NIMH grantees have demonstrated that a form of behavioral therapy can augment antidepressant treatment of obsessive compulsive disorder (OCD) better than an antipsychotic. The researchers recommend that this specific form of cognitive behavior therapy (CBT) – exposure and ritual prevention – be offered to OCD patients who don't respond adequately to treatment with an antidepressant alone, which is often the case. Current guidelines favor augmentation with antipsychotics.
In the controlled trial with 100 antidepressant-refractory OCD patients, 80 percent of those who received CBT responded, compared to 23 percent of those who received the antipsychotic risperidone, and 15 percent of those who received placebo pills. Forty-three percent experienced symptoms reduced to a minimal level following CBT treatment, compared to 13 percent for risperidone and 5 percent for placebo.
The study, published September 11, 2013 in JAMA Psychiatry, was led by Helen Blair Simpson, M.D., of Columbia University, in New York City; and Edna Foa, Ph.D., of the University of Pennsylvania, Philadelphia.
In an accompanying editorial, grantees Kerry Ressler, M.D., and Barbara Rothbaum, Ph.D., of Emory University, Atlanta, note that antidepressants are effective in treating only a subset of OCD patients. They add that the targeted form of CBT works via different mechanisms – such as retraining the brain's habit-forming circuitry to unlearn compulsive rituals.
Matthew Rudorfer, M.D., chief of the NIMH Somatic Treatments Program, which funded the study, said that in demonstrating how different patients respond best to different approaches, it helps to move the field toward the goal of more personalized treatment.
Simpson HB, Foa, EB, Liebowitz MR, Huppert JD, Cahill S, Maher MJ, McLean CP, Bender Jr. J, Marcus SM, Williams MT, Weaver J Vermes D, Van Meter PE, Rodriquez CI, Powers M, Pinto A, Imms P, Hahn C-G, Campeas R. Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder – A Randomized Clinical Trial. JAMA Psychiatry, Sept. 11, 2013.
Ressler, KJ, Rothbaum BO. Augmenting Obsessive-Compulsive Disorder Treatment – From Brain to Mind. JAMA Psychiatry, Sept. 11, 2013.