seem to be any kind of signs that there's any long-term effects at this point.

SPEAKER_00 32:10

Yeah. I mean, if you have an imbalance and your body needs it and you are, you know, better on the medication. I mean, it's like people with diabetes. If you need insulin, it's a that's what your body needs because it's not producing it on its own. And therefore, you yeah, I guess for me, knowing that it's OCD related, my depression and anxiety was probably a result of my OCD. I don't want to be on medication forever. So I am, you know, I am worried about weaning myself off. But yeah, I don't know. It's tough.

SPEAKER_04 32:42

That's why you want to, that's why you want to be doing this with a professional that actually knows what they're doing and, you know, and explains everything to you so you know what they're doing. Right. Yeah. And and, you know, and that's, you know, that's again, you know, there there are ways you know, there are ways to do things. There's ways to get people off medicine. Um, one of them is making sure you're doing it unbelievably slowly so that if there are problems, right, you catch them early. You don't, you know, do it so quickly that suddenly the patient goes from here and suddenly a week later they're they're in the floor.

SPEAKER_00 33:14

So Well, that and and the medication convinces us that we're better, that we can get off of it. But you're like, no, that's actually the medication making you feel better.

SPEAKER_04 33:24

But like you say, you don't know, right? You don't know for sure, especially when you're in therapy. Like, what's doing what it is? You know, it's very hard for people to tell. You know, I'll I ask people all the time when they come see me, um, you know, when I'm seeing them for the first time and they're on medicine or they've been on certain medicine, then I'll ask them, like, did you find this helpful or not? And I'm not sure is a completely legitimate answer to any question. Because sometimes people aren't. They're just like, I don't know. I was helped maybe at the beginning, and then I don't know if it was helping. And also my life circumstances got better, and you know, admin therapy, and it's hard to know. There's lots of variables, and so I don't know that anybody could always know for sure what's doing what. And again, sometimes the only way to figure that out is to changing something. But when you change something, you change it slowly, you watch carefully. That's the way you make changes, right? And in a safe manner.

SPEAKER_01 34:16

I want to ask you a little bit about alternatives to the SSRIs and kind of pharmaceutical medication. And you might not have any uh you know background on this, so feel free to say, you know, you just don't feel qualified to talk about it. But there is growing uh chatter online in OCD communities about psilocybin for potentially OCD treatment, depression, anxiety.

SPEAKER_00 34:49

I thought you were gonna say inocital.

SPEAKER_02 34:52

Inositol. Oh, psicodin.

SPEAKER_00 34:58

Magnesium, nope, Liam's going straight to the mushrooms.

SPEAKER_01 35:02

Straight to the hard stuff.

SPEAKER_04 35:04

Yeah. So I try not to I try to preface it, but I try not to think of my thoughts. I try to tell people what the actual research shows. And so, you know, uh the psilocybin study is being done by Christopher Pittinger at Yale. Um, and his group has been looking at psilocybin. Um I think they have some nice preliminary data. Um, and I think Dr. Pittinger would tell everybody nobody should be taking psilocybin for OCD right now. Nobody should be doing it on their own, nobody should be seeing anybody. We don't know enough yet. We are we are not there as far as how to dose it, what the scenario has to be, how often uh it's uh the patient population that works for and does it. So again, you know, part of the problem is with this stuff is people look at it and they get ahead of the curve, and then people just start saying, all right, I'm gonna get psilocybin from somebody. I'm gonna go to the are there people or clinics or whatever. And they do it. And, you know, as we know, like these aren't medicines that literally don't have negative effects. People can have really horrible experiences of psilocybin. So I think it looks like it's promising for a bunch of things in OCD. I think again, um, my guess is Dr. Pittinger will probably talk about it at the OCD conference this summer and where they're at. Oh. You know, he always does.

SPEAKER_00 36:25

Um brings some to to hand out to the audience, Liam. Let everyone just imagine a bunch of people with OCD on Sil Simon at an event. It is, it, it is, there is a record of people saying they have short-term relief, right? But the long-term effects of it and what are they supposed to microdose every day to feel good? And and I mean, that's just opening up a whole bunch.

