REVIEW OF: Cohen SE et al, J Am Acad Child Adolesc Psychiatry 2025;64(7):775–785
STUDY TYPE: Individual participant data meta-analysis of RCTs

SSRIs are a mainstay of medication treatment for pediatric OCD, but clinicians often wonder how much improvement they realistically deliver—and for whom.

Investigators analyzed data from 614 children and adolescents ages 6–18 enrolled in four North American trials. Participants received an SSRI or placebo for 10–13 weeks. Outcomes were measured with the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS).

SSRIs led to greater improvement than placebo, but the effect was modest. On average, SSRI treatment reduced CY-BOCS scores by about three points more than placebo. Children receiving SSRIs were nearly twice as likely to meet response criteria (35% reduction of symptoms).

Baseline severity mattered. Children with milder OCD benefited more, while those with more severe symptoms were less likely to respond. Each single point of increase in baseline severity reduced the odds of response by 8%. Severity did not affect partial response rates (25% reduction of symptoms). Age, sex, weight, and illness duration did not meaningfully affect outcomes.

Limitations include short follow-up, high placebo response rates typical in OCD trials, unspecified SSRIs, and a 90% North American sample that may limit generalizability.

CARLAT TAKE
SSRIs work for pediatric OCD, but they don’t work wonders. A three-point CY-BOCS improvement is real, yet often falls short of what families hope for, especially in moderate-to-severe cases. SSRIs are part of a combined strategy, not a stand-alone fix. For mild OCD, we recommend cognitive behavioral therapy with exposure and response prevention, although medication alone may be reasonable. For more severe presentations, SSRIs play a supporting role. When setting expectations, be honest: SSRIs can help take the edge off, but meaningful recovery usually requires more than medication alone.