A controlled, randomized clinical trial at Columbia University shows that patients with Obsessive Compulsive Disorder do significantly better and remain better when treated with exposure therapy alone, or exposure plus clomipramine (Anafranil), than with clomipramine alone..

Investigators at The New York State Psychiatric Institute at Columbia University sought to determine whether adults with obsessive-compulsive disorder (OCD) who respond to intensive exposure and response (ritual) prevention (EX/RP), with or without clomipramine (Anafranil, a tricyclic antidepressant with anti-obsessional features) fare better 12 weeks after treatment discontinuation than responders receiving clomipramine alone. After receiving 12 weeks of treatment for obsessive compulsive disorder (having been randomly assigned to either exposure therapy plus clomipramine, exposure alone, clomipramine alone or pill placebo, at three outpatient research centers, the 46 adults who responded to treatment (18 exposure therapy, 11 clomipramine, 15 both, 2 placebo) were followed after treatment discontinuation for 12 weeks.

Patients were assessed every 4 weeks with the Yale-Brown Obsessive-Compulsive Scale, the National Institutes of Health Global Obsessive-Compulsive Scale, and the Clinical Global Impressions scale by an evaluator who was blind to the original treatment assignment.

The primary hypothesis was that EX/RP and EX/RP+CMI responders would be less likely to relapse 12 weeks after treatment discontinuation than responders to CMI alone. Twelve weeks after treatment discontinuation, exposure and exposure plus clomipramine responders, compared to clomipramine responders, had a significantly lower relapse rate (4/33 = 12% versus 5/11 = 45%) and a significantly longer time to relapse. The clomipramine relapse rate was lower than previously reported. Nonetheless, responders receiving intensive exposure therapy with or without clomipramine fared significantly better 12 weeks after treatment discontinuation than responders receiving clomipramine alone.

Citation: Simpson HB, Liebowitz MR, Foa EB, Kozak MJ, Schmidt AB, Rowan V, Petkova E, Kjernisted K, Huppert JD, Franklin ME, Davies SO, Campeas R.Post-treatment effects of exposure therapy and clomipramine in obsessive-compulsive disorder. Depression and Anxiety. 2004; 19 (4): pages 225-33. [email protected]