What is the typical treatment for Obsessive-Compulsive Disorder (OCD)?

From the Guidelines

The most effective treatment for Obsessive-Compulsive Disorder (OCD) is a combination of cognitive-behavioral therapy (CBT), specifically Exposure and Response Prevention (ERP), and medication, with SSRIs being the first-line choice, as supported by the most recent and highest quality study 1. The treatment of OCD typically involves a combination of psychotherapy and pharmacotherapy.

• Cognitive-behavioral therapy (CBT) is a type of psychotherapy that is effective in treating OCD, with Exposure and Response Prevention (ERP) being a key component.
• ERP therapy involves gradually exposing patients to situations that trigger their obsessions while helping them resist performing compulsive behaviors.
• This therapy typically requires 12-20 weekly sessions, with patients practicing exercises between sessions. For medications, selective serotonin reuptake inhibitors (SSRIs) are the first-line choice, including:
• Fluoxetine (20-80 mg/day)
• Sertraline (50-200 mg/day)
• Fluvoxamine (100-300 mg/day)
• Paroxetine (20-60 mg/day)
• Escitalopram (10-40 mg/day) These medications usually require 8-12 weeks at therapeutic doses to show maximum benefit and should be continued for at least 1-2 years after symptom improvement, as indicated by 1. In treatment-resistant cases, augmentation strategies might include adding antipsychotics like risperidone (0.5-2 mg/day) or aripiprazole (2.5-15 mg/day), as suggested by 1. The combination of ERP and medication is often more effective than either treatment alone because ERP helps patients develop coping skills while medications help normalize brain chemistry, particularly serotonin function, which is implicated in OCD pathophysiology. Additionally, unguided computer-assisted self-help therapy for OCD is effective compared to waiting lists or psychological placebo, and an ERP component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy, as found in the systematic review and meta-analysis 1.

From the FDA Drug Label

Adult — In the controlled clinical trials of fluoxetine supporting its effectiveness in the treatment of OCD, patients were administered fixed daily doses of 20,40, or 60 mg of fluoxetine or placebo. A dose of 20 mg/day, administered in the morning, is recommended as the initial dose. Since there was a suggestion of a possible dose–response relationship for effectiveness in the second study, a dose increase may be considered after several weeks if insufficient clinical improvement is observed. The full therapeutic effect may be delayed until 5 weeks of treatment or longer. Doses above 20 mg/day may be administered on a once–a–day (i. e., morning) or BID schedule (i.e., morning and noon). A dose range of 20 to 60 mg/day is recommended; however, doses of up to 80 mg/day have been well tolerated in open studies of OCD.

The typical treatment for Obsessive-Compulsive Disorder (OCD) is with medications such as fluoxetine, with an initial dose of 20 mg/day.

• The dose may be increased after several weeks if insufficient clinical improvement is observed.
• The full therapeutic effect may be delayed until 5 weeks of treatment or longer.
• Doses above 20 mg/day may be administered on a once-a-day or BID schedule.
• A dose range of 20 to 60 mg/day is recommended, with a maximum dose of 80 mg/day 2.
• Other medications such as sertraline and paroxetine are also indicated for the treatment of OCD 3, 4.

From the Research

Treatment Options for Obsessive-Compulsive Disorder (OCD)

The typical treatment for OCD includes:

• Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) as first-line treatments 5, 6, 7
• Combination of CBT and SRIs, which may be beneficial for patients with severe depression 5
• Sequential administration of CBT after medications, which can be useful in promoting remission in patients who partially responded to drugs and in promoting response in resistant patients 5

Pharmacological Treatments

Pharmacological interventions for OCD include:

• Selective serotonin reuptake inhibitors (SSRIs) as the most effective treatment 6, 8, 7
• Clomipramine, a tricyclic antidepressant, as a second-line treatment 6, 7
• Atypical antipsychotics as an augmentation strategy for refractory OCD 6, 8

Psychotherapy

Psychotherapy options for OCD include:

• Cognitive-behavioral therapy (CBT) as a first-line treatment 5, 6, 8
• Exposure and response prevention (ERP) as a similarly oriented therapy to CBT 6
• Online-based dissemination of cognitive behavioral therapies, which have demonstrated clinically significant decreases in OCD symptoms 8

Treatment Resistance

For treatment-resistant OCD, strategies include:

• Switching to another SSRI or clomipramine 6
• Augmentation with an atypical antipsychotic 6, 8
• Neuroleptics and neuromodulatory approaches, such as deep-brain stimulation and neurosurgical ablation 8
• Pharmacogenomics and personalization of therapy to reduce treatment resistance 6