How Medication & ERP Help Manage OCD: A Chat with Dr. Aaron Reichlin
In today's episode, I had a fascinating chat with Dr. Aaron Reichlin, a seasoned psychiatrist based in Chicago, who prescribes medications for OCD. Dr. Reichlin shared invaluable insights into the appropriate medications for OCD and severe anxiety, including the roles of SSRIs and benzodiazepines.
We discussed the critical importance of exposure response prevention (ERP) therapy combined with medication management. He also introduced his innovative AI-driven mental health tech company, PsychNow, which aids in efficient patient screening and care. Plus, we covered common patient concerns about medication and the necessity of empathy and connection in treatment. Stay tuned until the end to learn how you can connect with Dr. Reichlin and discover more about cutting-edge OCD treatments!
00:00 Introduction and Guest Introduction
01:52 Dr. Reichlin's Background and Current Work
02:29 Innovative Mental Health Tech: Psych Now
04:47 Challenges in Mental Health Screening and Intake
05:58 Medication Management for OCD
08:50 Exposure Response Prevention (ERP) Therapy
11:55 Combining Medication and Therapy for OCD
17:28 Addressing Patient Concerns and Side Effects
30:15 Closing Thoughts and Contact Information
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Erin: [00:00:00] Hi, and welcome to today's episode where I'm gonna be chatting with Dr. Arron Reichlin, who is a psychiatrist. And this is a special episode because if you've been curious about medications or how medications work with OCD, what are the correct ones or the ones that just aren't a good fit? If you're struggling with severe forms of anxiety, worry, control.
[00:01:00] This was a really cool conversation because we got to talk about the different approaches and how to help someone who is dealing with a lot of intense emotions and how We can help you move forward in getting the help you need.
Thank you, Dr. Reikland so much for being here. So happy to chat with you.
Aaron Reichlin: This is great. It's nice chatting with you too, Erin.
[00:02:00] Erin: Yes. And we connected over LinkedIn. I don't know how long we've been a connection on LinkedIn, but I mean, you're a psychiatrist in the field and you're, you've got a lot of things that you're working on and doing.
Do you care to share a little bit about your background and who you are?
Aaron Reichlin: Sure. Well, I'm based in Chicago. I've been a psychiatrist for about, well, I mean, over 20 years. If you count my training. I trained at Northwestern, where I finished my chief residency year in 2006 or so.
And so I've been in private practice, at least part time. For a long time. And recently I've been, in addition to having a private practice, a private psychiatric practice, which is, you know, both a medication management and psychotherapy practice, I'm also working on and running a small software company, a mental health tech company called psych now.
[00:03:00]And what we're doing with that is we're an, AI application that, Kind of helps anyone in the mental health field, whether you're a counselor, social worker, psychologists, psychiatrists, small business perform and do screening intake and ongoing care in a much smarter fashion. And so we're very excited about what we're doing there.
Erin: Yes, I'm sure. Well, and that's really neat how you've branched out to do other tech and AI tools, because I mean, that's. Kind of the way of the future, and it's probably a huge help to all the practitioners.
Aaron Reichlin: Well, it's really, as a clinician, I think, as a clinician co founder, I think it's really important to have clinicians doing work in this field because It's important to have the clinician voices you know, understood and heard and translated into products that matter to us, right? As clinicians. So, that's what I'm really striving to bring to market and to bring to life on behalf of everybody and all the patients and clients that we take care of.
[00:04:00] Erin: Yes. So I'm super curious, how does the like consultation screening work with the site now platform?
Aaron Reichlin: I'm the first user of this platform and we'll have more users by the end of this year as our product gets kind of more widespread. But what this does is it allows me to kind of gather the patient's story and present it back to me as the clinician. in a way that's both clinically nuanced, , and really high quality, and do it all faster. And even in my case, in a more cost efficient way for potential patients that I take care of. So it's allowed me to reach a whole lot more patients. , and it's allowed me to be able to treat more patients too without losing a beat on quality.
Erin: Awesome. Well, that sounds great. And I'm sure that's especially helpful as a psychiatrist.
