OCD: An Overview of Effective Treatments

In this video, Dr H. Blair Simpson gives a brief overview of the some of the treatments for obsessive-compulsive disorder (OCD).

Dr Simpson is Professor of Clinical Psychiatry, Columbia University, and Director of the Anxiety Disorders Clinic and the Center for OCD and Related Disorders at New York State Psychiatric Institute in New York City. Dr Simpson is funded by the National Institute of Mental Health (NIMH).

Her team is recruiting adults for an OCD treatment study. Information can be found at:
http://www.ocdtreatmentstudy.comhttp://www.columbia-ocd.org

Some highlights:

One pharmacological treatment is a class of medications called serotonin reuptake inhibitors and that class of medications includes medications like the selective serotonin reuptake inhibitors (SSRIs). These are medications [like fluoxetine (Prozac) or sertraline (Zoloft). One more, clomipramine (Anafranil), is an old-fashioned tricyclic antidepressant, but its primary action also works on the serotonin reuptake inhibitor in the brain.

Clomipramine plus the SSRIs (all serotonin reuptake inhibitors=SRIs) have been shown to be effective for OCD and all of them, with the exception of escitalopram (Lexapro) and citalopram (Celexa) have been approved by the Food and Drug Admistration (FDA) for the treatment of OCD. It is not that the other ones don't work . . . but they have not gone through FDA approval.

Big picture: Serotonin reuptake inhibitors, which include SSRIs, like fluoxetine, as well as clomipramine, all work in the treatment of OCD. There have been large multiple randomized controlled trials multisite.

The other first-line treatment we have for OCD is a type of psychotherapy, cognitive-behavioral therapy (CBT) of a very particular type. CBT is sort of a big umbrella term right now in the literature, and it can mean lots of different things . . . Specifically, we know what works for OCD is a type of CBT called exposure and response prevention, or sometimes also called exposure and ritual prevention. It has all sorts of acronyms in the literature-behavioral therapy, ExRP, ERP-but it is all the same thing. It is exposure and response and ritual prevention.

It is important for psychiatrists to know about medications as well as psychotherapeutic treatments and how to use them together. They also need to be able to evaluate when a patient says they have had therapy but it "didn't work." It is important to follow up and ask them what treatments they have had, because many people have not received treatment that is evidence-based.

More in this video.