OCD and Depression: How They Interact and How They Are Treated Together
Around half of people with OCD will develop major depression at some point the two conditions feed each other, and treating them together, with safety monitoring built in, is the standard of care.
Senior Consultant Psychiatrist, Abhasa Rehab and Wellness
- Last Updated: 2026-06-24
- Published: 2026-06-24
- 12 min read
Key Takeaways
- Depression is the single most common co-occurring condition with OCD lifetime prevalence around 40–50%, current prevalence 25–30% in clinical samples[2][3].
- The two conditions interact in both directions. Untreated OCD often produces secondary depression. Untreated depression makes ERP much harder to engage.
- Sequencing matters. Severe depression is usually stabilised first if it is interfering with treatment engagement; otherwise, the two are treated in parallel.
- SSRIs at OCD doses treat both. Adequate trial duration and dose titration matter for both conditions.
- Suicide-risk monitoring is non-negotiable. People with OCD plus depression have higher suicide risk than either condition alone [4].
- Treatment is most effective when delivered by a team that understands both conditions, not just one.
- Lifetime co-occurrence of OCD and major depression is around 40–50% in community samples and 25–30% at presentation in tertiary clinical care. Pallanti et al. (2011), Frontiers in Psychiatry [2]
OCD with Depression (comorbid OCD-MDD)
Co-occurrence of Obsessive-Compulsive Disorder (ICD-10 F42; DSM-5-TR 300.3) with Major Depressive Disorder (ICD-10 F32-F33; DSM-5-TR 296.x). Lifetime co-occurrence is approximately 40–50% in community samples and 25–30% at presentation in tertiary clinical samples.
Standard care is integrated treatment of both conditions concurrently, usually one SSRI at OCD-effective dose covering both, plus depression-modified ERP. Suicide-risk monitoring is part of routine care.
OCD rarely arrives alone. Around half of people with Obsessive-Compulsive Disorder will develop major depression at some point in their lives, and many are living with both at the same time when they first meet a psychiatrist[2]. The two conditions share more than they appear to on the surface: overlapping brain circuits, overlapping family histories, and a tangled cause-and-effect that often runs in both directions.
This guide explains what OCD with co-occurring depression looks like clinically, how the two interact, why sequencing matters, what treatments work for both, and what the safety priorities are when depression is severe. It is written for patients, families, and the general practitioners and counsellors who often see this picture first.
Who This Guide Is For
This guide is written for:
- Adults with OCD who are also experiencing low mood, hopelessness, loss of interest, or thoughts of suicide.
- Family members are trying to understand why a loved one’s OCD seems to come with sadness, exhaustion, or withdrawal, and what to do.
- General practitioners, counsellors, and physicians in India often see depression first and only later identify the OCD beneath.
- Referring psychiatrists seeking a patient-friendly summary of the co-occurrence to share with families.
If you or your loved one are unsafe, please scroll up and call iCall (9152987821) or Tele-MANAS (1-800-91-4416). You will not be judged. Reach out to Abhasa Rehab and Wellness today at +91 73736 44444.
How Often Do OCD and Depression Co-Occur?
QUICK ANSWER
Major depression is the single most common co-occurring condition with OCD. According to research in Frontiers in Psychiatry (Pallanti et al., 2011) and Comprehensive Psychiatry (Quarantini et al., 2011), approximately 40–50% of people with OCD will develop major depression at some point in their lives, and 25–30% are in a depressive episode at any given time when they present for treatment[2][3].
The Indian National Mental Health Survey of India 2015–16 found that over half of those with OCD had at least one other mental health condition [5].
The numbers vary by setting and method, but the broad picture is consistent across studies. In community samples, the lifetime co-occurrence of OCD and major depression sits around 40–50%. In tertiary clinical samples, the people who reach a specialist clinic current depression rates are higher, often 25–30% at presentation[2][3].
The Indian picture mirrors international data. According to the National Mental Health Survey of India 2015–16 (NIMHANS Publication No. 129, 2016), conducted across 12 states by NIMHANS in collaboration with the Ministry of Health and Family Welfare, comorbidity was the rule rather than the exception in OCD [5].
