More Effective than an Antidepressant/Antipsychotic Combination?

According to the National Institute of Mental Health (NIMH), studies show that exposure and response prevention (ERP) therapy—also called exposure/ritual prevention therapy—combined with an antidepressant is more effective than an antipsychotic/antidepressant combination to treat OCD that doesn't respond to antidepressants alone. ERP is a specific type of cognitive behavioral therapy (CBT).

In one clinical trial involving 100 people with obsessive-compulsive disorder not adequately treated with antidepressants, about 80 percent of people treated with ERP and an antidepressant responded to therapy, compared to about 23 percent of those treated with an antidepressant and the antipsychotic risperidone (Risperdal). The results of this trial were published in JAMA Psychiatry in 2013.

In this study, OCD symptoms were reduced significantly—to a minimal level—in 43 percent of those receiving CBT/antidepressant treatment and 13 percent of those treated with an antidepressant and risperidone. Researchers noted that medications—including antidepressants and antipsychotics—are only effective in some people with OCD.

The NIMH reports that while OCD medications can relieve symptoms in people with the disorder, behavioral therapy may actually help alter connections in the brain to reduce obsessions and compulsions. When a person with OCD is exposed to anxiety- or fear-producing situations and he/she does not experience the expected consequences, the brain is able to "unlearn" compulsive behaviors.

Exposure and response prevention therapy often is difficult for people with OCD, but it is very effective for many people who have the disorder. If you or someone you love has obsessive-compulsive disorder, it's important to find the right balance of medications, behavioral therapy, and stress management techniques. Talk to your health care provider(s) about ERP.

Source: National Institute of Mental Health (NIMH)

Publication Review By: the Editorial Staff at

Published: 10 Jun 2014

Last Modified: 28 Sep 2015