Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo

Abstract

Background We investigated whether the combination of multimodal behaviour therapy (BT) with fluvoxamine is superior to BTand placebo in the acute treatment of severely ill in-patients with obsessive-compulsive disorder (OCD). Method In a randomised, double-blind design, 30 patients were treated for nine weeks with BT plus placebo and 30 patients with BT plus fluvoxamine (maximum dosage 300 mg, mean dose 288.1 mg). BT included exposure with response prevention, cognitive restructuring and development of alternative behaviours. Results Both groups showed a highly significant symptom reduction after treatment. There were no significant differences between the groups concerning compulsions. Obsessions were significantly more reduced in the fluvoxamine and BT group than in the placebo and BT group. Furthermore, the group BT plus fluvoxamine showed a significantly higher response rate (87.5 v. 60%) according to a previously defined response criterion. Severely depressed patients with OCD receiving BT plus placebo presented a significantly worse treatment outcome (Y–BOCS scores) than all other groups. Conclusions The results suggest that BTshould be combined with fluvoxamine when obsessions dominate the clinical picture and when a secondary depression is present.