Systematic Review ARTICLE
The effectiveness of Selective Serotonin Reuptake Inhibitors (SSRI) for Treatment of Obsessive- Compulsive Disorder (OCD) in Adolescents and Children: A Systematic Review and Meta-Analysis
- 1Manhattan Psychiatric Center, United States
- 2University of Texas Rio Grande Valley Edinburg, United States
- 3Brigham and Women's Hospital, Harvard Medical School, United States
- 4Jamaica Hospital Medical Center, United States
- 5Zucker Hillside Hospital, United States
- 6McMaster University, Canada
- 7St. John's University, United States
- 8Liaquat University of Medical & Health Sciences, Pakistan
Background: Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRI) are the first pharmacological choice for this condition due to mild adverse effect profile. Objective: This systematic review was performed to evaluate the efficacy of SSRI for OCD in adolescents and children. Methods: Search terms were entered into PubMed, PsycINFO, Scopus, CINAHL and Google Scholar. The included studies were randomized, placebo-controlled trials of SSRIs conducted in populations of children and adolescents younger than 18 years. Change from baseline CY-BOCS, end-treatment CY-BOCS with respective SD and response and remission rates were collected for continuous and dichotomous outcome assessment, respectively. Cochrane Rev Man software was used for meta-analyses, providing Forest plots where applicable. Results: SSRIs were superior to placebo with a small effect size. There was no additional benefit of combination treatment over CBT alone, but CBT added substantial benefit to SSRI monotherapy. Fluoxetine and Sertraline appear to be superior to Fluvoxamine. Conclusion: The results of current systematic review and meta-analysis support the existing NICE guidelines for choosing CBT as the first line of treatment and substituting it with SSRI depending on patient preference. Adding CBT to current SSRI treatment is effective for non-responders and partial responders but adding SSRI to ongoing CBT does not prove beneficial. The SSRIs have different effectiveness and their relative efficacy remains to be investigated.
Keywords: Selective serotonin reuptake inhibitors (SRIs), OCD (obsessive-compulsive disorder), adolescents, Children, CBT (cognitive-behavioral therapy)
Received: 20 Nov 2018;
Accepted: 02 Jul 2019.
Edited by:Martine F. Flament, University of Ottawa, Canada
Reviewed by:Vivek Agarwal, King George's Medical University, India
DEEPAK KUMAR, Institute of Human Behaviour and Allied Sciences, India
Copyright: © 2019 Kotapati, Khan, Dar, Begum, Bachu, Adnan, Zubair and Ahmed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Vijaya Padma Kotapati, Manhattan Psychiatric Center, New York, United States, email@example.com