The same NMHS 2015–16 report documented a current weighted prevalence of OCD of approximately 0.8% of adults in India, with roughly 1.0% reporting OCD at some point in life [5]. Most of those individuals carry one or more co-occurring diagnoses, with depression at the top of the list.
Why Do OCD and Depression Travel Together?
QUICK ANSWER
OCD and depression share underlying neurobiology particularly the serotonin system and circuits connecting the prefrontal cortex with deeper brain structures. Family studies suggest a shared genetic vulnerability.
On top of that, the daily impact of severe OCD lost time, social withdrawal, exhaustion, shame, hopelessness about ever being free of it produces secondary depression in many people [8].
There are three broad explanations, and most clinicians think all three contribute.
Both OCD and major depression respond to medications that increase serotonin signalling SSRIs and clomipramine which points to real overlap in the serotonin system. Imaging studies in OCD highlight the cortico-striato-thalamo-cortical (CSTC) circuit; imaging in depression highlights overlapping prefrontal-limbic circuits [6].
The networks are not identical, but they touch each other in important ways. Family and twin studies also show some shared genetic vulnerability across anxiety, OCD, and depressive disorders[2].
Untreated OCD is exhausting. A person who spends three to six hours a day on rituals, who avoids work, school, food, faith, or family because of obsessions, who carries the constant background hum of intrusive thoughts that person is at high risk of becoming depressed even without any independent depressive vulnerability.
The hopelessness (“I will never be free of this”), the social withdrawal, the loss of pleasure in things that once mattered these can be a direct response to living with severe OCD for years [6].
Less commonly, depression comes first, and OCD-spectrum symptoms emerge or worsen during a depressive episode. In these cases, treating the depression sometimes resolves what looked like emerging OCD. Sometimes the OCD persists and needs its own treatment.
In a real clinical encounter, sorting out which came first is often less important than treating both well.
OCD-Driven Low Mood vs. Primary Depression: How to Tell Them Apart
Not all depression in OCD is the same. Distinguishing OCD-driven secondary low mood from primary depression that runs independently shapes the treatment plan particularly around sequencing and SSRI dose decisions.
| Feature | OCD-driven secondary depression | Primary depression with OCD |
|---|---|---|
|
Feature
Onset
|
OCD-driven secondary depression
After OCD symptoms intensify
|
Primary depression with OCD
Independent of OCD course
|
|
Feature
Course
|
OCD-driven secondary depression
Improves as OCD improves
|
Primary depression with OCD
May persist after OCD improves
|
|
Feature
Suicidal ideation
|
OCD-driven secondary depression
Often ego-dystonic intrusive thoughts
|
Primary depression with OCD
Sustained, hopelessness-driven
|
|
Feature
Treatment focus
|
OCD-driven secondary depression
Treat OCD; depression often lifts
|
Primary depression with OCD
Treat both as separate conditions
|
|
Feature
Typical SSRI dose
|
OCD-driven secondary depression
OCD-effective (higher) covers both
|
Primary depression with OCD
OCD-effective dose; reassess depression separately
|
|
Feature
ERP timing
|
OCD-driven secondary depression
Usually possible alongside
|
Primary depression with OCD
May need depression stabilisation first
|
In practice, the two pictures overlap and co-exist in the same person. The table is a clinical guide, not a hard boundary a psychiatrist assessing both formally will use structured measures for each.
How Does Each Condition Make the Other Harder to Treat?
QUICK ANSWER
Untreated depression makes ERP very hard to engage with, as the motivation, energy, and ability to tolerate distress that ERP requires are all reduced in depression.
Untreated OCD keeps producing the daily losses that feed depression. Treating one without the other usually disappoints both patient and family [6].
Exposure and Response Prevention asks a person to deliberately face triggers and tolerate distress without performing the compulsion. That requires a baseline of energy, hope, and capacity to engage.
A person in a severe depressive episode who cannot get out of bed, who feels nothing will help, who is exhausted by 10 a.m. usually cannot do effective ERP work. Sessions become passive, homework does not happen, and what looks like ERP failure is often unrecognised depression.
See ERP therapy for OCD for how a standard ERP course is structured and what genuine engagement looks like.
