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Review suggests combination therapy best for OCD

A comprehensive analysis of all available treatments for obsessive-compulsive disorder suggested a combination of psychotherapeutic and psychopharmacological interventions may be most effective to treat the disorder.

“Previous systematic reviews and meta-analyses have generally compared the efficacy of pharmacological interventions with placebo, not with each other. Psychotherapeutic interventions have typically been compared with a waiting list or other inactive therapy. Only a few studies have directly compared psychotherapeutic with pharmacological interventions or combinations of them, and their results are inconclusive,” Petros Skapinakis, PhD, of University College London, and colleagues wrote.

To compare all available treatments for obsessive-compulsive disorder (OCD), researchers conducted a systematic review and network meta-analysis of randomized controlled trials in which an active psychotherapeutic or pharmacological intervention was used among adults with OCD. Analysis included 53 articles among 6,652 participants.

Behavioral therapy (mean difference = –14.48; 95% CI, –18.61 to –10.23), cognitive therapy (mean difference = –13.36; 95% CI, –18.4 to –8.21), behavioral therapy and clomipramine (mean difference = –12.97; 95% CI, –19.18 to –6.74), cognitive behavioral therapy (CBT) and fluvoxamine (mean difference = –7.5; 95% CI, –13.89 to –1.17), CBT alone (mean difference = –5.37; 95% CI, –9.1 to –1.63), clomipramine alone (mean difference = –4.72; 95% CI, –6.85 to –2.6), and all SSRIs (class effect = –3.49; 95% CI, –5.12 to –1.81) were more effective than placebo.

Clomipramine and SSRIs had comparable efficacy (mean difference = –1.23; 95% CI, –3.41 to 0.94).

Psychotherapeutic interventions were more effective than medications, but analysis was limited as most psychotherapeutic trials included participants receiving stable doses of antidepressants.

“The results of our analysis generally support current National Institute for Health and Care Excellence guidelines. For pharmacological management, the recommendation to use SSRIs rather than clomipramine as the first-line agents is supported by our findings since SSRIs have better tolerability than does clomipramine and we identified no convincing evidence for clomipramine being more efficacious than are SSRIs. For nonpharmacological management, all three types of psychotherapy are probably more efficacious than is nonspecific therapy, but evidence is limited to patients taking stable doses of antidepressant medication before initiating psychotherapy. The combined initiation of both medication and psychotherapy (either behavioral therapy or CBT) seemed an efficacious treatment,” the researchers concluded. – by Amanda Oldt

Disclosure: Skapinakis reports receiving non-financial support from Lundbeck to attend a conference during the conduct of this study. Please see the full study for a list of all authors’ relevant financial disclosures.