Medication For OCD

OCD Treatment of that combines behavior therapy with antidepressant medication (combined therapy) is used often, especially for patients with complicated Obsessive Compulsive Disorder, even though no strong evidence exists that it is superior to behavior therapy alone. 

Antidepressants do have an advantage when it comes to treating depression, but relapse after discontinuation of medication is highly likely. Behavior therapy, on the other hand, generally has lasting benefits. Are there any advantages to combined therapy?

In a review of studies that had used clomipramine, Abel (1993) found that although clomipramine was helpful in the treatment of OCD, its effectiveness was enhanced by behavior therapy. She also found that behavior therapy was the treatment of choice in the absence of depression, and that clomipramine plus behavior therapy was only more effective than behavior therapy alone during the initial stages of treatment.

This was also true for fluvoxamine, but fluvoxamine was more effective than behavior therapy in treating depression. Marks et al. (1988) have argued that the advantage of an antidepressant is to treat the depression in depressed OCD patients and diminish suicidal risk. Lifting mood can facilitate the process of exposure and response prevention. At 18-months follow up, they found that a greater number of subjects in the fluvoxamine-only group still required medication, unlike those in the behavior therapy + fluvoxamine or behavior therapy + placebo groups.

A two-center study is currently comparing clomipramine alone and in combination with behavior therapy. Preliminary results with a modest sample size indicate that behavior therapy was more effective than clomipramine alone, but that the combination of behavior therapy and clomipramine was no more effective than behavior therapy alone. It must be emphasized, however, that these results are only preliminary.

In summary, while there is no unequivocal evidence that combined therapy is superior to behavior therapy alone, several studies do suggest that combined therapy is superior to behavior therapy alone during the initial stages of treatment. It is also likely that antidepressant medications can enhance the effectiveness of behavior therapy in patients with depression and overvalued ideas. Or perhaps cognitive therapy can be an effective treatment for overvalued ideas of Obsessive Compulsive Disorder.