Pharmacological treatment of obsessive-compulsive disorder in children and adolescents: An overview

Table 1 Evidence on effectiveness of first line treatment in pediatric obsessive-compulsive disorder

Year	Ref./meta-analysis	Treatment(s) examined	Sample size	Key findings
2004	Pediatric OCD Treatment Study (POTS) Team[6]	CBT, sertraline, or both combined	112	Remission rates were highest for combination therapy (53.6%), followed by CBT (39.3%), sertraline (21.4%), and placebo (3.6%). Both combination and CBT outperformed sertraline and placebo
2015	McGuire et al[23]	CBT, SSRI	CBT: 507, SSRI: 789	CBT demonstrates a large effect size with a remission rate of 53%, while SSRIs show a moderate effect and a 24% remission rate. The NNT is 3 for CBT and 5 for SSRIs
2015	Ivarsson et al[24]	CBT, sertraline, or both combined	14 RCTs	SSRIs outperform placebo; CBT outperforms SSRIs; combining both adds little to CBT; adding CBT to SSRIs benefits non-responders
2016	Öst et al[25]	CBT, sertraline, or both combined	34 RCTs	CBT led to 53% remission, combination therapy 49%, SSRI 24%, and placebo 15%. Combining treatments was no more effective than CBT alone
2016	Varigonda et al[15]	SSRIs, clomipramine	801	The most significant effect is observed early in treatment; clomipramine is more effective than SSRIs
2020	Uhre et al[7]	CBT vs no intervention, CBT vs SSRIs	645 (CBT vs no intervention), 146 (CBT vs SSRIs)	CBT is more effective than no treatment and similar in efficacy to SSRIs
2023	Mendez et al[26]	CBT, SSRI, or both combined	1146	Both SSRI and SSRI + CBT outperform placebo; the combination shows higher scores than SSRI alone, but the difference is not statistically significant. Improvement depends on sample characteristics
2024	Steele et al[27]	ERP, SSRIs, clomipramine, or combining SSRI/clomipramine with ERP	71 RCTs	ERP demonstrates greater efficacy than SSRIs when used alone; combining ERP with SSRIs also produces better outcomes compared to SSRIs alone. Both SSRIs and clomipramine show effectiveness
2025	Cohen et al[28]	SSRIs vs placebo	614	SSRIs result in a modest CY-BOCS decrease (average 3 points) with a small effect size; higher initial severity reduces response

OCD: Obsessive compulsive disorder; CBT: Cognitive behavioral therapy; SSRI: Selective serotonin reuptake inhibitors; ERP: Exposure and response prevention; RCT: Randomized controlled trial; NNT: Number needed to treat; CY-BOCS: Children’s Yale-Brown Obsessive Compulsive Scale.

Table 2 Studies examining the use of antipsychotics in resistant obsessive-compulsive disorder

Ref.	Study design	Sample size	Population	Medication (dose)	Response	Side effects
Masi et al[43]	Open label	39	Adolescents with SSRI-resistant OCD	Aripiprazole (12.2 ± 3.4 mg)	59.5% responded	Mild agitation and sleep disturbances (approximately of 10% of cohort)
Masi et al[44]	Open label	69	Children with tic-related OCD	Risperidone (1.7 ± 0.8 mg) or aripiprazole (8.9 ± 3.1 mg)	56.5% responded	Risperidone: Weight gain, sedation. Aripiprazole: Mild to moderate agitation
Akyol Ardic et al[45]	Retrospective chart review	48	Children and adolescents with treatment resistant OCD	Aripiprazole (3.4 ± 2.2 mg)	Significant improvement in YBOCS/CGI scores	Statistically significant weight gain

SSRI: Selective serotonin reuptake inhibitors; OCD: Obsessive compulsive disorder; YBOCS: Yale-Brown Obsessive Compulsive Scale; CGI: Clinical Global Impression.