Penn study: When drugs fail, there’s still hope for OCD patients

Even after two kinds of medication have failed, a type of psychosocial therapy can make a big dent in symptoms for people with obsessive-compulsive disorder (OCD), a new study from the University of Pennsylvania found.

The research tested exposure and response prevention  therapy in people who were not doing well after treatment with serotonin reuptake inhibitors, which are a first-line treatment, and risperidone, an antipsychotic that is sometimes added if antidepressants are not enough.

In the study of 32 people, those who received 17 therapy sessions had significant reductions in OCD symptoms and depression as well as significant increases in insight, quality of life and social functioning. Thirty-two weeks after treatment, 17 patients had at least a 25 percent reduction in symptoms and 11 of those had achieved an “excellent” response.

The study was led Carmen McLean, an assistant professor of clinical psychology. Edna Foa director of the Center for the Treatment and Study of Anxiety, was the senior author.

A previous Penn study had found the therapy to be superior to treatment with risperidone or placebo. The new study, published last week in the Journal of Clinical Psychiatry, involved patients who had crossed over from the placebo and therapy arms of the earlier one.

Foa said that the studies show that “if you have a choice between taking risperidone and doing exposure and response prevention, you are better off doing exposure and response prevention. You are more likely to improve, but also you don’t have the side effects that risperidone has.”

Earlier work showed that exposure and response prevention was a more effective first-line treatment, Foa said, but it is not widely available so many patients are given drugs.

OCD is an anxiety disorder in which people perform rituals in response to obsessive thoughts. They may, for example, wash their hands repeatedly because of fear of germs or check whether the door is locked constantly for fear of intruders.

In exposure and response prevention therapy, which was developed by Foa, OCD patients, who often try to avoid their obsessive thoughts, learn instead to tolerate them through repeated exposure. They are also taught not to respond with compulsive rituals.

Even after treatment, most people with OCD have some symptoms, Foa said, but they can learn to cope enough that they can socialize comfortably and go to work. Instead of washing their hands for three hours a day, they may be able to only wash after a trip to the rest room.

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