The review concluded that overall, the combination of psychotherapeutic and psychopharmacological interventions is likely to be more effective than are psychotherapeutic interventions alone, at least in severe obsessive-compulsive disorder.
According to a commentary, this comprehensive, carefully done study is an example of how obtaining of evidence-based information to guide clinical practice is challenging, even in a well explored research area. It notes that despite the large number of published RCTs, important clinical questions remain unanswered. One of gaps in knowledge is that no potential differences in the efficacies of individual SSRIs or between SSRIs as a group and clomipramine could be shown. Another point is that although the effect of psychotherapeutic interventions was greater than that of medications, pure psychotherapeutic and pharmacological treatments could not be compared directly because most studies of psychotherapy included patients taking stable doses of antidepressants. In addition, the median duration of the RCTs included in the analysis was short (12 weeks) but obsessive-compulsive disorder is usually a long-lasting condition, and consistent clinical improvement might take much longer than 3 months to achieve.