What follows is the course of treatment that was recommended for me by trained professionals. In no way am I able to suggest these treatments for anyone else; only your own medical providers can recommend the appropriate treatment for you.

• Christian counseling: I have worked with a number of counselors over the years, but my first counselor accompanied me into the darkness of my pain and fear. I will never forget the first thing she had me do for "homework" after our history-taking session. She asked me to sit on the floorin a corner at home, my back up against a wall on each side, to pull up my knees, and either hug a doll or my little dog, and to concentrate on feeling safe (as though the walls gave me a sense of being protected).

I learned in the corner what a feeling of safety felt like, quite different from the almost unbearable level of anxiety that I lived with constantly. When my OCD was particularly bad, I was instructed to try to break up the loop of obsessing and immediately going to a ritual, bytrying to sit down (and yes, I did often get in that corner) and try to feel "safe" for a short time,and then I could wash my hands, one time. The goal in OCD treatment is not to escape the anxiety, but to learn to be okay with the anxious feelings, to know that the anxiety WILL dissipate, you will not die--even though it feels like it--if you don't do the rituals. Initially, even delaying the ritual byone minute upon having that anxious thought is a start. This philosophy is known as "exposure and response prevention."

Yes, I still have some anxiety every day regarding stains I cannot identify, using public restrooms, having to pick things up from the floor and using them normally, etc., but though I am not happy about it, I can manage the anxiety, and I continue to practice this daily when I must face triggers. Sometimes I do have to go wash my hands, but I can delay it and do whatever is necessary in my life, until there is an appropriate time to leave my desk at work, for instance. Once a friend was helping me administer subcutaneous fluids to my dog who was in kidney failure and she accidentally pricked herself with the IV needle. I was able to get a Band-Aid for my friend and show her where to wash the cut and be sure she was okay, before washing my own hands. On another recent occasion, I noticed a red stain on my shopping cart at the grocery store behind my bag of apples. I bought the apples anyway and though I thought of carefully removing the apples from the bag so as not to potentially contaminate the refrigerator and then thoroughly washing my hands, I just quickly looked at the bag, saw no red stains that had transferred to the bag, and put the bag in the refrigerator normally. I later removed some of the apples tearing open the plastic of that bag, just rinsing them as I normally would, and made an apple cobbler. Of course I had some anxiety, but the cobbler was delicious and I shared it with a friend. We are both alive and well.

Thankfully, my OCD symptoms are manifested primarily in cleanliness obsessions and rituals and I do not have difficulty with checking or hoarding, but I have learned over the years that I do have some obsessive thinking particularly around topics that are very close to my heart such as significant relationships and when I make mistakes (I have a tough time forgiving myself and dealing with false guilt/shame (this is the thinking not that I did a bad thing, but that I am a bad person).  A good verse to remind myself of the truth is Romans 8:1 (NKJV) "There is therefore now no condemnation to those who are in Christ Jesus..."

I am learning that the best way to work on this obsessive thinking is to work on replacing the tapes of lies in my head (those that believe things are either black or white, those that catastrophize situations, those that tell me how worthless I am or that I'm not good enough) with the truth, that I am a precious child of God, uniquely gifted and with a purpose, and that the Lord is my righteousness.

Jeremiah 33:16 (NKJV) "In those days Judah will be saved, And Jerusalem will dwell safely. And this is the name by which she will be called: THE LORD OUR RIGHTEOUSNESS.'" 2 Corinthians 5:21 (NKJV) "For He made Him who knew no sin to be sin for us, that we might become the righteousness of God in Him."

I love the New Living Translation's version of Romans 12:2 "Don't copy the behavior and customs of the world, but let God transform you into a new person by changing the way you think. Then you will know what God wants you to do, and you will know how good and pleasing and perfect His will really is."

I have done some inner child work with counselors trying to look at sources of anxiety, my role in my family, boundary issues, fears, lack of self esteem, and learning to see shades of gray and not just black or white. Counselors continue to help me to identify areas where my thinking is faulty and when I am obsessing needlessly (usually over things that are out of my control) which helps me lower my anxiety over day-to-day situations.

When your stress/anxiety level is high, your OCD symptoms are much more easily triggered and more difficult to manage, so learning to look objectively at my thinking is very, very helpful. Proverbs 23:7 "For as he thinketh in his heart, so is he..." I have also done a lot of work on problem solving and breaking up tasks into smaller, manageable pieces; this is a tremendously helpful technique for handling the feelings that tasks are overwhelming, feelings which often accompany depression.

