Medication Management of Childhood OCD

Drug treatment in pediatric OCD has been used for close to 40 years, and the evidence for the efficacy of serotonin reuptake inhibiting (SRI) drugs that has been accumulated is substantial. Starting out with placebo-controlled studies it was established that patients on SRI (e.g., clomipramine, sertraline, fluoxetine, or fluvoxamine) did decrease OCD symptoms with a moderate effect size. However, in direct head-to-head comparisons CBT is superior to SRI and is more robust across different comparisons. For example, does CBT in combination with SSRI work well in SSRI nonresponders, while CBT and sertraline do as well in CBT nonresponders (in a trial of average duration) and sertraline treatment does not enhance good CBT. We argue that CBT should be the first-line treatment in OCD and that SSRI should be reserved for those who do not respond to expertly delivered and possibly extended CBT (i.e., 16–24 sessions). The teams working with pediatric OCD patients should as well consider if pharmacological treatment may be needed for comorbid problems that may interfere with CBT (e.g., treatment for ADHD, severe aggression, etc.).