SPEAKER_04 36:51

There's also stories for every everything, right? I mean, look, yeah, there are plenty of people who tell you when they drink, they always see these better in the short term. Right. You know, and so again, this, and again, this is why we have research.

SPEAKER_01 37:01

On the research question, I'm curious what the setting is or kind of what it is that they are researching. Are they researching macrodoses where you are with a clinician during your experience? Are they researching microdoses that you're taking daily or semi-regularly? And no real data to support microdosing.

SPEAKER_04 37:25

Um, you know, it doesn't actually look like it it does very much, despite, again, the chatter on the internet and things like that. So I don't know the exact dosages they use. I know pretty much as I remember that people are getting a dosage and then they stay there for a while, and they're kind of getting seen daily, and they're and they're doing it with a team and a therapist. These are not people that are giving you psilocybin and sending you home and saying come back in a week. So it's a fairly controlled setting at this point in time. Again, I I don't want to overspeak because I'm doing this from memory. But as I remember, I think they were there for a few days, sometimes four or five days after the dose, um, and kind of you know being monitored. And so again, it's just it's something, again, uh, you know, the problem is is people get a whiff of this stuff, and then a bunch of people just start doing it way before we know how to do it safely, how well it works. Um and and you know, that's always that's always a scary thing.

SPEAKER_00 38:25

Yeah, something to confess, Liam.

SPEAKER_01 38:28

No, no. Nothing to confess. Um I wanted to ask the same question about MDMA. Um, we've seen that specifically with PTSD. I know there's a lot of research into PTSD. Is there any research that you know of happening as it relates to OCD?

SPEAKER_04 38:46

Yeah, I think Caroline Rodriguez's group at Stanford is looking at it, if I'm not mistaken. Um I don't know where they are with it. Again, I could be wrong, but I'm pretty sure again Caroline will be at the conference as well. Um, you know, it's funny, we do a we do uh uh every year we do an Ask the Experts panel um about medicine. And every year, the uh you know, there are a million questions, but there's so many questions about psychedelics. Um so you know, if anybody's gonna come to the conference, I those questions will be asked. Um and you'll have really the best people.

SPEAKER_01 39:23

I'm gonna be in the audience asking every question. You know what I think it is, is that OCD is such a miserable experience that people are desperate for a fix, right? And and you know, askest RIs definitely have provided for me a lot of relief. Um they got me, I would say, 50% of the way there, somewhere around there. And then therapy has gotten me a long ways as well. Um, I've been in ERP for the last, I don't know, how long has it been, at least four or five months? And I've definitely had relief from that as well. But I, you know, if if you can find, I think that that appeal of some natural solution. Now I take this and it's fun, and I take it and I can learn something about myself. And then I wake up the next morning and maybe my OCD isn't there or not as strong. Like that's super, super appealing. And that's why I imagine people showing up at the conference going, let me talk to the person researching MDMA or psilocybin, like, yeah, sign me up.

SPEAKER_00 40:30

That's what leads to addiction, Liam.

SPEAKER_01 40:35

Valid. Valid.

SPEAKER_00 40:37

That's why people with ADHD drink alcohol because it gives them the relief. That doesn't mean that that's the solution.

SPEAKER_04 40:44

But I think I think this is a right, you know, this is always tough, right? Because first of all, I think people's vision of how this would work and how it works are different. I I think people hear the stories about people who are you know hardcore drug addicts and they go to the Amazon and they have one experience, and after the experience, it's just gone, and and and I'm sure that happens. It's not typically the way these things work. So it's also kind of the dream of how it would work is very appealing, right? Um definitely I I think we don't really know that. And I also just am very careful with, you know, when people start using the word natural, um I I um um I think it's an odd, you know, again, remember, there are places where you can go into the woods and eat these very pretty berries and they kill you. So just natural has the this this kind of thing that somehow safety and natural go together.

SPEAKER_00 41:46

Okay, so sum up for our listeners, your top three recommendations for OCD medications and then your absolutely stay away from like well butrin, had I known, I wish I would have. What are your top three recommendations for OCD?

