You did the work. You found a therapist and sat through sessions that were genuinely hard. You took the medication for months and put up with the side effects.
And you are still checking. Still washing. Still stuck in the same loop at eleven at night, arguing with a thought that will not accept an answer.
Somewhere in there a quieter conclusion formed. It works for other people. So the problem must be me.
When someone tells us their OCD is not responding to treatment, the first useful move is almost never the next intervention. It is to look at what was tried, how it was delivered, and for how long. “It did not work” is a statement about what was tried, not about the person who tried it, and what was tried can still be changed.
If you are thinking about ending your life, or you are not sure you can keep yourself safe, get help now. Call or text 988 to reach the Suicide & Crisis Lifeline, free and available 24/7, or go to your nearest emergency room. Our office line is 817-659-7344. We are an outpatient practice, not a crisis service.
What “OCD not responding to treatment” usually turns out to mean
Partial response is the ordinary shape of OCD treatment, not a rare misfire.
Kathmann and colleagues reported in Psychotherapy and Psychosomatics in 2022 on 393 adults with OCD treated with exposure-based cognitive behavioral therapy in ordinary clinical care. Remission rates were 46.3% for everyone who entered treatment and 52% among those who completed it. Roughly half finished a solid course of the best-supported therapy without reaching remission.
Medication data look similar. The International OCD Foundation states that with any given trial of an SSRI, “about 40-60% of patients with OCD will have a clinically significant improvement.” Rodriguez and colleagues, in Neuropsychopharmacology in 2013, named the limits of first-line medication plainly: “incomplete symptom relief and 2-3 months lag time before clinically meaningful improvement.”
A 2017 JAMA review by Hirschtritt, Bloch and Mathews adds what most people never hear. OCD “is often missed in primary care settings and frequently undertreated.”
Was the therapy the right kind, delivered at real intensity?
The psychotherapy with the strongest evidence in OCD is exposure and response prevention, or ERP. The International OCD Foundation urges trying ERP or medication first, calling them “the types of treatment that have been shown through extensive research to be the most effective for treating OCD.” Exposure means deliberately confronting the thoughts, images, objects and situations that set off the anxiety. Response prevention means not performing the compulsion afterward.
A great deal of careful, well-meant talk therapy is not that. If your sessions were mostly about analyzing the content of the thoughts, or about being talked down when you were spiraling, you may not have had an inadequate response to ERP. You may not have had ERP.
Intensity matters too. There is no fixed session count that makes a course adequate, so the reference points are what the trials used: in the 2013 JAMA Psychiatry trial by Simpson and colleagues, ERP was “17 sessions delivered twice weekly.” That is a trial protocol, not a standard of care, but it is a fair reference point.
If you are not sure which you had, ask. The International OCD Foundation keeps a clinician directory and questions worth asking before you book, starting with what techniques the therapist uses for OCD.
Was the OCD being accommodated at home?
Family accommodation, as Lebowitz and colleagues defined it in Expert Review of Neurotherapeutics in 2012, means the ways family members “take part in the performance of rituals, avoidance of anxiety-provoking situations or modification of daily routines” to help a relative with OCD. Answering the same question for the ninth time. Doing the checking so a spouse can finally sleep.
Those authors found that accommodation “is common in OCD and is strongly and consistently correlated with OCD symptom severity,” and that levels of it are associated with how treatment goes. That research is correlational, and the people accommodating are usually trying to help. But if nobody asked what happens in your house at six in the morning, a real variable went unmeasured.
Did the medication trial run long enough?
OCD runs on a slower clock than depression does, and courses get abandoned early because of it.
The International OCD Foundation states that “an adequate trial of an SSRI for OCD requires eight to 12 weeks,” that progress “often occurs at a slow rate,” and that “further improvement can continue well beyond the 12-week mark.” The same source notes that OCD generally responds best to higher doses than are typical in depression and anxiety. What that means for your medication is a conversation with your prescriber, not something a web page should quantify. Do not adjust anything on your own, and never stop a psychiatric medication abruptly.
So the reassessment asks how long a medication ran, at what level, and whether the trial finished or stopped at week six because week six felt like enough. When a first-line medication is not enough by itself, the Foundation describes adding ERP, adding an adjunctive medication, or switching to a different primary medication.
