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| |  CINP: Behavior Therapy and Antidepressants Boost Response in Patients with Obsessive Compulsive Disorder By Heather Pengelley Special to DG News MONTREAL, QC -- June 26, 2002 -- Behavior therapy, when combined with effective antidepressant medication, significantly benefits patients with obsessive compulsive disorder (OCD). This finding was presented at the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum (CINP). A randomised, comparative trial in the Netherlands included patients with OCD who had responded to 12 weeks of antidepressant therapy with venlafaxine or paroxetine. Mean age was 35.5 years and mean duration of illness was 14.77 years. The majority of patients were women (70.5 percent). The patients were divided into two treatment groups: 40 patients received medication only and 38 were given a combination of medication and behavior therapy. Patients were evaluated at baseline and at six months. "What you can see is that the combination works," said Dr. Femke de Geus, on behalf of her colleagues in the department of psychiatry, University Medical Center, Utrecht, Netherlands. Behavior therapy followed a strict protocol for 18 sessions and focused on exposure and response prevention. Patients listed their obsessions and compulsions at the beginning of therapy, then discussed exercises that they could use to reduce their symptoms. The patients then agreed to implement those strategies at home. A 41 percent reduction in OCD symptoms occurred among the 25 patients who completed the course of combination therapy. Of 35 patients the medication-only group who completed the study, OCD symptoms increased by 18 percent. This difference was highly significant (p<0.0001). A high dropout rate plagued the group in combination therapy. At six months, the number of participants had dropped from 40 to 25. Despite this setback, the combination group showed positive findings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other standard clinical outcome measures. When the response of all patients, including dropouts, was analysed, patients on combination therapy still showed a significant improvement versus patients on medication only. The combination-therapy group had a 26 percent drop in OCD symptoms, while patients in the medication-only group had a 17 percent increase in symptoms. Again, these findings were highly significant (p<0.0001). Because many patients with OCD choose either medication or behavior therapy, Dr. de Geus believes physicians should encourage their patients to try combination therapy, which these results indicate is more effective in controlling symptoms. In patients with OCD, symptoms are rarely completely resolved with medical treatment, she said. "You can imagine a doctor with a patient who has already responded to medication having to say, 'This is it. I can't do any more for you.’ But he can."
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