SPEAKER_04 42:02

So again, I would say, you know, look, if you have OCD, you know, you know, the there's pretty, you know, you should be on a serotonergic reuptake inhibitor, which are the SSRIs. If they don't work, sometimes we try another SRI, which isn't an SSRI. It's an what's called a tricyclic, which is called clamipramine or anaphronil. Um and so, you know, if you're being treated pharmacologically, you should always, that should always, again, if there's unless there's something happening where you have bipolar disorder as well, but generally people should be started at an SRI. And you want to make sure that the dose is high enough and that you're on it for a long enough period of time to judge it, right? Because there are time, again, there are tons of people on them, but the dose isn't high enough. Um I think, you know, I think the other thing is again, is there are some augmentation strategies, but again, they shouldn't be tried until you've kind of been maximized on an SSRI. Often people will give low doses of an SSRI that's not helping, and they start adding other drugs that have more side effects like antipsychotics before they've really actually done what they're supposed to do.

SPEAKER_00 43:06

Is the dosage based on the severity of the OCD or the symptoms that they're coming to you with? Because we just upped mine and I don't love the way that I feel. So how long, how long should I deal with the new side effects before I realize that maybe the dose was too high and I go back down?

SPEAKER_04 43:25

Well it depends again, you know, it has to know in particular what side effects we're talking about, right? Different some side effects people get better with some don't.

SPEAKER_00 43:33

Um, some do get better and some don't.

SPEAKER_04 43:36

And so just monitoring that and you know, but I think, you know, uh again, I think there's no relationship to severity and dosage. It's not that people need higher dosage if their OCD is more severe, that that's that there's no relationship. There's no relationship to even if somebody somewhat what we'd call has low insight needing needing a different dose, it's just not, it's just some people because of the Their brains, their bodies, they need a little higher than somebody else. We all break things down differently. Um, and you know, I think I think making sure that like kind of those things are intact, but I think also like to me, the biggest thing is making sure that you understand everything. If a doctor's not explaining things to you in a way that you can understand and you don't have all your questions answered, this isn't a good doctor for you. And I again I think, you know, and and that's really important, you know, to make sure you feel comfortable, you understand things, you know. And again, I think the other most important thing I would say, because I think it's important when you're talking about this stuff, and I know you guys have have dealt with these things and brought up, is it's also remember if a medicine's not working for OCD, sometimes the reason is because they have other comorbid disorders that are being treated. So with ADHD, I can do everything I want for the OCD, but until I treat the ADHD, it's hard to get under control. Other people might have bipolar illness. So sometimes you, you know, you I see patients and they say the refractory OCD patients, nothing working, and then I see them and I say, Yeah, but did anybody else tell you you have this and that you have this? So that's another reason patients might not be responding the way you expect. And so really making sure sometimes people come in and say, I have OCD, and they just go from there as opposed to you need a full diagnostic interview, everybody consultation to see what else could be going on. Um, you know, because I also have to check people are they taking drugs, right? There are some people that if they're smoking pot every day, I can do whatever I want, and the needle doesn't move. So you Oh really? You really have to know the whole picture, what they're taking, what what other diagnoses they have, what other medical stuff, because often the reason people don't succeed is because there are other things going on.

SPEAKER_02 45:56

Right.

SPEAKER_01 45:56

That just touched off so many questions for me. One, how many so the THD, I I used to use THC maybe like twice a week. Um, and I was like, oh, this is cutting the edge for me at night. It was uh, especially like during COVID, I want to say I was using it a fair amount, just because boy, life was boring and and so you'd spice it up a little bit, take the edge off. Then over time I found I was waking up the next day, I was much more anxious. At least that was how I believed I was reacting to it. And so I stopped using it. Are you saying that that can inhibit the impact of an SSRI?

SPEAKER_04 46:38

I think that I there are tons of patients, and again, what the dosage is, it's hard to know, right? Is is once a month not a problem, but once a week is, or is once a week not a problem? I can just tell you that, you know, I continually have seen that when you try to treat people, whether it's for depression, anxiety, OCD with SSRIs, and they're regular pot smokers, the the amount of times you get a response is significantly less. Wow.

SPEAKER_00 47:09

So then do you recommend that they quit smoking pot? I mean, that person's probably so dependent thinking that was helpful, and now they have to go through the withdrawals of that and then start a new medication. What do you do?