When obsessions are loud and compulsions are taking hours, the person stays in a state of constant threat-arousal. Antidepressant medication and behavioural activation for depression both work less well in that state.
Treating only the depression can leave the person feeling slightly better in mood but no closer to being free of OCD.
The mental story OCD tells (“I am dangerous”, “I am contaminated”, “I am responsible”) and the mental story depression tells (“nothing will ever change”, “I am a burden”) feed each other. And here’s the thing the person told they have both conditions can hear that as a worse prognosis.
The clinical reality is the opposite. The two are highly treatable together when the team understands the interaction.
Sequencing Which Do You Treat First?
QUICK ANSWER
The general principle is that severe depression, especially with suicidal thinking, is stabilised first or in parallel before pushing hard on ERP.
Mild-to-moderate depression that is largely secondary to OCD is often treated together with OCD from the start, since OCD improvement frequently improves the depressive picture. The choice is made by a psychiatrist who has assessed both.
There is no universal rule, but two practical principles guide most decisions.
If the depression is severe, with significant suicidal thinking, the priority is stabilisation. That can mean a higher level of care, closer monitoring, an antidepressant started promptly, and ERP postponed until the person can engage. Postponed is not the same as cancelled. ERP enters as soon as the person is safe and capable.
When the depression is mild-to-moderate and largely secondary to OCD, the two are usually treated together. SSRIs at OCD doses treat both. ERP that goes well usually also lifts the secondary depression. Trying to treat OCD alone when depression is in the background or depression alone when OCD is the engine of distress often disappoints.
Practical sequencing in an Indian clinical setting
Practical sequencing in an Indian clinical setting usually looks like: a careful joint assessment, an SSRI started at OCD doses (which also covers depression), psychoeducation for both conditions for patient and family, ERP introduced once the person can engage, and regular re-assessment of both depression and OCD severity. See treatment options for OCD for the broader framework of how these decisions are made.
In our experience at Abhasa Rehab and Wellness
In our experience at Abhasa Rehab and Wellness, the most common clinical mistake we encounter in referrals is treating OCD and depression as a sequence rather than a pair.
A person spends months on antidepressants for depression, the depression lifts partially, and yet they are still spending four hours a day in rituals because nobody addressed the OCD. The reverse happens too.
We see people who have done ERP work that stalled because undiagnosed depression was draining the energy that ERP requires. Joint assessment from the start changes both outcomes.
Medication Choice When Both Are Present
QUICK ANSWER
SSRIs at OCD doses are first-line for OCD with co-occurring depression they treat both conditions, with the OCD usually requiring the higher dose and the longer trial duration of the two.
The five SSRIs commonly used in OCD (fluoxetine, sertraline, fluvoxamine, paroxetine, escitalopram) all also have evidence for major depression. Choice between them depends on side-effect profile, drug interactions, and individual response.
Five SSRIs are commonly used in OCD: fluoxetine, sertraline, fluvoxamine, paroxetine, and escitalopram. A 2018 network meta-analysis published in The Lancet (Cipriani et al.) covering 21 antidepressant drugs confirmed all five have established evidence in major depression as well [7]. This makes them the natural first choice when both conditions are present.
A few considerations matter for choice.
The OCD-effective dose is usually higher than the depression-starting dose, as documented in the APA Practice Guideline for OCD [1]. The treatment plan is built around the OCD requirement; the depression usually responds within that range. See medications for OCD for typical OCD dose ranges and what to expect from an adequate trial.
A depression trial is usually called at 4–6 weeks; an OCD trial runs for 10–12 weeks[1]. When both are present, the longer OCD timeline applies. Families should know this so that an apparent lack of response at week 4 is not over-interpreted.
Fluvoxamine has more drug interactions than the others it is a strong CYP1A2 inhibitor. Where the person is on multiple medications, escitalopram or sertraline often have cleaner interaction profiles. The choice belongs with the prescribing psychiatrist.
When SSRI plus ERP has not been enough, the next steps are similar to those for treatment-resistant OCD switching SSRI, switching to clomipramine, augmentation. See severe and treatment-resistant OCD.
When SSRI plus ERP has not been enough, the next steps are similar to those for treatment-resistant OCD switching SSRI, switching to clomipramine, augmentation. See severe and treatment-resistant OCD.
