Exposure Therapy Boosts Antidepressant Treatment of OCD

Exposure therapy for those with obsessive-compulsive disorder combined with antidepressants is more effective  in reducing symptoms than medication alone, according to a new study by New York’s Columbia University.

Current guidelines favor augmentation of antidepressants with antipsychotics for those who suffer from OCD.

Researchers at Columbia concluded that cognitive behavioral therapy, also known as exposure and ritual reduction therapy, in conjunction with certain antidepressants provides better outcomes than antidepressants combined with antipsychotic drugs. During exposure therapy, a patient is made to confront phobias or anxieties under the guidance of a trained therapist. For example, a compulsive hand-washer might be asked to touch the door handle in a public restroom and be prevented from washing so s/he can see that nothing bad will happen.

The findings by Helen Blair Simpson, M.D., Ph.D., and colleagues from Columbia were widely reported Thursday.

“I don’t want to say that add-on antipsychotics never work,”Simpson told MedPageToday.  “That’s not true. But the percentage of patients responding to them is much smaller than with cognitive therapy, so it makes sense to try that first in patients needing augmentation therapy.”

In the 12-week trial with 100 OCD patients, 80 percent of those who received exposure therapy  responded, compared to 23 percent 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 exposure treatment, compared to 13 percent for risperidone and 5 percent for the placebo.

“This data strongly suggests that OCD patients on [antidepressants] with clinically meaningful symptoms should be first offered exposure and ritual prevention therapy to get better still,” Simpson, told Reuters Health.

OCD is a condition suffered by an estimated 2.2 million adult Americans and another half a million children, and is defined as having unwanted intrusive thoughts – obsessively – that compel sufferers into repeated or ritualistic actions. Among the most commonly known is the cleanliness obsession, but hoarders or “pack-rats” are also suffering from a form of OCD.

“Therapy specifically targets the underlying problem whereas the antipsychotic — just puts a Band-Aid over the symptoms,” Dr. Kerry Ressler, from the Department of Psychiatry at Emory University in Atlanta, wrote in an editorial of the study published in JAMA on Sept. 11.

An early instance where obsessive-compulsive disorder made prime time was on the popular show “Monk,” in which an ex-cop’s OCD rituals frequently aid his crime-solving. It was not exactly a positive portrayal, but in recent years celebrities such as comedian and “America’s Got Talent” judge Howie Mandell has come out about his OCD, hoping to educate others. He has said he does not like to shake hands with people and maintains his own home behind his family’s.


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