SPEAKER_04 47:19

They often tend to not even do anything else until they're off of the pot. Yeah. Because I don't know who that person is. I know who that person on pot is. Right. So even being able to judge what their symptoms are and everything. And remember, one of the problems with cannabis is people use it slowly over years. And if you ask them, is it affecting you negatively? They will often say no. But once you do a trial of getting off it and they're off it for a couple of months, they will say, I sleep better. I have more energy, uh, my mood is better. And so it's one of those things that I think sneaks up on people. So they don't know the effects that cannabis is having on them.

SPEAKER_01 48:01

Yeah, really interesting. The other, the other thing you mentioned was uh ADHD and OCD. So we've had this conversation a few times on this podcast, but I think it's worth revisiting. Alicia and I are both diagnosed with both ADHD and OCD. And since being diagnosed with OCD, I've often wondered if actually I'm not ADHD at all, and that the attention deficit stuff that was showing up for me was much more a result of the fact that I was in my head constantly with horrible intrusive thoughts and ruminations and mental compulsions, and that I, as a result of that, appeared distracted and would miss things, which I still do. I still miss things now. But I don't know that I actually have ADHD anymore. Like I've met other people with ADHD. I have a very good friend who has ADHD and I see her functioning in the world, and I'm like, I don't know if I have ADHD. This person is way beyond my level of attention deficit. So anyway, what are your thoughts on that? That's that some people are being diagnosed with both of these things, and maybe the OCD is causing what looks like ADHD.

SPEAKER_04 49:13

Well, I think, look, I think one of the problems with ADHD is the diagnosis has the word attention in it. So the second people have attention issues, people are like, oh, you must have ADHD. The problem is almost every psychiatric disorder, one of the symptoms is inattention, right? One of the diagnostic criteria for depression is poor attention in bipolar disorder of distractability, um, in generalized anxiety, poor concentration and focus. And so I think you know, you have to be careful, you know, that just somebody having some saying I have inattention does not mean they have ADHD. Right. And so you really need to do a full diagnostic of ADHD. And you also need to ask them questions, right? Like, well, tell me what's going on in those periods of time. You know, is it because you're lost in your head going over a thought or kind of doing this stuff? Um, so I think it's, yeah, I think, you know, people sometimes, and I think ADHD is something that is both over-diagnosed and underdiagnosed. I think I think there are plenty of people that don't have ADHD but have given the diagnosis. And I think there are plenty of people that have ADHD that have never been diagnosed. And so I think something people talk about is this over or under? Things can be both. And and so, you know, a lot of people that I've treated for OCD that don't respond, it's because they also had ADHD. And if you think about it, right, if you have ADHD and one of the symptoms is impulsivity, right? So it's hard for you to not give into impulses, how would you be able to resist compulsions? Yeah, yeah, yeah, yeah. Like yelling and screaming in class, how is he going to resist a compulsion? And if somebody's got ADHD and their thoughts are already disorganized, how are they gonna get be able to step back from the OCD in any way? And so often you'll see if you treat the ADHD, even if you treat it first and do nothing else, you find some of the OCD just improves from that.

SPEAKER_00 51:14

How do they treat uh uh ADHD?

SPEAKER_04 51:17

So ADHD is, you know, the the you know, the the kind of standard has always been stimulants. Um stimulants come in basically two flavors, right? They are either amphetamine-based, and those are things like dextoamphetamine, adderall, adderall XR, vivants, or they're Ritalin-based. And Ritalin is called also is known as methylphenidate. So there's short-acting Ritalin, a little Ritalin LA, long-acting Ritalin, which is concerta. And so both treat, you know, both are stimulants. There's not a lot of evidence that one's better than the other. And so those are the standard treatments. Not everybody tolerates those. Um, either sometimes it does make somebody's anxiety worse.

SPEAKER_01 51:57

Every now and then you I was just gonna ask, couldn't couldn't a stimulant make your OCD worse? I I I've worried about that. Yeah, yeah.

