Therapy Over Meds for OCD

OCD symptoms decreased more with cognitive therapy than with prescription drugs in new study

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) For people with OCD, the compulsive rituals that characterize their condition can be frustrating and even disabling. So, the goal of treatment is to reduce or even stop those rituals. 

Patients being treated for obsessive-compulsive disorder (OCD) frequently are prescribed serotonin reuptake inhibitors (SRI), the only type of medication the US Food and Drug Administration (FDA) has approved to treat the illness. But these medications alone may not help OCD patients fully minimize their rituals.

A new study has found that adding a type of cognitive behavioral therapy along with the usual SRI medications was more effective than adding the medication risperidone in reducing the symptoms of OCD.

"Ask your doctor about the most effective treatments for OCD."

Helen Blair Simpson, MD, PhD, director of the Columbia University School of Medicine Anxiety Disorders Clinic, was lead author of this study.

The study enrolled 100 participants whose OCD symptoms were at least moderately severe, even though they were taking Zoloft, Celexa, Paxil or some other SRI medication aimed at easing those symptoms.

The researchers divided the 100 patients into three groups. For eight weeks, 40 of those 100 patients had risperidone, an atypical anti-psychotic medication, added to their regimen of prescribed medicines. Forty other patients spent those eight weeks completing a total of 17 exposure and response prevention (EX/RP) sessions but took no risperidone, which is sold a Risperdal. The remaining 20 patients took a placebo pill that contained no medicine at all for eight weeks.

The 40 patients undergoing EX/RP therapy would confront, for example, a fear of being contaminated by germs by touching objects in a public bathroom. By confronting this fear, patients were correcting a mistaken belief, which in turn, reduced their anxiety and discomfort, Dr. Simpson told dailyRx.

Her study specifically found that 32 of 40 EX/RP patients and nine of the 40 risperidone patients saw their symptoms decrease, while three of the 20 patients taking a placebo experienced a decrease.

Symptoms fell to a minimum level for 17 of 40 EX/RP patients, for five of the 40 patients taking risperidone and for one of the 20 patients taking a placebo.

"Patients with OCD...should be offered EX/RP before antipsychotics, given EX/RP’s superior efficacy and less negative [symptoms]," the researchers wrote. "Identifying who achieves minimal OCD symptoms from adding EX/RP to SRIs and whether such patients can then successfully discontinue their SRIs warrants future research."

Barbara Long, MD, PhD, a practicing psychiatrist and psychiatric consultant based in Atlanta, GA, said cognitive behavioral therapy should always be in the care regimen for people with OCD. She advises against use of anti-psychotics to treat the disorder.

“OCD is not a psychotic disorder. So you want to try to do the least invasive mode of treatment before you move to more invasive modes of treatment. The least invasive treatment and one that is specifically designed to help OCD patients is cognitive therapy," Dr. Long said.

“If that doesn't relieve symptoms, you can move into the medication territory, first trying medications that, No. 1, are not anti-psychotic and, No. 2, are not prone to causing addiction or dependence. Third, if all of that fails, you can try a low dose of an [anti-anxiety medicine] — as infrequently as possible — to contain the symptoms. If an anti-psychotic is recommended, it would be advisable to seek a second opinion,” she said.

"Though medication can help relieve the anxiety often underlying OCD, directly confronting the specific thoughts and compulsions present for someone often plays a central role in their improvement. While relieving OCD symptoms as measured in this study is important, I also believe in addressing through therapy the underlying feelings that caused the symptoms in the first place," Charlotte Howard, PhD, a licensed psychologist and certified group psychotherapist with a private practice in Austin, Texas, told dailyRx News. 

This study was published online September 11 in JAMA Psychiatry.

The National Institute of Mental Health funded the study. The authors also disclosed that they received research grants payments and free medications from a pharmaceutical company, and that one researcher sits on a pharmaceutical company's advisory board.

Review Date: 
September 10, 2013
Last Updated:
December 31, 2013