Research published in Lancet Psychiatry found that SSRIs and psychotherapeutic interventions are more effective than placebos, and when taken together, can be more effective than psychotherapeutic intervention alone, in treating obsessive compulsive disorder in adults.
Obsessive compulsive disorder (OCD), considered the fourth most common mental disorder amongst adults, ranks as the tenth leading cause of disability worldwide. Currently, chlomipramine and selective serotonin reuptake inhibitors (SSRIs) are the preferred treatment methods for OCD. Behavioural and psychotherapeutic interventions are also recommended, along with pharmaceutical treatments. There have only been a few studies that have directly compared psychotherapeutic treatments with pharmacological interventions or combinations, and results have been inconclusive. The current research is a systematic review and meta-analysis, with the aim to compare all available treatments for OCD using both direct and indirect data.
The current research, published in Lancet Psychiatry, involved 53 randomized controlled trials in which an active psychotherapeutic or pharmacological intervention had been used in adults with obsessive-compulsive disorder. All comorbid diagnosable disorders were included except for schizophrenia or bipolar disorder. The primary outcome of the research was to analyze symptom severity, as measured by the Yale-Brown Obsessive Compulsive Scale.
Results displayed that behavioral therapy, cognitive therapy, behavioral therapy combined with chlomipramine, cognitive behavioral therapy combined with fluvoxamine (SSRI), cognitive behavioral therapy, chlomipramine, and all SSRIs had greater effects than did a placebo drug. Overall, it was revealed that psychotherapeutic interventions had a greater effect than medications, but a serious limitation was that most psychotherapeutic treatments included patients who were taking stable doses of antidepressants, and this could falsely impact the results of the data.
Overall, it was found that several pharmacological and psychotherapeutic interventions could be considered more effective than a placebo drug. They found that SSRIs are generally equally effective, with no evidence to suggest that one type of SSRI is better than the other. All differences between psychotherapies were not significant, therefore cognitive therapy, behavioral therapy, and cognitive behavioral therapy showed no significant differences in their effects.
It can be said that a range of interventions are effective in the management of obsessive-compulsive disorder in adults, but there still stems considerable uncertainty regarding their relative efficacy, and future research can include experimental procedures to further investigate the efficacy of OCD treatment. Taking all the current evidence into account, the combination of psychotherapeutic and psychopharmacological interventions is likely to be more effective than psychotherapeutic interventions alone, in treating obsessive compulsive disorder in an adult population.
Written By: Rachel Berkovich, BSc