Aaron Reichlin: It's very helpful. I think for anybody that needs to, you know, screening and intake in particular is a very cumbersome process.
[00:05:00] Aaron Reichlin: I'm calling people, you know, checking to see if they're a good fit for your practice or getting them to the right person. Otherwise. It's time consuming, most of which is not even reimbursable, right? Totally. Even if you're in the network. So we've devised just a total front end to end, , you know, system that will help anybody, you know, kind of both evaluate. With terrific nuance and, graduate those individuals to a consultation to complete that process.
Erin: Wow.
Aaron Reichlin: And really the most efficient way possible.
Erin: Well, that's excellent because like, you know, as a private practice owner, I've got my website and I try to market specifically to my ideal client.
And even then I'll get people's questions. You know, who squeak in and schedule a consult. And I'm like, Oh goodness, like , we're not a match. And so now we've just kind of wasted both our times. So, love that you have created this tool. And I think this is something very much needed for, The mental health field.
[00:06:00] But anyway, let's get to it, while we're here today, I reached out with a question about, , you know, a lot of med management stuff because I'm running into at least one person who had some concerns about taking medication for OCD. So I really appreciate your insight and expertise. And so, and kind of, getting started, Aaron, I'm curious about your experience just in general, whenever you have done medication for folks who are struggling with OCD.
Aaron Reichlin: Well, I certainly treat a lot of people, , with lots of different kinds of anxiety disorders OCD being one, one of those. , and you know, what we know in terms of the evidence base is that, , certain kinds of therapies and certain kinds of medications actually have good evidence for, , managing OCD. And some have less, , more counterintuitively sort of problematic in kind of working with patients who have OCD long term.
[00:07:00] So we routinely use different kinds of antidepressants, even newer and older agents in combination to sometimes help control OCD. Obsessions and compulsions for some individuals in it, of course, as you know, can be very disabling. But one of the hallmarks of treatment for OCD is, exposure response Kinds of therapies and other, you know, which is so ERT obviously very central for, managing patients, clients with OCD and medication management can be helpful alongside that.
Aaron Reichlin: But sometimes. The medicines that one would think would be the most useful like, anxiety medications, anxiolytics, like benzodiazepines, Xanax, Klonopin, Ativan, while they are good for absolute emergencies, sometimes are counterintuitive and not necessarily good for patients with OCD, right? Right, right.
[00:08:00] Erin: So many good points because you're highlighting how there are You got to find that sweet spot with the medication, not only are you finding the right, like, let's say Zoloft or Prozac or, you know, something along those lines, but you're also taking note that the Xanax and the Klonopin are a not so good mixture for an OCD sufferer.
Aaron Reichlin: You know, we do use medicines like this for people who have OCD. severe bouts of anxiety, usually when they're not with me or not during a session. But we don't generally like to use those long term for people with OCD. We like to get them into kinds of treatments that will actually help to eradicate or work through the symptoms usually like with ERT, right?
Erin: Right. Yes. And thank you for bringing up the ERP emphasis because, you know, in my work, I mean, that's the bread and butter. That's what I do day in, day out.
[00:09:00] Now, I am incorporating another theory, which is, Fairly new to Americans, like the inference based cognitive behavioral therapy. But anyhow, with the ERP, it is so effective in helping patients. And I explain it to them, like we're dipping our toes in the water and gradually getting used to, you know, a cold pool, say, for example. So, Erin, in, you know, just out of curiosity, like when you have referred patients to ERP treatment, do they even tell you that they feel scared or hesitant? They don't want to do it.
They're nervous.
Aaron Reichlin: Oh, yeah, I mean, and by the way, I apologize. I ERP, ERT, I kind of use them sort of in my head in the same kind of terminology, but ERP is like a, you know, another abbreviation for the same thing. Exposure response therapy, exposure response, preventative prevention.
[00:10:00] The but the answer to your question is I mean, this is a lot like if you have a knee surgery, right.