Where does depression fit into this?
Depression commonly travels with OCD; the National Institute of Mental Health notes that co-occurring mood or anxiety disorders are common, without attaching a figure. The tempting conclusion is that depression is why the OCD treatment failed. Two good data sets say otherwise. A 2013 meta-analysis by Olatunji and colleagues in the Journal of Psychiatric Research, pooling 16 randomized trials and 756 patients, found that “neither higher pre-treatment OCD (p = 0.46) or depression symptom severity (p = 0.68) was significantly associated with a decrease in CBT effect size.” The 2022 Kathmann study found that comorbid depressive and anxiety disorders “showed no effects on symptom change.”
That does not make depression a footnote. It matters in its own right, for function, motivation and safety. A 2015 review of 48 studies by Angelakis and colleagues in Clinical Psychology Review found a significant association between OCD and suicidality, with severity of comorbid depressive symptoms and hopelessness among the predictors. That is why depression gets assessed in the same visit rather than later.
Where brain stimulation fits, and where it does not
Stimulation does not substitute for a course never adequately delivered.
In August 2018 the FDA granted De Novo classification to the Brainsway Deep Transcranial Magnetic Stimulation System for use, in the agency’s own words, “as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder.” That is a clearance, not an approval; devices are cleared and drugs are approved. “Adjunct” is the FDA’s own word, and participants in the pivotal trial stayed on their existing OCD medication or therapy throughout. It was the first TMS clearance for OCD and not the only one; the FDA device database lists several others.
In that trial, published by Carmi and colleagues in the American Journal of Psychiatry in 2019 with 99 patients across 11 sites, 38.1% of the active group met the response threshold at six weeks against 11.1% with sham. Most did not reach it, and all were already on stable treatment. The authors concluded that deep TMS “may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.”
Our TMS page describes the BrainsWay Deep TMS system and protocols we use. Whether stimulation belongs in your plan is a question for a full evaluation, not a web page.
What an OCD second opinion evaluation actually reviews
A reassessment is mostly careful history-taking. Expect questions about:
- Every medication tried, at what level, for how long, and why it stopped
- Whether the therapy was ERP specifically, how many sessions, and how often
- What you avoid, and who in your life helps you avoid it
- Mood, sleep, functioning and safety, assessed in their own right
- Whether the diagnosis still fits, including a missed bipolar disorder, which changes what is safe to prescribe
Our OCD service page covers how we work with adults in Fort Worth. We are self-pay, and current fees are on our price list.
Frequently asked questions
ERP did not work for my OCD. Does that mean nothing will?
Not by itself. The question is whether what you received was ERP as the research defines it, and whether it ran at real intensity. In the 2013 JAMA Psychiatry trial by Simpson and colleagues, ERP was 17 sessions delivered twice weekly. A short or discussion-based course has not answered the question.
How long should an OCD medication trial run before it counts as adequate?
The International OCD Foundation states that an adequate SSRI trial for OCD requires eight to 12 weeks, and that improvement can continue well beyond the 12-week mark. That is longer than many people get. What applies to you is your prescriber’s call, and you should not change anything on your own.
Is deep TMS for OCD approved by the FDA?
Not in those words. Devices are cleared, drugs are approved. In August 2018 the FDA granted De Novo classification to the Brainsway Deep Transcranial Magnetic Stimulation System as “an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder.” It was the first such clearance for OCD, not the only one, and an add-on, not a first step.
How do I find a therapist who actually does ERP?
Ask directly what techniques they use for OCD, and how much of a session goes to exposure and response prevention rather than discussing the content of the thoughts. The International OCD Foundation keeps a directory of clinicians who treat OCD and a list of questions worth asking first. Our part of the work is diagnostic clarity, the medication questions and next-tier options, alongside whoever is doing the ERP.
The bottom line
Partial response is the ordinary shape of OCD treatment, not evidence of a personal defect. Roughly half the adults in a large 2022 study of exposure-based therapy did not reach remission, and fewer than four in ten of the actively treated group in the deep TMS registration trial met the response threshold. Before anyone escalates, the last course deserves examination: was the therapy really ERP, delivered at intensity, was avoidance being accommodated at home, did the medication trial run its full eight to 12 weeks, and is depression being addressed on its own terms. Deep TMS is FDA-cleared as an adjunct for OCD, not a first step and not a replacement for treatment never fully given. No one can promise you an outcome in advance. What can be examined is whether the last course was ever truly tried.
