Even for people with severe obsessive-compulsive disorder (OCD), cognitive-behavioral therapy outperforms anti-psychotic medication in some hard-to-treat patients, finds a recent study by researchers at Columbia University Medical Center and New York State Psychiatric Institute.
More than 6 million Americans are affected by OCD, which causes intrusive thoughts, images or urges (obsessions) as well as repetitive behaviors or mental acts (compulsions).
OCD patients are often treated first with serotonin reuptake inhibitors (SRIs), but most will continue to have significant residual symptoms. Clinicians have two options to augment SRI treatment—the anti-psychotic resperidone and cognitive-behavioral therapy that teaches patients to ignore the triggers that provoke their compulsive behaviors (called exposure and ritual prevention or EX/RP).
Choosing which treatment is best for each individual patient, however, can be a complicated decision for clinicians to make. Clinicians have been wary of using EX/RP for severely ill OCD patients and for patients with co-morbid depression, because of concerns that the treatment would not prove effective in these cases.
In the new study, the researchers compared the two recommended augmentation strategies in a randomized controlled trial and found EX/RP to be more effective across all demographic and clinical variables.
“Despite clinical intuition that anti-psychotics may be more effective in severe cases, this study suggests that EX/RP should be the treatment of choice to augment SRIs,” says the study’s principal investigator, H. Blair Simpson, MD, PhD, professor of psychiatry at Columbia University Medical Center and director of the Center for Obsessive-Compulsive and Related Disorders.
For additional information on OCD, watch Dr. Blair Simpson on the Mental Health Channel Big Thinkers Series:
Results of the study are published in a paper in the October issue of the Journal of Consulting and Clinical Psychology: “Augmenting Serotonin Reuptake Inhibitors in Obsessive–Compulsive Disorder: What Moderates Improvement?” Authors are: Michael G. Wheaton (New York State Psychiatric Institute), David Rosenfield (Southern Methodist University), Edna B. Foa (University of Pennsylvania), and H. Blair Simpson (New York State Psychiatric Institute and Columbia University Medical Center).
Medication was provided at no cost by Janssen Scientific Affairs LLC. During the study period, H. Blair Simpson received research funds for clinical trials from Janssen Pharmaceuticals (2006 –2012), Transcept Pharmaceuticals (2011–2013), and Neuropharm Ltd. (2009), served on a Scientific Advisory Board for Pfizer (for Lyrica, 2009 –2010) and Jazz Pharmaceuticals (for Luvox CR [controlled release], 2007–2008), consulted for Quintiles Inc. (on the therapeutic needs for OCD, September, 2012), and received royalties from Cambridge University Press and UpToDate Inc. Edna B. Foa was a consultant to Jazz Pharmaceuticals (for Acetelion) and received royalties from Bantam and Oxford University Press for book sales, including a manual of cognitive-behavioral therapy for OCD. No other disclosures were reported.