Among patients with obsessive-compulsive disorder (OCD), adding cognitive-behavioral therapy to serotonin reuptake inhibitors (SRIs) was associated with greater reduction in symptoms and improvement in functioning and quality of life compared with adding an antipsychotic or placebo, according to a report published by JAMA Psychiatry, a JAMA Network publication.
SRIs are the only medications approved by the U.S. Food and Drug Administration to treat OCD. Few patients achieve minimal symptoms from an SRI alone and practice guidelines recommend adding antipsychotics or cognitive-behavioral therapy consisting of exposure and ritual prevention (EX/RP), according to the study background.
Helen Blair Simpson, M.D., Ph.D., of Columbia University, New York, and colleagues randomized 100 adult patients to receive eight weeks of risperidone (n=40), 17 twice-weekly EX/RP sessions with a therapist (n=40) or placebo (n=20) added to SRIs.
According to the results, more patients receiving EX/RP achieved minimal symptoms, and adding EX/RP was superior to adding risperidone or placebo for improving insight, functions and quality of life.
“Patients with OCD receiving SRIs should be offered EX/RP before antipsychotics given EX/RP’s superior efficacy and less negative adverse effect profile,” the study concludes.
In an editorial2, Kerry J. Ressler, M.D., Ph.D., and Barbara O. Rothbaum, Ph.D., of the Emory University School of Medicine, Atlanta, write: “Simpson et al call for a change in practice, because augmentation for SRI nonresponders with atypical antipsychotics is recommended in the American Psychiatric Association guidelines. This is a well-controlled randomized clinical trial worthy of strong conclusions.”
“As always, more work remains, but the data presented by Simpson and colleagues are intriguing and thought provoking. They remind us that there are likely unique aspects of brain function that are differentially targeted by medication and psychotherapeutic approaches. As the neurology of OCD and other disorders are further dissected, we can hope for progress with targeted combined pharmacotherapy and psychotherapy in which rationally designed therapeutics can be fully derived from our understanding of the brain, its dysfunction, and mechanisms of recovery,” they conclude.
1. JAMA Psychiatry. Published online September 11, 2013. doi:10.1001/jamapsychiatry.2013.1932
2. JAMA Psychiatry. Published online September 11, 2013. doi:10.1001/jamapsychiatry.2013.2116.