I have found that fighting the anxiety, setting my face like stone to battle the OCD, to work to the point of exhaustion to try to alleviate the anxiety or to so avoid anxiety-provoking situations that I miss out on life, is not the solution. Instead, I am trying to fill my mind with truth and rejecting the lies.  Philippians 4:6-9 says (NKJV) "Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let your requests be made known to God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus.

Finally, brethren, whatever things are true, whatever things are noble, whatever things are just, whatever things are pure, whatever things are lovely, whatever things are of good report, if there is any virtue and if there is anything praiseworthy--meditate on these things. The things which you learned and received and heard and saw in me, these do, and the God of peace will be with you. "

I am still a beginner in this, but I do believe God CAN transform your thinking if you wash it with the Word by studying scripture, daily talking and listening to God in prayer, writing down and keeping with you verses that tell you the truth, listening to music that is uplifting and truth-giving, surrounding yourself with encouraging support people and friends, and doing low-stress things in your life that are fulfilling, joyful, and that give of yourself. I think it is important to remember also, that while there are things we can do in our own mind and body (e.g. relaxation techniques when anxious, exposure and response prevention, switching your mind actively away from the anxiety trigger and onto the task at hand as though you are not anxious), God is the one who heals, and it is usually a lengthy growing process. I have been told that reading every self-help book out there is not as important as sitting with our Lord (remember Mary and Martha? (see below)), resting in His presence (Psalm 46:10 "Be still and know that I am God."), seeking His peace and His truth, and letting Him carry the burden of fear and lack of control (I Peter 5:7 "Cast all your anxiety on him because He cares for you." NIV), and I think this is true.

Luke 10:38-42 (NKJV) Now it happened as they went that He entered a certain village; and a certain woman named Martha welcomed Him into her house.  And she had a sister called Mary, who also sat at Jesus' feet and heard His word.  But Martha was distracted with much serving, and she approached Him and said, "Lord, do You not care that my sister has left me to serve alone? Therefore tell her to help me." And Jesus answered and said to her, "Martha, Martha, you are worried and troubled about many things. But one thing is needed, and Mary has chosen that good part, which will not be taken away from her." (italics mine)

Do not be so hard on yourself; it is a process, and let Him help you. You will not remain as you are is perhaps one of the most encouraging things ever told to me. Phillipians 1:6 (NIV) ends this way "...he who began a good work in you will carry it on to completion until the day of Christ Jesus."

• Art therapy  This was tremendously helpful to me and I highly recommend Christian Art Therapy. My therapist helped me unearth some feelings, family dynamics, and fears that were revelations to me. Upon doing artwork I could see in front of me, I was able to look objectively at some things and have truth clarified. If art is a creative outlet for you, I would highly recommend looking to see if this is offered in your area.

• Medication.  I was terrified to go on medication. My first experience was with Paxil which an Urgent Care physician suggested I try. Unfortunately, I was allergic to it and was very dizzy which certainly did not encourage me to try other medications. But, finally, at my counselors insistence that I talk to a psychiatrist, I accepted prescriptions for Mellaril, Anafranil, and Prozac upon receiving my diagnoses. The doctor suggested Klonopin, but I would absolutely not consider a medicine to which I might become addicted, so he prescribed the Mellaril. If I had known that I would gain 40 pounds in 30 days on the MellarilI would have taken the Klonopin. In my case, I had visible tremors due to anxiety, and I had to take more Mellaril to reduce the tremors. Klonopin helps with my tremors much more effectively and I only notice them now if I am very anxious about something (e.g. job interview, new situation out of my comfort zone). All psychotropic medicines have side effects which are different for everyone based on your own biochemistry. Fortunately the only side effects I dealt with from Anafranil were sleepiness (I took it before bed), a dry mouth (I used a special toothpaste to reduce decay), and constipation (raisins every day worked well for me). When I was taking 250 mg of Anafranil a day (I no longer take any Anafranil now 3/30/09), my doctor did check my liver function tests to be sure my body was processing the drug without any ill effects.

The Klonopin (clonazepam) beautifully takes the edge off of the anxiety so that you can deal with exposure and response prevention. Because it is maintained in your bloodstream consistently, you are always prepared for whatever trigger may arise. My only side effects with this medicine were sleepiness and my equilibrium/balance reactions have been affected. I had adequate balance for walking, running, etc, on Klonopin, but it was very difficult to stand on one foot very long or walk a straight line heel to toe. I had been told that my balance reactions would return to normal when I no longer needed this medicine. (5/30/2009, I have stopped the Klonopin completely . My balance reactions are back to normal).

