[Combined treatments in obsessive-compulsive disorder: current knowledge and future prospects]

Area of Science:

• Psychiatry
• Clinical Psychology
• Pharmacology

Background:

• Obsessive-compulsive disorder (OCD) is a debilitating mental health condition.
• First-line treatments include serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT).
• The optimal treatment strategy, including combination and sequential approaches, requires further investigation.

Purpose of the Study:

• To evaluate if combining SRI and CBT from the outset (ab initio) is more effective than monotherapy for OCD.
• To assess the efficacy of sequential treatment in both patients who respond to initial therapy and those who do not.

Main Methods:

• A systematic literature search was conducted on the Medline/PubMed database for randomized controlled trials (RCTs) in English.
• Nine RCTs comparing combined SRI+CBT versus CBT alone were analyzed.
• Six RCTs comparing combined SRI+CBT versus SRI alone were analyzed.
• Naturalistic studies on sequential treatments were examined (2 for responders, 7 for non-responders) due to a lack of controlled trials.

Main Results:

• Seven of nine studies found no added benefit of combined SRI+CBT over CBT alone.
• Combination therapy was more effective than CBT alone in children/adolescents and severely depressed adults with OCD.
• Combination therapy showed mixed results compared to SRI alone (more effective in 2/6 studies).
• All examined naturalistic studies indicated the efficacy of sequential treatment strategies in OCD.

Conclusions:

• Combined SRI+CBT is not consistently superior to monotherapy for OCD, except in specific populations (severe depression, pediatric/adolescent).
• Sequential treatment approaches demonstrate effectiveness in managing residual symptoms in responders and achieving clinical response in treatment-resistant patients.