SPEAKER_04 52:03

It used to be that people would say that like almost like it was a fact. Um, it there are definitely cases where it can make people worse. We've also used done studies on stimulants in people with OCD without ADHD, just for OCD that have been successful. Lauren Corinne did studies years ago. And, you know, not a lot of people followed up on them, but there have been several studies just using stimulants for OCD. And I think at ADHD, OCD, they're often really helpful. There's always going to be, there is a small cohort who have like OCD or ticks, and then sometimes they just make them worse. Um, but it depends also, sometimes if I'm treating them with an SSRI as well. Um, but again, you know, and so if people can't tolerate stimulants, we have other treatments, non-stimulant treatments, things like Stratera, well, butrin, um, both can work for AHD. They're not as strong as the stimulants are, but they tend to sometimes be a little bit more side effect friendly. Um depending on the case.

SPEAKER_00 53:07

Do you think psychiatric meds are overly prescribed?

SPEAKER_04 53:11

Again, I'm gonna probably give you the boring same answer. I think they're over-prescribed and under prescribed. I think there are people that are on them that don't need to be, and I think there are tons of people whose lives are being destroyed because they're not on them. And I think I think it just I think it it goes both ways. Um I think, you know, and and that's why, you know, we have like kind of criteria for which we're supposed to be prescribing things. And not everybody follows those. And, you know, some people just anytime somebody feels an emotion, we'll throw a pill at them. And, you know, having normal.

SPEAKER_00 53:47

Or in my experience, trust a doctor who isn't aware of what OCD actually is. And when I tell him I have OCD and he prescribes bulbran, we have a problem.

SPEAKER_04 53:56

Yeah. Well, and again, I think this is just another thing that people don't do enough, which is it's okay as a doctor to say at some point, this falls out of my area. I'm willing to, because you came to me, I'm gonna find you the person that's better to deal with this than I am. And sometimes doctors just try to do stuff that they don't know at the expense of the patient. And I don't want a doctor practicing on my family. And you know, let the ego go. Yeah. So when there are things that I'm not the best at treating, or people come, I will help them and I will find them somebody to go see and things like that. But unfortunately, I don't think that's done enough.

SPEAKER_01 54:34

Dr. Poscar uh famously does do heart surgeries, though.

SPEAKER_04 54:41

It's really a hobby, and nothing of friends and family.

SPEAKER_01 54:44

It's a hobby. Some do woodworking and heart surgery. Um I as kind of a last question because we've taken up a lot of your time. Um some people still really feel shame about being medicated for OCD or any number of mental health issues. Why do you think medication still carries that stigma even within the mental health community? You'll hear from people who are like, no, I was able to do it with therapy, you should just do it with therapy, or, you know, exercise more, eat better, drink more water. You hear all these things. And I've certainly felt the shame around it, whether that's internal or external. So what are your thoughts on that?

SPEAKER_04 55:24

Well, I think a few things. I think, you know, we have to take one step further back, right? And say, not why is it a shame of medicine, but why is it a shame of mental illness? And I think one of the problems with mental illness, in my opinion, is that they sound like things that other people experience. So people would say, you know, ah, I have depression, I'm on medicine. And somebody will say, you know, I was depressed and down for a while, but I just kind of pushed through. And they're comparing being sad and down to major depressive disorder. They're not the same thing, right? Or somebody saying, you know, hey, you know, I'm anxious and I just kind of pushed through it, but that's not the same thing as having OCD or generalized anxiety disorder or panic disorder. So I think because people talk like that, I think then patients think, oh, this is a weakness, right? I'm just not strong doing, I'm not pushing enough. And I think, you know, and so I think, you know, patients realizing this this is a medical disorder of the brain. You know, why, you know, would people feel, you know, kind of shame about taking medicines for migraine headaches, right? And and again, it's just this somehow that these have been thought of as this separate category. But, you know, like you said, I don't know. There are some people with high cholesterol and and high blood pressure that can do diet and exercise and it works. I hope people don't feel shame if they have, if it doesn't, that doesn't do it alone and they need blood pressure medicine or cholesterol medicine. And so, you know, I think, I think again, I think, you know, I I just to me this, I don't look at these as any different than any other medical disorder. And I think when you do, then you start kind of thinking about medicine differently. But again, and and that doesn't mean again, it's, you know, you know, part of also, you know, I think part of the problem is it's good, it's a lot of people can do therapy alone, but it's the responsibility of a therapist or anybody you go see for OCD to tell you what the full treatments are, right? So to let you know, and vice versa, right? This happens in medicine all the time. Most psychiatrists don't even know what exposure therapy is. You can say you have OCD and if they they'll give you an SSRI and they'll never tell you that. Well, it's both on both sides. It's your responsibility to give informed consent, which is what you want, what the treatments are, what the what the downsides are. And I think that's you know, really important and not to put your own stuff into that when you're treating a patient.

