CBT recommended for initial treatment of pediatric OCD

Children and adolescents with obsessive-compulsive disorder (OCD) should initially be treated with combined cognitive behavior therapy (CBT) plus a selective serotonin reuptake inhibitor (SSRI) or CBT alone, claim researchers.

The team from the Pediatric OCD Treatment Study (POTS) found that combining sertraline and CBT was more effective than either treatment alone. Moreover, CBT alone proved to be superior to setraline alone, which, in turn, was more effective than placebo.

They randomly assigned 112 patients with OCD aged between 7 and 17 years to receive treatment with CBT, the SSRI sertraline, both treatments combined, or placebo for 12 weeks.

In total, 97 (87%) of the participants completed the full 12 weeks of treatment. The remission rates were 53.6% for patients receiving combined treatment, 39.3% for those assigned to CBT, 21.4% for those taking sertraline, and 3.6% for patients given placebo.

The large majority of patients who received their treatment as intended highlights the acceptability of such medications to patients, say John March (Duke University Medical Center, Durham, North Carolina, USA) and colleagues. They add that the active treatments were all generally well tolerated, with no evidence of treatment-emergent harm to the patients or others.

This finding carries "significant public health implications for the management of OCD in youth and for future directions in research," March et al. note in the Journal of the American Medical Association.

"We believe that the results of this study will contribute to the appreciation by non-physician mental health clinicians of the strengths and limitations of pharmacological treatments and to the appreciation by physicians of evidence-based psychosocial treatments."

They conclude: "It is imperative that the focus of research turn to identifying and testing dissemination strategies for CBT."

JAMA 2004; 292: 1969-1976