And you have your ACL repaired and you put it in a brace. The goal is not to walk around with the brace forever, right? The goal is to take the brace off. And do the exercises in physical therapy that hurt like hell, but then it stops, stops hurting, right? To some degree, right? So it's not like you want to get rid of the brace. All the time, but you certainly want to get rid of the brace in the moment or in the session in which you're going to work on strengthening the muscles that will make it hurt no more, right, or no longer. So, I think that's a good way to understand how exposure response treatment works, right? And you know, why, You have to find the sweet spot with the, with medications.
[00:11:00] The goal of medicines in my view is to be on as minimal of medication as possible to raise the floor and make the challenge, whatever it is, the session. Or the treatment at hand, just tolerable enough, right? So that you can do the work.
Erin: Absolutely. Yeah. I love that example about physical therapy because that's so true. I mean, people accept physical therapy when they have hip surgery, knee surgery, you name it, like they know that's coming and that it's going to be painful, but they'll still do it. Cause they know ultimately they're going to get better. I love this example. And that's so true for OCD treatment. Like it's going to be tough at first, but they can come out feeling stronger on the other side.
So that's awesome. I love that you share, I'm sure you share that example with your patients because it's so important that they get the right kind of treatment.
Aaron Reichlin: I have shared that example before. It's also hard because sometimes people have more than one anxiety disorder.
[00:12:00] They actually may have more than one. And so while for OCD. Benzodiazepines are really not the mainstay of treatment.
Aaron Reichlin: Sometimes having some benzodiazepines for somebody that has like a panic attack or panic disorder, it can be more useful. Fortunately, the same underlying, you know, methodologies and medication management work for both of these disorders, but it's good in terms of antidepressants, SRIs. And even other types of antidepressants. They tend to work for both of these disorders, but it's good to recognize and understand that people can have more than one anxiety disorder, right, at the same time.
Erin: Valid. [00:13:00] So, how do you explain to your patients, let's say they are concerned that they can't take their Xanax or they can't take their Klonopin, how do you explain to them that those medications are like counterproductive or they're not helpful?
Aaron Reichlin: Well, I'll kind of give them the example we just talked about with you know, physical therapy after a surgery. That, you know, some movement and rehabilitation is expected to hurt a little bit, right? But kind of working through that in a safe manner and let them know that, you know, I'm supporting them and watching and I'm going to make sure that the experience they have is going to not be intolerable.
It'll be, you know, something that can be managed. That's kind of how I talk to patients.
Erin: Okay. Great. So you're giving them comfort and reassurance to an extent that they're not going to be doing anything that they can't tolerate. You're going to be there to monitor them.
Aaron Reichlin: Correct. Correct. And everything will be made sure to be safe and, you know, within their grasp and within their ability to manage.
Erin: [00:15:00] Right, so I'm super thankful to have you on the show today because I encountered a psychiatrist who told their patient that Exposure response prevention would be quote unquote too intense and that they shouldn't do it So I feel like there's a little bit of education that needs to go out To even, I guess, other psychiatrists out there, so how would you respond to say a colleague who was a fellow psychiatrist and said, Oh, you know, ERP or ERT is too intense?
Aaron Reichlin: I think that, you know, people may have sort of varying capacities, both as clinicians and as clients, right? So it's sort of manage, you know, and the art of finding the appropriate level, right, of what's needed is an art that relies both on the clinician and the clinician's ability to sort of, you know, assess the situation with a particular client or patient. So I, I'm of the belief that. That can always be dialed, right?
[00:16:00] And adjust it. And so, I think it's more you know, maybe that better is needed for both you know, both providers, clinicians, multidisciplinary clinicians and teams and clients and patients that, you know, we all have to sort of remind each other how this works. It really, I think, comes down to the clinician and making sure to, you know, help clients, patients, and collaborating providers, right, to understand one's orientation and background.
Erin: Right. So true, because obviously the exposure response prevention could be too intense if the provider was not attuned to their patient, if they were not paying attention to the signals, if they were not making the hierarchy. Basically, there'd be a lot of things going wrong you know, for that to happen and for it to feel too intense for the patient because that's right.
Yeah. Bottom line. I mean, any medical care provider is to do no harm.
Aaron Reichlin: That's right.
Erin: Yeah.
