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Augmenting Serotonin Reuptake Inhibitors With Exposure and Ritual Prevention Helps OCD Patients: Presented at ADAA

By Jill Stein

ST. LOUIS, MO -- April 4, 2007-- Augmentation of serotonin reuptake inhibitors (SRIs) with exposure and ritual (EX/RP) prevention is an effective strategy for managing obsessive-compulsive disorder (OCD), researchers announced here at the 27^th Annual Conference of the Anxiety Disorders Association of America (ADAA).

Exposure and ritual prevention is an established cognitive-behavioural therapy (CBT) for OCD.

Helen Blair Simpson, MD, director, Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, New York, United States, and colleagues studied the effects of adding EX/RP to SRI therapy in 108 patients diagnosed with OCD.

"Both CBT involving EX/RP and pharmacotherapy with SRIs have been found effective in multicentre, randomised, controlled trials," Dr. Simpson pointed out in a presentation on March 31^st. "Serotonin reuptake inhibitors are used more frequently than EX/RP in clinical practice, however SRIs typically yield only a 20% to 40% decrease in OCD symptoms, which means that many SRI responders continue to have clinically significant symptoms."

While several medications have been studied for their potential efficacy in augmenting SRI response, the only SRI augmentation strategy with documented efficacy in multiple, randomised, placebo-controlled trials involves antipsychotics, she continued. However, antipsychotic medications have 2 notable drawbacks. "Only about half of patients respond when response is defined as a decrease in OCD severity of at least 25%," she said. "Also, antipsychotics can cause significant adverse effects."

The trial included adult outpatients with primary OCD and a total score on the Yale-Brown Obsessive Compulsive Scale (Y-BCOS) of 16 or greater despite having been on a therapeutic dose of SRI for at least 12 weeks prior to enrolling in the trial.

In the study, patients received 17 sessions of twice-weekly EX/RP or stress management therapy (SMT) while continuing their SRI treatment.

Exposure and ritual prevention consisted of 2 introductory sessions and 15 EX/RP sessions. SMT consisted of 2 introductory sessions and 15 sessions of relaxation training, assertiveness training, and problem solving.

The primary efficacy measure was Y-BOCS total score.

Results showed that EX/RP was better than SMT at decreasing OCD symptoms (P <.001).

At week 8, significantly more EX/RP than CBT patients had a Y-BOCS decrease of at least 25% (74% vs 22% for the 2 groups, respectively, P < .001). In addition, significantly more EX/RP patients had achieved remission, defined as a Y-BOCS score of 12 or less (33% vs 4%, P < .001).

While EX/RP augmentation is effective for reducing OCD symptoms, 15 exposure sessions is usually not enough to help SRI-resistant patients achieve remission, Dr. Simpson commented.

Finally, she said that while EX/RP seems to be at least as effective as antipsychotic augmentation, a head-to-head comparison is needed to determine which approach leads to superior and more prolonged favourable outcomes.


[Presentation title: CBT Augmentation of SRI Pharmacotherapy in OCD. Abstract P57]

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