Efficacy and acceptability of cognitive‐behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive‐compulsive disorder: a network meta‐analysis

Abstract

BackgroundCognitive‐behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive‐compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in‐person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet‐delivered CBT (ICBT).MethodsPubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in‐person, webcam/telephone‐delivered, or ICBT) or SRIs with control conditions or each other. Network meta‐analyses were conducted to examine efficacy (post‐treatment Children's Yale‐Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta‐Analysis).ResultsThirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In‐person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95–11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [−2.51, 4.21]; moderate), SRIs (MD: 3.07 [−0.07, 6.20]; low), or the combination of in‐person CBT and SRIs (MD: −1.20 [−5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low.ConclusionsIn‐person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in‐person CBT overall having a stronger evidence base. The combination of in‐person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.

The Psychology of Atopic Dermatitis

“…Oral antidepressants evaluated in these studies included SSRIs (e.g., fluoxetine, fluvoxamine, paroxetine), sertraline, tricyclic antidepressants (e.g., amitriptyline, nortriptyline, doxepin), and the atypical tetracyclic antidepressant, mirtazapine [ 43 ]. Typically, due to their favourable safety profile, SSRIs are considered the primary pharmacological choice for treating depression, anxiety, and OCD in the elderly, adult, and paediatric populations [ 44 , 45 , 46 , 47 ]. Alternative preferred options in adults include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine [ 44 ].…”

“…Effective treatments for OCD in adult and paediatric patients include behavioural therapy (exposure and response/ritual prevention and CBT) and serotonin-reuptake inhibitor (SRI) pharmacotherapy [ 45 , 46 ]. The latter includes clomipramine (a nonselective serotonin–norepinephrine reuptake inhibitor with preferential serotonergic action), and selective SRIs (SSRIs), including sertraline, fluvoxamine, fluoxetine, paroxetine, citalopram, and escitalopram [ 45 ].…”

“…The latter includes clomipramine (a nonselective serotonin–norepinephrine reuptake inhibitor with preferential serotonergic action), and selective SRIs (SSRIs), including sertraline, fluvoxamine, fluoxetine, paroxetine, citalopram, and escitalopram [ 45 ]. A combination of in-person CBT and SRIs may increase efficacy, but paediatric studies remain limited and treatment personalisation is important [ 45 , 46 ].…”