Which drugs work best for children with
obsessive compulsive disorder?
Geller DA, Biederman J, Stewart SE, Mullin B, Martin A, Spencer T, Faraone SV
The Bottom Line:
In 12 studies of drugs commonly used to treat obsessive compulsive disorder, a tricyclic antidepressant called clomipramine seemed to work best. The other drugs – SSRI drugs which included paroxetine, fluoxetine, fluvoxamine, and sertraline – were found to be more effective than a placebo for many, but not all, of the children and adolescents who took them. There was no difference between any of the SSRI drugs. One problem with clomipramine is that it has some severe side effects, including problems with heart beat rhythm, which may cause some patients to stop taking it. |
What problem is being addressed?
Obsessive compulsive disorder (OCD) is a type of anxiety disorder that often begins in childhood. The child or adolescent with this condition may experience uncontrollable thoughts (obsessions) or impulses. They perform routines or rituals (compulsions) to try to stop the thoughts.
People with OCD keep repeating the rituals or routines so that they can avoid an imagined consequence. For example, many people with OCD are frightened of germs and so will wash their hands until they are raw out of fear that they will catch a disease. The obsessions and compulsions take up so much time that they interfere with daily living and cause a lot of distress and anxiety.
What intervention is being tested?
This review looked at which of the drugs called Selective Serotonin Reuptake Inhibitors (SSRIs) worked best in children and adolescents with OCD. The SSRIs they looked at were paroxetine, fluoxetine, fluvoxamine, and sertraline. They also looked at studies of the drug clomipramine, which is a tricyclic antidepressant (TCA).
What is the real scientific evidence?
The reviewers found 12 randomized controlled trials (RCTs) that met their standards. A total of 1,044 children and adolescents had taken part in these studies. All of the drugs were found to work better than placebos (pills with no effect) and no one SSRI worked better than another. The SSRIs did not work for everyone, though. Clomipramine worked better than any of the SSRIs. However, it sometimes has severe side effects, including the potential to cause heart beat rhythm problems.
The preceding is a summary of:
Geller DA, Biederman J, Stewart SE, Mullin B, Martin A, Spencer T, Faraone SV. Which SSRI? A Meta-Analysis of Pharmacotherapy Trials in Pediatric Obsessive-Compulsive Disorder. American Journal of Psychiatry 2003, 160(11): 1919-1928.
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