title: 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.
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.
authors.affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, 0405 Oslo, Norway. Electronic address: tord.ivarsson@r-bup.no.
authors.forename: Tord
authors.initials: T
authors.lastname: Ivarsson
authors.affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, 0405 Oslo, Norway.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Skarphedinsson
authors.affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, 0405 Oslo, Norway.
authors.forename: Hege
authors.initials: H
authors.lastname: Kornør
authors.affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, 0405 Oslo, Norway.
authors.forename: Brynhildur
authors.initials: B
authors.lastname: Axelsdottir
authors.affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, 0405 Oslo, Norway.
authors.forename: Sølvi
authors.initials: S
authors.lastname: Biedilæ
authors.affiliation: Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: Isobel
authors.initials: I
authors.lastname: Heyman
authors.affiliation: Child and Adolescent Anxiety Disorders Program, Department of Psychiatry University of São Paulo Medical School, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Asbahr
authors.affiliation: Aarhus University Hospital, Child and Adolescent Psychiatric Centre, Risskov, Denmark.
authors.forename: Per Hove
authors.initials: PH
authors.lastname: Thomsen
authors.affiliation: National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, Herts, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Fineberg
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: March
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Combination treatments; Obsessive-compulsive disorder; Psychopharmacology; Psychotherapy; Sequential treatments