Obsessive-compulsive disorder in adults: efficacy of combined and sequential treatments

Objective: the aims of the present paper are to review literature data on pharmacological and cognitive behavioral therapy (CBT) combination treatments for adult patients with OCD and answer the following questions: 1) does combination treatment add benefits as compared to either monotherapy? 2) is a sequential combination useful for patients with residual symptoms or resistant patients? Method: we reviewed available data concerning combining Serotonin Reuptake Inhibitors (SRIs) and CBT in the treatment of OCD. Only studies performed in adults were selected. 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 eight controlled studies which investigated the efficacy of combination treatments versus CBT alone and five which evaluated the efficacy of combination versus medications alone. Six studies, one of which double-blind, investigated sequential treatments. Methodologies and results of these studies are presented and discussed. Conclusions: the combination ab initio of CBT, or better Exposure and Response Prevention techniques (ERP), and SRIs has not been found to be clearly superior to either therapy alone in most studies that have examined this question, except for patients with severe depression who might benefit more from the combination than from CBT only. A sequential administration of CBT after medications is useful in promoting remission in patients who responded to drugs and in promoting response in patients who failed to respond to medication.