Patients with obsessive-compulsive disorder (OCD) who achieve wellness after exposure/response prevention (EX/RP) therapy appear to be able to discontinue serotonin reuptake inhibitor (SRI) medication, although careful monitoring for worsening is warranted, according to a study published in JAMA Psychiatry.

“SRIs are the only medications approved for OCD, yet most patients taking SRIs exhibit significant symptoms,” researchers explained in the study background. “Adding EX/RP therapy improves symptoms, but it is unknown whether patients maintain wellness after discontinuing SRIs.”

To investigate outcomes with SRI discontinuation after successful EX/RP therapy, researchers conducted a double-blind, randomized clinical trial involving 101 adult patients who had achieved wellness after augmentation with EX/RP therapy. Participants were randomly assigned either to taper to placebo or to continuation of SRI and monitored for 24 weeks.

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The study found noninferior results for the group that tapered to placebo compared with the group that continued SRIs. At 24 months, average scores on the:

• Yale-Brown Obsessive-Compulsive Scale were 11.47 points with tapering and 11.51 points with SRI continuation;
• Hamilton Depression Rating Scale were 5.69 points with tapering and 4.61 points with continuation; and
• Quality-of-Life Enjoyment and Satisfaction Questionnaire–Short Form were 68.01% with tapering and 70.01% with SRI continuation, researchers reported.

However, rates of clinical worsening were higher in the tapering group: 45%, compared with 24% in the SRI continuation group.

“Results of this randomized clinical trial show that patients with OCD who achieve wellness after EX/RP therapy could, on average, discontinue their SRI with noninferior outcomes compared with those who continued their SRI,” researchers wrote. “Those who tapered the SRI had higher clinical worsening rates. Future research should evaluate if SRI half-life alters these rates.”

Reference

Foa EB, Simpson HB, Gallagher T, et al. Maintenance of wellness in patients with obsessive-compulsive disorder who discontinue medication after exposure/response prevention augmentation: a randomized clinical trial. JAMA Psychiatry. 2022;79(3):193-200. doi: 10.1001/jamapsychiatry.2021.3997