ERP When Depression Is in the Picture
QUICK ANSWER
ERP can be modified to work when depression is present, but severe depression usually has to be partially stabilised first. Adaptations include shorter sessions, gentler initial exposures, more behavioural activation alongside ERP, and integrated work on the depression-related avoidance and inactivity that often run alongside OCD avoidance.
ERP for OCD plus depression is not fundamentally different ERP but the delivery often needs to be adapted. Three adaptations are common.
Behavioural activation gradually reintroducing activities that bring meaning, mastery, or pleasure is a core technique for depression. Adding it to the ERP plan addresses the depression-driven inactivity directly, while ERP addresses the OCD-driven avoidance.
The two often look similar from the outside (a person not leaving the house) but require different responses from a trained therapist
A person with significant depression has less capacity to absorb new exposures. The ERP hierarchy is climbed more slowly. Sessions may be shorter. Homework is calibrated to what is realistic, not what the textbook suggests.
Hopelessness (“nothing will help”) is a depressive symptom that can masquerade as a treatment refusal. A skilled therapist names this directly, treats it as part of the clinical picture, and continues to engage rather than withdrawing.
ERP done well in this context, with depression in mind, paced appropriately, and integrated with antidepressant treatment, produces meaningful change in both conditions. It is the absence of integration that disappoints.
From our clinical psychology team at Abhasa: “Doing ERP when you are depressed is genuinely harder. We pace it to your energy, start with smaller exposures, and build from there. The work still produces change, it just needs the depression to be acknowledged in the room.” Ms. Meera K., M.Phil Clinical Psychology, Abhasa Rehab and Wellness
For more on ERP itself, see ERP therapy for OCD. For more on the broader anxiety spectrum that OCD sits within, see OCD and anxiety.
Suicide Risk in OCD with Depression
QUICK ANSWER
People with OCD plus depression have higher suicide risk than people with either condition alone. Risk monitoring is a non-negotiable part of treatment. Specific risk factors include severity of depression, hopelessness, prior suicide attempts, OCD with aggressive or harm themes, and isolation. A safety plan, family awareness, and easy access to crisis support are standard parts of care [4].
This is the section families most need to read clearly. OCD has historically been thought of as an anxiety condition without major suicide risk a picture that is no longer accurate.
A systematic review and meta-analysis published in Clinical Psychology Review (Angelakis et al., 2015) established that people with OCD have meaningfully higher rates of suicidal ideation, attempts, and completed suicide than the general population, and this risk is amplified when depression is co-occurring [1].
Several risk factors are particularly important:
- Severity of depression especially severe depression with hopelessness.
- Prior suicide attempts the strongest single predictor.
- OCD with aggressive, harm, or sexual themes the shame and isolation around these themes can make people withdraw rather than seek help. See harm OCD and Pure O / mental OCD.
- Long illness duration without effective treatment particularly the picture of someone who has tried treatment without adequate dose or duration and concluded “nothing works”.
- Recent treatment changes especially the first 2–4 weeks of an antidepressant trial.
- Co-occurring substance use alcohol, in particular, removes inhibition. See OCD and substance use.
- Isolation, lack of social support, and family conflict.
What good care looks like in practice: explicit asking about suicidal thinking at every clinical contact, a written safety plan that names triggers, coping steps, and emergency contacts, family awareness where the person consents, removal of access to means where appropriate, easy access to follow-up, and the helpline numbers above stored in the patient’s and family’s phones.
A note on harm-themed obsessions. Obsessional thoughts about harming oneself or others common in OCD are not the same as suicidal ideation. The OCD thought is unwanted, distressing, and goes against the person’s values. A trained psychiatrist or therapist can tell the difference and will treat them differently. See harm OCD for more.
When a Higher Level of Care Helps
QUICK ANSWER
Most people with OCD plus depression can be treated as outpatients. Higher levels of care day programmes, residential or rehabilitation settings are considered when safety risk is high, when functional impairment is severe, when the home environment is unable to support recovery, or when intensive ERP is needed alongside depression treatment.
A higher level of care is considered when one or more of the following are true:
- The person is at meaningful suicide risk and outpatient monitoring is not enough.
