• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » SSRIs May Work More Quickly in Pediatric OCD Than You Realize

SSRIs May Work More Quickly in Pediatric OCD Than You Realize

November 1, 2016
Bret A. Moore, PsyD, ABPP
bret-a-moore-psyd-abppBret A. Moore, PsyD, ABPP Board-Certified Clinical Psychologist, San Antonio, TX Dr. Moore has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Review of: Varigonda A et al. Journal of the American Academy of Child & Adolescent Psychiatry 2016; ahead of publication.

Study Type: Systematic literature review and meta-analysis

The pharmacological treatment of obsessive-compulsive disorder (OCD) for adults is pretty well worked out. Selective serotonin reuptake inhibitors (SSRIs) are the gold-standard treatment. We have multiple randomized, placebo-controlled trials to back this up. However, we know less about medication treatment of OCD for children.

In a prior research update, we reported that SRIs and CBT are the treatments of choice for pediatric OCD (CCPR, March 2015). For this meta-analysis, researchers dug deeply into the SRI literature to answer five practical questions about the pharmacological treatment of childhood OCD: 1) How quickly do SSRIs work; 2) Are higher doses of SSRIs more effective; 3) Is one SSRI better than another; 4) Are SSRIs better than clomipramine; and 5) Are there differences between the response of children and adults to SSRIs?

To answer these questions, PubMed was mined for randomized controlled trials that compared SSRIs or clomipramine to placebo and used the Children’s Yale-Brown Obsessive-Compulsive Scale as an outcome measure. Trials had to be double-blinded, and participants could not have received behavioral therapy while engaged in pharmacotherapy. Nine studies totaling 801 children were analyzed.

Results
Eighty-five percent of the improvement on SSRIs occurred within the first two weeks and topped out at around week 6. Maximum dosing of SSRIs revealed no therapeutic benefit over lower doses. There were no differences between the effectiveness of fluoxetine, fluvoxamine, sertraline, and paroxetine. Clomipramine was statistically better than SSRIs. And there were no significant differences between the level of response to SSRIs in children and adults.

CCPR’s Take
This meta-analysis reveals some important information about treating pediatric OCD. Most notable is the relatively rapid onset of therapeutic benefit. This challenges the notion that we must wait several weeks to determine efficacy. Other findings, however, are suspect. For example, the lack of a dosing effect may be a result of limited pediatric trials with insufficient participants to adequately compare fixed doses. And, even though clomipramine fared better than the SSRIs, this could easily be because it was the first OCD medication on the market and hasn’t been put through the wringer with treatment-resistant cases, as the SSRIs have been. Also, the relative increased side effect profile of clomipramine must be balanced against possible increased benefits.

Practice implications
The biggest clinical takeaway is that you should be looking for improvements in your OCD pediatric patients earlier than you may previously have planned.
KEYWORDS research-update
    Bret a moore psyd abpp
    Bret A. Moore, PsyD, ABPP

    Extended-Release Guanfacine Improves ADHD Symptoms in Autism

    More from this author
    Introducing Carlat Total Access Subscriptions

    Complete access to every article you search on the website.

    Shop for Total Access
    Free Psychiatry Updates
    The latest unbiased psychiatric information sent to your inbox.
    Specify Your Interests
    Featured Book
    • PB4e_Cover2.png

      Psychiatry Practice Boosters, Fourth Edition (2023)

      Teaches you the key points of 63 of the most clinically relevant studies in psychiatry.
      READ MORE
    Featured Video
    • therapist_canstockphoto9201097.jpg
      General Psychiatry

      Using SAMe In Clinical Practice with Garrett Rossi, MD

      Read More
    Featured Podcast
    • autistic_suicidality.jpeg
      Child Psychiatry

      Addressing Suicidality in Autistic Children and Teens

      Autistic kids and teens can become despondent or suicidal. This episode explores the distinction between self-injurious behavior and suicidality in autistic children,...

      Listen now
    Recommended
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    info@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.