Meta-Analysis: Combination Therapy Most Effective in Adult OCD

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The combination of behavioral and cognitive therapy approaches with medications is likely the most effective intervention for adults diagnosed with severe obsessive-compulsive disorder.
The combination of behavioral and cognitive therapy approaches with medications is likely the most effective intervention for adults diagnosed with severe obsessive-compulsive disorder.

Combining psychotherapeutic and psychopharmacological interventions is likely to be more efficacious than psychotherapeutic interventions alone for the management of obsessive-compulsive disorder (OCD), a study published in Lancet Psychiatry has shown.

There are limited studies comparing the relative efficacy of available interventions for OCD in adults. Researchers from United Kingdom aimed to compare all treatments at once using both direct and indirect data through a systematic review and network meta-analysis. The team searched controlled trial registers up to February 16, 2016 and selected randomized controlled trials (RCTs) where an active psychotherapeutic or pharmacological intervention was used in adults with OCD.

The primary outcome was symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. A total of 1 480 articles were identified, and 53 were included for the network meta-analysis. Researchers found that compared to placebo, behavioral therapy (mean difference –14.48, 95% CI: –18.61 to –10.23), cognitive therapy (–13.36, 95% CI: –18.40 to –8.21), behavioral therapy + clomipramine (–12.97, 95% CI: –19.18 to –6.74), cognitive behavioral therapy + fluvoxamine (–7.50, 95% CI: –13.89 to –1.17), cognitive behavioral therapy (–5.37, 95% CI: –9.10 to –1.63), clomipramine (–4.72, 95% CI: –6.85 to –2.60), and all SSRIs (class effect –3.49, 95% CI: –5.12 to –1.81) had greater effects.

Clomipramine was no better than SSRIs (–1.23, 95% CI: –3.41 to 0.94). Also, psychotherapeutic interventions demonstrated a greater effect than medications but the authors pointed out a serious limitation that most of these trials included patients who were already on stable antidepressant doses (12 of 15 psychotherapy trials allowed antidepressants). 

Although there is a broad range of available interventions in managing OCD, uncertainty and limitations regarding their relative efficacy exist. The analysis suggests that the combination of psychotherapeutic and psychopharmacological interventions are more effective than only psychotherapeutic interventions, at least in cases of severe OCD.

Reference

Skapinakis P, Caldwell DM, Hollingworth W, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2016. doi: 10.1016/S2215-0366(16)300069-4. [Epub ahead of print]

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