- Daily functioning has collapsed the person is unable to leave the room, eat, sleep, or self-care.
- Home is reinforcing OCD (family accommodation) or depression (isolation, conflict) in ways that outpatient sessions cannot reach.
- Intensive, daily ERP is clinically indicated and outpatient sessions of 1–2 hours weekly are not sufficient.
- Substance use is co-occurring and needs concurrent treatment.
The decision is made by a psychiatrist who has assessed the situation in full. It is not a sign of failure. It is the matching of intensity of care to severity of presentation.
Not sure whether the current plan is working?
Many families reach this point after months of outpatient treatment that has not quite moved things forward. That is a normal part of a complex presentation not a reason for despair.
Our clinical team can review the picture with you confidentially, with no obligation, and help you understand whether a change in approach or a higher level of care makes sense.
Call +91-73736-44444 or request a callback
How Abhasa Rehab and Wellness Approaches OCD with Depression
At Abhasa Rehab and Wellness, OCD with co-occurring depression is one of the more common dual-diagnosis presentations we see. Our approach is built around three principles.
SSRI selection considers both conditions and any other medications. Therapy planning sequences ERP and behavioural activation according to the patient’s current capacity. The psychiatrist, therapist, and family are aligned on the plan.
Suicide-risk assessment is part of every clinical contact. Safety planning is done with the patient and, with consent, the family. Where indicated, residential care provides the structure and monitoring that outpatient settings cannot.
Family accommodation — the ways that loving family members can inadvertently reinforce OCD by providing reassurance, helping with rituals, or avoiding triggers together is gently named and worked with. So is the depression-driven withdrawal that can leave the family unsure how to reach their loved one.
If you would like to discuss whether residential care for OCD with depression is the right next step, our admission guide explains the process. Our OCD treatment programme and our dual-diagnosis programme are both relevant routes for this presentation.
How Integrated Treatment Is Delivered, Step by Step
Most people want to know what actually happens not just what the principles are. Here is how integrated care for OCD with co-occurring depression is typically structured.
If active suicidal ideation is present, a written safety plan is created before any other treatment step proceeds. The plan names triggers, coping steps, and emergency contacts, and is shared with family where the person consents.
One SSRI (commonly fluoxetine, sertraline, or escitalopram) is started, titrated over 4–6 weeks toward OCD-effective dose which is typically higher than the dose used for depression alone [1]. The plan is built around the OCD requirement; the depression usually responds within that range.
ERP begins once mood is sufficient to support the work sometimes immediately, sometimes after 4–8 weeks of medication. The hierarchy is climbed at a pace calibrated to the person’s current energy and capacity, not a textbook timetable.
Both conditions are formally reassessed. Decisions about adding an antidepressant, switching SSRI, augmentation, or considering a residential level of care are made jointly with the patient with updated Y-BOCS and depression scores informing the conversation.
Frequently Asked Questions
It can be either, and often both. In many people, the daily exhaustion and isolation of severe OCD produces secondary depression that lifts as the OCD improves. In others, depression is an independent condition with its own course. The clinical approach treats both, regardless of which came first.
Most likely yes. The five SSRIs commonly prescribed for OCD all have established evidence for major depression, per the 2018 Lancet network meta-analysis (Cipriani et al.) [7]. The OCD dose is typically higher than the depression dose, and the trial duration is longer — 10–12 weeks for OCD versus 4–6 weeks for depression [1]. Your psychiatrist will tailor the dose to your situation.
A trained psychiatrist or therapist can tell the difference. OCD intrusive thoughts about suicide are typically unwanted, distressing, ego-dystonic (they feel “not me”), and the person does not want to act on them. Genuine suicidal thinking in depression is more sustained, accompanied by hopelessness, and may include planning. If you are unsure, please call iCall (9152987821) or AASRA (9820466627). It is always safer to ask.
ERP can be done with mild-to-moderate depression, often with adaptations — shorter sessions, gentler initial exposures, behavioural activation alongside. With severe depression, especially with significant suicidal thinking, depression usually needs to be partially stabilised first. Your psychiatrist and therapist will decide the right sequence together with you.
