Question: I started CBT 3 weeks ago to work on my OCD hoarding and cluttering. I was not put on any medications at this time because the intern felt that a SSRI won’t help with the hoarding and cluttering. I was told to try CBT first. Should I just wait and see, or should I press the medication issue?
Answer 1: Wait and see. There is pretty good evidence SSRIs are not as effective for hoarding as for other OCD symptoms. If a good and sustained effort at CBT does not produce some benefits (allow at least 6 months to see significant progress), then consider adding medication. CBT should include efforts to stop or reduce acquiring of new items (however you usually do this — buying, free things, etc.), gradual discarding of hoarded items starting with easier ones and working toward harder items, deliberate organizing of possessions you decide to keep, work on dysfunctional beliefs associated with hoarding (needing to have more than one copy/item, objects representing memory aids, excessive attachment to possessions as representations of one’s identity or life experience, beliefs about being wasteful, etc.). Good luck. Continued near the bottom of this page.
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Answer 2: In my experience, hoarding itself does not respond at all to medications. However, for some reason, people who hoard often get depressed and the medications will help with the depression.