OCD: Adding Cognitive Therapy to SSIs

H. Blair Simpson, M.D., Ph.D. Professor of Clinical Psychiatry, College of Physicians and Surgeons at Columbia University Director of the Anxiety Disorders Clinic and the Center for OCD and Related Disorders at the New York State Psychiatric Institute 1051 Riverside Drive, Unit 69 New York, NY 10032MedicalResearch.com Interview with:
H. Blair Simpson, M.D., Ph.D.
Professor of Clinical Psychiatry, College of Physicians and Surgeons at Columbia University
Director of the Anxiety Disorders Clinic and the Center for OCD and Related Disorders at the New York State Psychiatric Institute
New York, NY 10032

MedicalResearch.com: What are the main findings of the study?

Dr. Simpson: This is the first RCT to compare two recommended SRI augmentation strategies for adults with OCD. Adding EX/RP to SRIs was superior to risperidone and to pill placebo in reducing OCD symptoms and improving insight, functioning, and quality of life. Risperidone was not superior to placebo on any outcome.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Simpson: Contrary to our expectations, adding EX/RP (a type of cognitive-behavioral therapy called Exposure and Response Prevention) to SRIs was superior to adding risperidone on every outcome. These findings are important because antipsychotics are increasingly prescribed to OCD outpatients, and risperidone is recommended as the medication of first choice to augment SRI response. Our results call for increased use of EX/RP for augmenting unsatisfactory SRI effects.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Simpson: OCD patients on SRIs should be offered EX/RP before antipsychotics given EX/RP’s superior efficacy and less negative side effect profile. Identifying who achieves minimal OCD symptoms from adding EX/RP to SRIs and whether such patients can then successfully discontinue their SRI warrants future research. Whether OCD patients on SRIs who fail to respond to EX/RP (or are unwilling to try it) can benefit from risperidone augmentation remains an unanswered question. Alternative medication augmentation strategies for OCD patients on SRIs are needed.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Simpson: We are now funded by NIMH to study whether patients who become well after the combination of SRIs and EX/RP can maintain their wellness if the SRI is discontinued. The study is described in more detail at www.ocdtreatmentstudy.com

We are also developing novel treatment strategies for patients who do not become well from the combination of SRIs and EX/RP. Our current work is described on our website at www.columbia-ocd.org

Citation:

Simpson H, Foa EB, Liebowitz MR, et al. Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2013;():-. doi:10.1001/jamapsychiatry.2013.1932.

 

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