Aaron Reichlin: [00:17:00] But it gets confusing. I think sometimes when people understand that a procedure might be somewhat painful, but that doesn't mean that's not the right procedure. Right. And that's, you know, That's a good thing to recall. I mean other kinds of talking therapies can be painful too, right? It's not just it's not just ERP.
Yeah, that doesn't mean that talking therapy is the wrong thing to do either, right? So yeah, it's just good to remember that.
Erin: Yes. So, now I kind of think about medications, you know, a lot of times people, I'm sure they want a quick fix.
They want to feel better right now. What is kind of the timeframe in general when you're prescribing, you know, we'll say SSRIs? What's the general timeframe for someone to expect to start to feel better, to start to see results? What's that look like?
Aaron Reichlin: Well, you know, it's hard. We have lots of information that lots [00:18:00] of data that, that says how and when and why someone might respond to a certain medication is certainly multifactorial.
Aaron Reichlin: We you know, It's not one size fits all when it comes to not only medications for an individual, but it's so nuanced that the same individual could have the same medication prescribed by 10 different doctors, if this were theoretically possible and have different responses to that very same medication, because part of it is beyond just biologic, right?
Part of it has to do with. How and who that medication is being dispensed from, right? And so, what's said along with it, the trust the therapeutic connection, the alliance matters a lot. Right. And this is backed by research as well.
Erin: Yes. I mean, it's true in therapy as well.
Aaron Reichlin: Right. So in therapy too same principle. But it
[00:19:00] means that patients have to, you know, you have to work to feel like they can trust and be understood by their patients. By the clinician that's working with them, whether they're a psychiatrist, a psychotherapist or whatever their background actually doesn't even matter. So with that said it can often take.
Usually by the end of the second week or into the third week of taking a medication to start noticing even the beginnings of the symptom, but I have had beginnings of symptom abatement of one source or another, but I've certainly worked with, you know, A lot of patients over many years where it takes longer, multiple medication trials and combinations that include things that are beyond just an antidepressant, right? And that's fairly common for me as a subspecialist to sort of work with people that need more than one agent and more than
[00:20:00] one kind of two to three week period to kind of, You know, get things adjusted properly,
Erin: right? Yeah, and so I kind of think about it like finding the right cocktail, but how do you phrase it? Whenever you're trying to find that sweet spot with the medications?
Aaron Reichlin: I think you know, we have some new tools that are at our disposal. In the last several years where we can do some genetic testing to kind of get a little bit of a better pointer to what kinds of medicines will or might work for certain individuals or how we would at least expect.
Those individuals to metabolize or respond to certain kinds of medicines They don't tell us exactly what will work right, but they can guide us a bit So in finding that cocktail, you know we've gotten we have some ways that we can kind of make that a little bit more efficient.
[00:21:00] But in truth, I think the problem Predictor of finding the right cocktail is about establishing an empathic and trusting connection. And in today's day and age, it's very hard to do this because it takes time to do so. Right? And you have to really get the backstory and understand someone and then demonstrate that you understand and then know what to do about it. Right. And so that process is really what I think has been damaged the most in our current environment in, you know, our field and more broadly as time has gotten very short the time that we can spend with people.
So that's, by the way, partly what I've been working on trying to solve with the software. It's like now I use it to kind of get hours and hours worth of material. Faster and assemble that in a way that helps people help. It helps them understand that I understand them even after just very short periods of time.
Erin: [00:22:00] Yes, so that you can validate them and empathize with them and connect, ultimately connect because that connection is honestly the key ingredient for their success.
Aaron Reichlin: If you make a cocktail that doesn't have a connection in it, you've made a really bad bar drink, So nobody will want it.
Erin: Right. Well, and it's great that you're using these other tools like with the metabolism testing. And I've heard of some of those like gene sites. Is there a particular one you prefer? I don't know. Or do you just,
Aaron Reichlin: I mean, that's the 1 that I'll usually use gene site. I've used that 1 for many years. There are others though that are a little bit, that are also very good, but I just tend to use that one.
Erin: Yeah. And not a lot of patients know about the metabolic testing. They haven't even heard about it. And so it's really neat, at least, you know, on this [00:23:00] platform or even in a therapy session, just to let people know what resources are available.
