High doses of SSRIs like fluoxetine (Prozac) and sertraline (Zoloft) can successfully treat obsessive-compulsive disorder (OCD). However, many people with OCD either don’t respond to SSRI treatment or continue to have significant symptoms.
Researchers at Columbia University and Penn compared two approaches to augmenting the effectiveness of SSRIs by adding either 17 sessions of exposure and response prevention (ERP)–a cognitive-behavioral therapy program and a first line treatment for OCD–or risperidone (brand name Risperdal), a medication used to treat schizophrenia. Both groups were compared to individuals on SSRIs who also received a placebo medication.
The results after 8 weeks were striking. Individuals in the ERP condition on average had a 52% reduction in their OCD severity scores, whereas those in the risperidone (13% reduction) and placebo (11% reduction) conditions were virtually indistinguishable.
These results provide valuable guidance to individuals with OCD who are taking a therapeutic dose of an SSRI and still have lots of symptoms. Based on the data it appears that ERP has much more to offer as an augmentation strategy than do antipsychotic medications.
The researchers should be commended for the tremendous amount of time and effort that went into this important study. I was on the faculty at the center at Penn where the study was conducted and would hear the study updates week after week during the 4 years I was there. Treatment outcome research can be difficult and painstaking, and in the end can tell us how best to help people who are suffering.
H. B. Simpson et al. (in press). Cognitive-behavioral therapy vs risperidone for augmenting serotonin reuptake inhibitors in obsessive-compulsive disorder: A randomized clinical trial. JAMA.