I took Prozac for 6 years, and thinking my libido was disappearing (actually that problem was entirely due to the reasons I was eventually rescued from my marriage), I asked to change to Zoloft with which you can safely take a weekend drug holiday, per my psychiatrist. I have not noticed any difference in the OCD or depression between these two medicines, but I have less sleepiness on the Zoloft. The SSRIs helped me so much with the psychomotor slowing, inability to concentrate (I could not even read!!), and the flat affect that are often present with major depression. Most people who work with me now do not realize I even have depression or OCD. I took one 100-mg tablet of Zoloft in the morning for years.  In 2011 I gradually weaned off of the Zoloft until I was taking half of a 1/4 of the 100 mg tablet.  I have been off of all medication except my medicine for my hypothyroidism and vitamins for a year now.  I still have times when I feel down and I wonder if I am heading back to depression, but I am monitoring this and my life is still fully functional.  If I ever think I am heading back down the depression road or the anxiety becomes overwhelming again, I will not hestitate to go back on medication and call my counselor.  I am amazed, and so grateful to God, though, that I have learned how to manage my symptoms with just cognitive retraining. 

Lack of energy has been a real struggle for me since the depression hit. Wellbutrin SR (for some reason XL does not work as well for me) has been a lifesaver for jump-starting my energy. This is the medicine I am most wary about coming off of when the time comes to try. I still take one 150-mg sustained-release tablet. I also had my thyroid functioning tested and found out I was slightly hypothyroid so I also take Cytomel (its an older drug than Synthroid, but because it puts me in a perfect therapeutic window and I don't want to go through all of the blood tests required to find the right dose of a newer drug, I just pay a little extra for my copay for this medicine--it is now available in a generic (5/30/09).  I was able to stop taking this in 2010.

• Fun things, getting out with people  It is absolutely essential when working on recovery from OCD and depression to enjoy hobbies and get out with people doing fun things. It is so easy to spiral down into the depths of despair when you are alone and in pain. Even going for a walk in a park by yourself or in a mall is better than sitting at home. Pets are very helpful with the loneliness; I honestly dont know what I would have done without my dog and later a cat also. I took up gardening, did some sewing, painted, joined support groups, spent a lot of time with family on the phone, and was involved with church activities. As tempting as it is to isolate and hibernate under the covers for days at a time, getting up only to go to the bathroom and eat, keep yourself on a schedule, get into sunshine often, get exercise, spend time with good people.

A note on relationships, if you are single as many who are diagnosed in their early twenties are, please be very careful about dating relationships. You are very vulnerable, and the pain may lessen significantly if you feel loved in a relationship, but I regret marrying the man I did because I settled. I was sure no one else would have me, as sick as I was, and after all, the whole world was married (black and white thinking). I chose to ignore the red flags I saw when we were dating, and I ended up in a very controlling, emotionally-abusive relationship. God has blessed me in SO many ways as I have gone through divorce recovery, but I don't want you to have to go through similar suffering that is not necessary.  While I am still concerned that I will never find someone who will love me as I am with my residual symptoms, I am becoming more comfortable with myself and know that should the right man appear who loves God and is head-over-heels for me, that I will make a good wife and have not ruled out motherhood.

• Partial-Hospitalization Day Treatment Program  In 1994, this was the best option for me to have some group therapy, some nursing monitoring to help me feel comfortable on medication, and to work on some exposure and response prevention. This was very difficult for me because I was not having trouble with addictions and did not have bizarre psychological problems as some of the participants did, which were frankly, quite scary for me. However, I learned from my fellow participants and not only gained some wisdom about dealing with mental illness and being on medication, but I also gained much more compassion and understanding of those who suffered with an illness affecting the mind.

• Rapha Day Treatment Program  Shortly after my marriage, my depression began to worsen (I wonder if I realized what I had done subconsciously). I cannot recommend this program enough. I attended the Day Treatment Program and stayed at a hotel. The groups, studying and applying the book The Search for Significance by Robert S. McGee, and the medical management was excellent. This program put me back on the path to recovery and helped me for the first time to begin to associate my illness with the lack of truth in my mind and heart. I highly recommend you work through the book and workbook. I really need to study it again. The medallion I received at the end of the program summarizes the truths I pray God will fully harvest in my heart:

Because of Christs redemption, I am a new creation of infinite worth. I am deeply loved, I am completely forgiven, I am fully pleasing, I am totally accepted by God. I am absolutely complete in Christ.