Aaron Reichlin: It is cool. I mean, our tools are many and varied. But. Our best tools, I think, are tools that, you know, have to do with what it takes to, you know, help people feel, like, understand and that they can, you know, trust that you understand what to do about it, right? So, this, like, empathy and the time it takes to build a connection is really the most essential and important part. Of any clinician's tool set, right? And so, so that's really, I think, at the heart of it all. And this is some of the research that has been done around even medications and the importance of trust and connection in terms of their efficacy. By many other researchers in, in, in our field.
Erin: Yes. So we've got the metabolic testing that kind of gives you a [00:24:00] sense of direction on which medicines will metabolize or work with the patient's metabolism better. And then two, they may see some results around week two or three, but mostly again, it kind of depends on the therapeutic connection that you have with the patient.
So I'm curious, like here's what I run into honestly, time and time again, as with any anxiety or OCD condition, they want not only guarantees and specific answers, but they also run into this common experience of being afraid to take the medicine. Even though they're in this space of like, I know it's helpful for me, and I know it'll be good for me.
I just don't want to. There's like a sense of fear or uncertainty coming up. Have you ever experienced that?
Aaron Reichlin: Oh, I mean, I have seen this clinically.
Erin: Okay.
Aaron Reichlin: I've seen this clinic that the individuals [00:25:00] usually who want the greatest amount to change often have. fear. It manifests in one way or another. And I actually think that's part of the condition of certain anxiety syndromes and certain kinds of character constructs. And we see it a lot in in patients with OCD. We see it a lot in patients with, Also perfectionistic tendencies and unwillingness. Yeah. So I do see this a lot.
I think it's a great observation.
Erin: Right?
Aaron Reichlin: Yeah.
Erin: How do you help them move forward again?
Aaron Reichlin: I think it's really about almost beating them to the punch and wondering about, I mean, I will often say to people, I have a feeling that. You're here because you know that you need you're hoping I can help you a bit more than what you've been experiencing.
But at the same time, I wonder if you're afraid of things like medication. And so talking to them about it, I think is how you kind of begin to find [00:26:00] the inroads to working on this, you know, over time.
Aaron Reichlin: But that is part of the process, right. And part of what has to happen.
Erin: Right. And. I have run into this obsessive compulsive cycle so many times where they're afraid that if something good happens, then something bad is right around the corner.
Aaron Reichlin: And yes, in many instances, you have to remember, contextualize this. Many of these people, Are afraid to leave their house. If the, you know, the oven burner was left on, even though it's off, right? It's the same idea. Like, even if you can reassure yourself many times over that this is the case that you're not going to get anywhere like that.
Sometimes the work to do is actually. ERT, ERP, right? With the notion of taking the medication, right? And trying to sort of break it simultaneously with the [00:27:00] rest of the clinical approach.
Erin: Yes. Cause the other way that I have helped explain medication, like when someone's on the fence like that and they're like, Oh, I'm afraid to take it.
I don't know what's going to happen. And I don't know if it is. You know, ultimately, if it will help me or if it will have bad side effects, whatever, I will tell them like that. I view medicine as if you're in this situation, like you're drowning in the ocean and there's like all these big waves coming at you, but the medicine helps is like your life raft.
It helps you float. And that way you can catch your breath. And then the exposure response prevention is teaching you how to swim. So then you can come back to shore. And be safe and well and happy and like, whew, I survived. I made it.
Aaron Reichlin: Yeah you can think, I sometimes tell people that medicine helps you to.
Have a fair shot and a level playing field, right? You know, where you're playing in a, you know, like an unfair environment, right? [00:28:00] Beforehand, the goal of the medicine is not to alleviate all the symptoms. In fact, it almost never does. It's to raise the floor enough that you can take the step to do the, to do what will be hard, but not too hard.
Right. And that's the goal.
Erin: Now, just to maybe address any. Concern someone has, what are common side effects?