Talk with us
If you are in Fort Worth or the surrounding North Texas area and what you have read here sounds familiar, we would be glad to talk it through with you. The Institute for Advanced Psychiatry is an outpatient practice at 6800 Harris Parkway, Suite 100, treating adults 18 and older. You can request an appointment or call 817-659-7344.
If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room.
Sources
- U.S. Food and Drug Administration. “De Novo Classification Order, DEN170078 – Brainsway Deep Transcranial Magnetic Stimulation System.” 2018. https://www.accessdata.fda.gov/cdrh_docs/pdf17/DEN170078.pdf
- U.S. Food and Drug Administration. “De Novo Summary (DEN170078).” 2018. https://www.accessdata.fda.gov/cdrh_docs/reviews/DEN170078.pdf
- U.S. Food and Drug Administration. “FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder.” 2018. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder
- U.S. Food and Drug Administration (openFDA). “510(k) premarket notification records for product code QCI.” 2026. https://api.fda.gov/device/510k.json?search=product_code:%22QCI%22&limit=100
- Carmi L, Tendler A, Bystritsky A, et al. “Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial.” American Journal of Psychiatry. 2019;176(11):931-938. https://pubmed.ncbi.nlm.nih.gov/31109199/
- International OCD Foundation. “OCD Treatment.” 2026. https://iocdf.org/about-ocd/ocd-treatment/
- International OCD Foundation. “Exposure and Response Prevention (ERP).” 2026. https://iocdf.org/about-ocd/ocd-treatment/erp/
- International OCD Foundation. “Medications for OCD.” 2026. https://iocdf.org/about-ocd/ocd-treatment/meds/
- International OCD Foundation. “How to Find the Right Therapist.” 2026. https://iocdf.org/ocd-finding-help/how-to-find-the-right-therapist/
- Hirschtritt ME, Bloch MH, Mathews CA. “Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment.” JAMA. 2017;317(13):1358-1367. https://pubmed.ncbi.nlm.nih.gov/28384832/
- Kathmann N, Jacobi T, Elsner B, Reuter B. “Effectiveness of Individual Cognitive-Behavioral Therapy and Predictors of Outcome in Adult Patients with Obsessive-Compulsive Disorder.” Psychotherapy and Psychosomatics. 2022. https://pubmed.ncbi.nlm.nih.gov/35034016/
- Simpson HB, Foa EB, Liebowitz MR, et al. “Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: a randomized clinical trial.” JAMA Psychiatry. 2013;70(11):1190-1199. https://pubmed.ncbi.nlm.nih.gov/24026523/
- Olatunji BO, Davis ML, Powers MB, Smits JA. “Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators.” Journal of Psychiatric Research. 2013. https://pubmed.ncbi.nlm.nih.gov/22999486/
- Angelakis I, Gooding P, Tarrier N, Panagioti M. “Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis.” Clinical Psychology Review. 2015. https://pubmed.ncbi.nlm.nih.gov/25875222/
- Lebowitz ER, Panza KE, Su J, Bloch MH. “Family accommodation in obsessive-compulsive disorder.” Expert Review of Neurotherapeutics. 2012. https://pubmed.ncbi.nlm.nih.gov/22288678/
- Rodriguez CI, Kegeles LS, Levinson A, et al. “Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept.” Neuropsychopharmacology. 2013. https://pubmed.ncbi.nlm.nih.gov/23783065/
- National Institute of Mental Health. “Obsessive-Compulsive Disorder (OCD).” 2026. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
Medical disclaimer
This article is for general education and is not medical advice, a diagnosis, or a treatment recommendation for any individual. Reading it does not create a physician-patient relationship. Treatment decisions, including whether any medication or procedure is appropriate for you, should be made with a qualified clinician who knows your history. Do not start, stop, or change a psychiatric medication without talking to your prescriber. If you are experiencing a medical or mental health emergency, call 911 or 988.