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The article “Cognitive-Behavioral Therapy vs Risperidone for Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Randomized Clinical Trial” by Simpson et al1 in this issue reports that exposure/ritual prevention (EX/RP) is without question more effective than risperidone or placebo in augmenting serotonin reuptake inhibitor (SRI) response in an 8-week randomized clinical trial with 100 participants. Simpson et al call for a change in practice, because augmentation for SRI nonresponders with atypical antipsychotics is recommended in the American Psychiatric Association guidelines.2 This is a well-controlled randomized clinical trial worthy of strong conclusions. Simpson et al have a track record of well-controlled combination studies in obsessive-compulsive disorder (OCD), and the conclusion that EX/RP should be considered first for SRI treatment augmentation is supported by the current data.
Ressler KJ, Rothbaum BO. Augmenting Obsessive-Compulsive Disorder TreatmentFrom Brain to Mind. JAMA Psychiatry. 2013;70(11):1129-1131. doi:10.1001/jamapsychiatry.2013.2116