Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review.

BACKGROUND: In Obsessive Compulsive Disorder (OCD)
current standard pharmacotherapies may be of limited efficacy. Non-conventional
interventions such as Complementary and Alternative Medicine (CAM), self-help
techniques, and lifestyle interventions are commonly used by sufferers of OCD,
however to date no systematic review of this specific area exists. METHODS: We conducted a systematic review of studies
using CAM, self-help, and lifestyle
interventions for treatment of OCD and trichotillomania (TTM). PubMed,
PsycINFO, China Academic Journals Full-text Database, The Cochrane Library and
CINAHL were searched (up to Jan 11th 2011), for controlled clinical trials
using non-conventional interventions for OCD. A quality analysis using a
purpose-designed scale and an estimation of effect sizes (Cohen's d) where data
was available, were also calculated. RESULTS:
The literature search revealed 14 studies that met inclusion criteria.
Methodological quality of nutraceutical studies (nutrients and herbal
medicines) were rated as high (mean 8.6/10), whereas mind-body or self-help
studies were poorer (mean 6.1/10). In OCD, tentative evidentiary support from
methodologically weak studies was found for mindfulness meditation (d=0.63),
electroacupuncture (d=1.16), and kundalini yoga (d=1.61). Better designed
studies using the nutrient glycine (d=1.10), and traditional herbal medicines
milk thistle (insufficient data for calculating d) and borage (d=1.67) also
revealed positive results. A rigorous study showed that N-acetylcysteine
(d=1.31) was effective in TTM, while self-help technique "movement
decoupling" also demonstrated efficacy (d=0.94). Mixed evidence was found
for myo-inositol (mean d=0.98). Controlled studies suggest that St John's wort, EPA, and
meridian-tapping are ineffective in treating OCD. CONCLUSIONS: While several studies were
positive, these were un-replicated and commonly used small samples. This
precludes firm confidence in the strength of clinical effect. Preliminary
evidence however is encouraging, and more rigorous research of some of the more
hypothesis-based interventions in the treatment of OCD and TTM may be
indicated.