Often yes — especially when the depression is largely secondary to the OCD. As OCD symptom hours come down, sleep improves, social engagement returns, and a sense of agency comes back. For depression that is more independent of the OCD, separate treatment of the depression is still needed.
This is one of the hardest situations families face. A few things help: keep contact warm and judgement-free, learn what OCD and depression actually are (the more you understand, the less the symptoms feel like personal choices), gently mention specific concrete next steps — a single appointment with a named clinician. Look after your own mental health too. If safety is a concern, do not wait — call a helpline together, or speak to a psychiatrist about how to bring your loved one in.
More questions?
More questions? Speak with our team confidentially. Call +91-73736-44444 or visit Abhasa OCD.
Closing A Realistic Picture
OCD plus depression is common, treatable, and deserves an integrated approach. The two conditions interact. Depression makes ERP harder, OCD keeps producing the losses that fuel depression but they also respond to overlapping treatments. SSRIs at OCD doses cover both.
ERP, paced for depression, treats the OCD and often lifts the secondary depression with it. Safety monitoring is non-negotiable, particularly in the first weeks of treatment. The right team treats both conditions together, with full awareness of how they shape each other.
You are not asking too much when you ask for both to be treated well. You are asking for the standard of care that the evidence supports.
If you would like to talk through whether the next step for you or your loved one is changing the current outpatient plan, adding an additional service, or considering residential care:
- Our admission guide explains the assessment and admission process.
- Our OCD treatment centre describes the OCD-specific programme.
- Our dual-diagnosis programme is built for co-occurring presentations.
- Our depression treatment page has more on how we approach depressive disorders.
References
[1] Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry. 2007;164(7 Suppl):5-53. https://pmc.ncbi.nlm.nih.gov/articles/PMC5310107/
[2] Pallanti S, Grassi G, Sarrecchia ED, Cantisani A, Pellegrini M. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Frontiers in Psychiatry. 2011;2:70. https://pmc.ncbi.nlm.nih.gov/articles/PMC3243905/
[3] Quarantini LC, Torres AR, Sampaio AS, et al. Comorbid major depression in obsessive-compulsive disorder patients. Comprehensive Psychiatry. 2011;52(4):386-393. https://pubmed.ncbi.nlm.nih.gov/21087765/
[4] Angelakis I, Gooding P, Tarrier N, Panagioti M. Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clinical Psychology Review. 2015;39:1-15. https://pubmed.ncbi.nlm.nih.gov/25875222/
[5] Gururaj G, Varghese M, Benegal V, et al. National Mental Health Survey of India 2015–16: Prevalence, Patterns and Outcomes (NIMHANS Publication No. 129). Bengaluru: National Institute of Mental Health and Neurosciences; 2016. https://indianmhs.nimhans.ac.in/phase1/Docs/Report2.pdf
[6] Pittenger C, Bloch MH. Pharmacological treatment of obsessive-compulsive disorder. Psychiatric Clinics of North America. 2014;37(3):375-391. https://pubmed.ncbi.nlm.nih.gov/25150568/
[7] Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic network meta-analysis. Lancet. 2018;391(10128):1357-1366. https://pubmed.ncbi.nlm.nih.gov/32021580/
[8] Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry. 1989;46(11):1006-1011. https://pubmed.ncbi.nlm.nih.gov/2684084/
- Reviewed by
- Senior Consultant Psychiatrist
- Abhasa Rehab and Wellness
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for personalised medical guidance. If you or someone you know is in crisis, please contact emergency services (112) or one of the helplines listed above.
If you or your loved one is in crisis right now — whether from substance withdrawal, suicidal thoughts, or overwhelming OCD distress — please call:
Emergency Helplines:
- Vandrevala Foundation: 1860-2662-345 (24/7 Mental Health Crisis)
- iCall: 9152987821 (Mon-Sat, 8am-10pm)
- NIMHANS Helpline: 080-46110007 (Psychiatric Emergency)
- National Mental Health Helpline (India): 1800-599-0019 (Toll-free)
Abhasa 24/7 Helpline: +91-73736-44444
Emergency: For substance-use medical emergencies (severe withdrawal, overdose), go to the nearest hospital emergency department.