Treatment-refractory obsessive compulsive disorder

Summary & key facts

This paper looks at obsessive-compulsive disorder (OCD) that does not get better with the usual treatments. The usual treatments are antidepressant medicines called SSRIs and a type of talking therapy where people face their fears and resist compulsions. The authors review why some people do not improve, how clinicians check that treatment was given properly, and the next steps that can be tried. These next steps include changing or increasing medicines, adding a different kind of medicine, trying drugs that act on a different brain chemical system, providing much more intensive therapy, or — in a few very severe cases — using brain stimulation or surgery. The review says the evidence for these options is mixed and that careful evaluation and specialist care are important.

Key facts:

• When OCD does not improve after getting standard medicines (SSRIs) and a therapy that targets compulsions, clinicians call it treatment-refractory OCD.
• Before calling OCD treatment-refractory, clinicians check that the diagnosis is correct, that the person actually took medicines at the right dose for long enough, and that the therapy was delivered properly.
• For people who keep having severe symptoms, doctors may try raising or switching medicines, adding antipsychotic medicines, or trying drugs that affect glutamate, a different brain chemical.
• Intensive forms of exposure-based therapy can help some people who did not respond to earlier treatment.
• A small number of people with very disabling, treatment-refractory OCD have been offered deep brain stimulation or neurosurgery; these are complex procedures done only in specialist centers and the benefits vary.
• Overall, the research shows mixed results and more high-quality studies are needed to know which second-line treatments work best for which people.

Topics

Body Image and Dysmorphia Studies Eating Disorders and Behaviors Obsessive-Compulsive Spectrum Disorders

Categories

Clinical Psychology Psychology Social Sciences

Tags

Composite material Materials science Medicine Obsessive compulsive Psychiatry Psychology Psychotherapist Refractory (planetary science)

Conditions & symptoms

Obsessive-Compulsive Disorder Anxiety or worry