SPEAKER_00 57:57

That is really important. If someone listening right now feels hopeless because medications haven't worked for them, what is something that you would like for them to hear?

SPEAKER_04 58:06

So I think that most people who medications haven't worked for, they're often just haven't been given the kind of, you know, type of medication treatment that can help. You know, most people that come to me, I rarely see people that, you know, have never been on meds before. I do occasionally. Most of the cases I see are people that have been on multiple meds, they haven't worked. And usually, you know, we can do something to get them better. So I think, and that's and that is where you want to maybe go see a specialist, right? That, you know, you get to a point, generalist is fine for things. But when it gets to a level that goes beyond that, that's the point you might want to find somebody that really does OCD, you know, work full time.

SPEAKER_01 58:49

Well, Dr. Stephen Poskar of OCD NYC, thank you so much for putting up with our foolishness for an hour and uh humoring us, you know, even with our crazy questions.

SPEAKER_00 59:00

Yeah, that was really good.

SPEAKER_04 59:02

It's been a pleasure, and thank you guys so much for doing this cast. I mean, it's a huge thing for people to know they're not alone and to see people that are smart and funny and have great, you know, full lives um, despite their their OCDs. So thanks so much for doing this.

SPEAKER_00 59:17

We'll see you in Seattle.

SPEAKER_04 59:18

See you in Seattle.

SPEAKER_00 59:23

I'm in the thick of this move, which by the way, you guys listening, if you've been following along this journey, we made a decision. My family is moving to Kansas City from Southern California. And to to say I am facing the most uncertain time of my life uh would be an understatement because we are blowing up our life as we know it in a good way and restarting. So we're gonna pivot and lean into to some other opportunities out there and be with our family and have that support and raise our kids with my in-laws and cousins and uncles and all the things. So we're very excited. Now that the decision fatigue is over and we can lean into that decision confidently, I'm feeling really good about it.

SPEAKER_01 1:00:08

And for people who've been following along, Alicia and Spence had been looking for houses in the area in Southern California where they are, and it was just insane. It was like a million dollars for a shithole.

SPEAKER_00 1:00:22

1.2 million will get you nothing out here. And at some point you have to just say, okay, like I'm done with the rat race. There's a lot of things I love about where we live, and there's a lot of things I'm really excited to not experience anymore. So yeah, it's wild though. I've been in I've been in LA, I've been in Hermosa for 13 years, in California for over 20. So my god. I don't even own a I don't know how to function in the in the cold. It's wild. Um but there's so many things to look forward to. So I'm just focusing on the positive and trying not to worry because we all know where that gets us. Um if I said that there wasn't a lot of those popping up. Um, I think I shared before that you can't you can't play God. You just have to make the decision and go with it and not think about worst case scenario. So that's what I'm doing.

SPEAKER_01 1:01:21

Yeah, your fear is that in making this decision, you have now somehow set in motion a chain of events that will lead to the death of one of your children, for instance. That like because you're moving to Kansas. Oh, so now I have to say it, and you need to sit with the distress.

SPEAKER_00 1:01:45

You know how I want to reframe that is if I stay in California, then maybe something would happen. I'm I'm leaving because I'm up, you know. We don't know. We don't know. And I'm gonna be okay with that because that is life, and life is full of uncertainty and change. And so there we have it.

SPEAKER_01 1:02:04

Thanks for listening to another episode of the OCD Confessional. Be sure to follow the show so you get new episodes. You can subscribe to us on YouTube or find us on Instagram and TikTok at the OCD Confessional.