Combining pharmacological and psychotherapeutic interventions for obsessive-compulsive disorder patients

Object: The aim of the present paper is to answer the following questions: 1) does combining medication and CBT add benefits as compared to CBT alone? 2) Does adding CBT to medication give further improvement as compared to medication alone? 3) Do benefits of combination treatments persist over the long-term? Method: We reviewed available data concerning combining medications (SRIs) and cognitive-behavior therapy (CBT) in the treatment of Obsessive-Compulsive Disorder (OCD). A separate analysis was made for studies which investigated combined treatments ab initio and for those which evaluated the efficacy of sequential treatments. Results: We identified nine controlled studies which investigated the efficacy of combination treatments versus CBT alone and five which evaluated the efficacy of combination versus medications alone. Few studies investigated sequential treatments. Methodologies and results of these studies are presented and discussed. Conclusions: The short-term or long-term treatment effect of CBT is not augmented by the addition of medication; a combination of CBT and medication might be superior to CBT alone when obsessions dominate the clinical picture and/or when a severe secondary depression is present. Children and adolescents with OCD could also benefit more from the combination treatment. The short-term treatment effect of antidepressants can be enhanced by the addition of CBT a) to augment the benefit from medication; b) to reduce the use of medication for those patients who are intolerant to side effects; 3) to prevent relapses for those patients who want to discontinue medication after short-term response. A sequential administration of CBT after medication might convert patients who failed to fully respond to medication in responders.