Rajalakshmi AK, Pawar AKS, Baweja R. Pharmacological treatment of obsessive-compulsive disorder in children and adolescents: An overview. World J Clin Pediatr 2026; 15(1): 114315 [DOI: 10.5409/wjcp.v15.i1.114315]
Corresponding Author of This Article
Aarya K Rajalakshmi, MD, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States. arajalakshmi@mgb.org
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Psychiatry
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Mar 9, 2026 (publication date) through Mar 9, 2026
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World Journal of Clinical Pediatrics
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2219-2808
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Rajalakshmi AK, Pawar AKS, Baweja R. Pharmacological treatment of obsessive-compulsive disorder in children and adolescents: An overview. World J Clin Pediatr 2026; 15(1): 114315 [DOI: 10.5409/wjcp.v15.i1.114315]
World J Clin Pediatr. Mar 9, 2026; 15(1): 114315 Published online Mar 9, 2026. doi: 10.5409/wjcp.v15.i1.114315
Pharmacological treatment of obsessive-compulsive disorder in children and adolescents: An overview
Aarya K Rajalakshmi, Aditya K S Pawar, Raman Baweja
Aarya K Rajalakshmi, Aditya K S Pawar, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
Raman Baweja, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
Co-first authors: Aarya K Rajalakshmi and Aditya K S Pawar.
Author contributions: Rajalakshmi AK and Pawar AKS performed the initial literature review, prepared the original draft, and they contributed equally to this manuscript and are co-first authors; Baweja R edited the draft and approved the final version. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: Baweja R has received grant funding from Cardinal Health Foundation (Children’s Hospital Association and Zero Suicide Initiative), research funding from Supernus and served on the advisory board for Ironshore. Rajalakshmi AK and Pawar AKS have no biomedical financial interests or potential conflicts of interest.
Corresponding author: Aarya K Rajalakshmi, MD, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States. arajalakshmi@mgb.org
Received: September 16, 2025 Revised: October 28, 2025 Accepted: January 4, 2026 Published online: March 9, 2026 Processing time: 171 Days and 15.5 Hours
Abstract
Pediatric obsessive-compulsive disorder (OCD) affects 1%-3% of children and adolescents. It is characterized by obsessions, and compulsions and is associated with significant distress and interference with functioning. The first line treatment for pediatric OCD is cognitive-behavioral therapy, specifically exposure response prevention. In situations where there are challenges to meaningful engagement in therapy, accessing therapy or when the illness is severe, pharmacological interventions can be a useful adjunct to treatment. Selective serotonin reuptake inhibitors are established as the initial pharmacological approach. Clomipramine is also an effective medication option, but its use is limited by tolerability concerns. However, a subset of patients does not respond to these first-line interventions of cognitive-behavioral therapy and serotoninergic medication. In these treatment-resistant patients, antipsychotic augmentation can be helpful as the next pharmacological option but should be used cautiously due to potential for side effects. Glutamate modulating agents are an emerging medication class as augmenting options. Newer treatments for pediatric OCD that are effective, safe, and well-tolerated are needed. This comprehensive review outlines the approach to pharmacological treatment of pediatric OCD and the evidence supporting their use.
Core Tip: Pediatric obsessive-compulsive disorder is a common and impairing condition associated with significant distress. First-line treatment is cognitive-behavioral therapy with exposure/response prevention. For moderate-to-severe cases or when therapy is inaccessible, pharmacotherapy is used adjunctively. Selective serotonin reuptake inhibitors are the initial drugs of choice, with clomipramine as an effective but less tolerated alternative. For treatment-resistant cases, antipsychotic augmentation is a next-step option, though used cautiously due to side effects. Glutamate modulators represent an emerging augmenting strategy. This review outlines the current pharmacological approach, highlighting the ongoing need for newer, effective, and well-tolerated treatments.