Aaron Reichlin: Well, it depends on the medication that one is sort of thinking about or trying, but assuming that we're talking about SRIs, which are the most commonly prescribed, most widely prescribed, because As you probably know, unfortunately, there's just not enough specialists to go around.
And we have primary care doctors doing a lot of the prescribing, which they're wonderful. I have many colleagues in primary care space, but most of them are most comfortable with SRIs, you know, as a primary medication. So you'll see most people taking SRIs. So those medicines are medicines like [00:29:00] Zoloft oftentimes other ones, Paxil, Lexapro Prozac, they all have similar side effects.
They can make some people have, you know, initially as they start a little bit of stomach upset, a little bit of you know, transient feelings of increased anxiety, even sometimes that then all generally abates that goes away.
Aaron Reichlin: The one side effect that I think people can have is some people can lose a couple pounds.
Some people can gain a couple pounds, but the particular side effect that. Does seem to affect some people more than if you were taking no medication is you may be More likely to experience sexual side effects,
Erin: right?
Aaron Reichlin: Fairly children either low libido or other sort of sexual issues it can be a little bit different for men and for women, but That is a heart, you know, not permanent side [00:30:00] effect that really only lasts once, as long as you're taking the medication, And goes away completely if you do have the side effect, goes away completely once you would stop the medication. And it tends to be dose dependent.
Erin: Okay. Yeah. Okay, well, we've covered a lot today, Dr. Reikland are there any closing thoughts or words of wisdom or things that we haven't touched on?
Aaron Reichlin: I mean, I think this is a great, you know, kind of, conversation about helping patients who I know suffer a lot from obsessive compulsive disorder.
And I really appreciate the work you're doing to kind of, you know, approach treating clients like this. It's very important important work. It's very common. And I think the stats are about two and a half to four percent of the population deals with OCD at some point. That's a lot of people, right? I mean, that's, you know, that's a lot of disease burden. But, you know, [00:31:00] I think it's, I think the main thing to remember is that in collaborative care with, you know, like a prescribing clinician, a psychiatrist, or a nurse practitioner, or a primary care doctor, and a therapist have to really collaborate closely.
And both of them, not just the therapist, both of them have to demonstrate empathic understanding of a client, of a patient, and you know, forge good connections. for change to occur and understanding where those roadblocks exist and, you know, where those things come up is really the art of good caring and good treatment.
And so, you know, I'm delighted to talk to you about this today and hopefully we can collaborate in the future on some clinical cases.
Erin: Sure, yes. Well, very much appreciate your time again, and thank you so much for just kind of clearing the air on medication management for OCD and [00:32:00] also acknowledging in your physical therapy example about how exposure and response prevention can be the treatment needed for the person to help them. Be well, because that may very well help someone else take that leap or take that next step of courage to get their form of happiness, their form of contentment and peace that they haven't had in so long because OCD has robbed them of that. So I really appreciate again, your time and your expertise and sharing all this with the listeners today.
Aaron Reichlin: It's my pleasure and anybody that might be in Illinois listening with these questions or issues. I'm happy to consult with you and you know, and then also, you know, share my findings with whomever you might be working with as a therapist and look forward helping whoever I can with this from a psychiatric perspective as well.
Erin: Yes, Okay. And how can people connect with you if they want to find out [00:33:00] more?
Aaron Reichlin: Sure. You can find me most easily by going to my private practice website, which is www.freudly.com, F R E U D L Y. com. And you can inquire there. Okay. And, you know, I've been Even though I'm out of network using my new software that I've created, I've actually brought the price down considerably to be able to care for more patients, more clients by doing expedited assessments that basically start immediately using our software.
And we're very excited to have that end to end solution in place by the end of this year, but I can take people now as well too.
Erin: Awesome. Okay. Thank you.
Aaron Reichlin: You're welcome.
Erin: What a great conversation it was with Dr. Reikland. If you'd like to learn more, you can follow him on LinkedIn. And I'll also have this interview available on my website at value driven therapy. com. And I look forward to having you back here next week, where I'm going to be talking about the difference between actual sexual attraction unwanted intrusive thoughts that could be related to OCD. So that's going to be an exciting episode. So come back for that one. [00:35:00]
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