The place of and evidence for serotonin reuptake inhibitors (SRIs) for obsessive compulsive disorder (OCD) in children and adolescents: Views based on a systematic review and meta-analysis

Tord Ivarsson*, Gudmundur Skarphedinsson, Hege Kornør, Brynhildur Axelsdottir, Sølvi Biedilæ, Isobel Heyman, Fernando Asbahr, Per Hove Thomsen, Naomi Fineberg, John March

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

49 Citations (Scopus)

Abstract

Serotonin reuptake inhibiting drugs (SRI) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years. We performed a systematic review and meta-analysis of the literature to discuss the place of and evidence for the use of SRI in paediatric OCD, based on 14 publications of methodologically sound, randomized and controlled studies. Both SRI and specific SRIs were examined and comparisons of SRI, placebo, cognitive behaviour therapy (CBT), combined (COMBO) treatments (SRI+CBT) made to investigate their relative efficacy. Using the Cochrane methodology, and as measures of effect size mean difference and Hedge's g, SRIs proved to be superior to drug placebo, with a modest effect size. From direct comparisons of CBT and SRI treatments, we conclude that CBT has the superior efficacy. COMBO versus CBT shows that SRI treatment adds little to concomitant CBT, while COMBO shows favourable outcome versus SRI alone. In pre-trial partial treatment responders, those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI. Those who failed CBT treatment did as well with continued CBT as with switching to a SRI. The studies of combinations and sequences of treatments need to be developed further.

Original languageEnglish
Pages (from-to)93-103
Number of pages11
JournalPsychiatry Research
Volume227
Issue number1
DOIs
Publication statusPublished - 30 May 2015

Bibliographical note

Publisher Copyright:
© 2015 Elsevier Ireland Ltd.

Other keywords

  • Combination treatments
  • Obsessive-compulsive disorder
  • Psychopharmacology
  • Psychotherapy
  • Sequential treatments

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