Tricyclic Antidepressants and Monoamine Oxidase Inhibitors for the Treatment of Child and Adolescent Psychiatric Disorders

Heleniak, Charlotte; Kaur, Tejal; Ghalib, Kareem; Rynn, Moira A.

doi:10.1002/9781119958338.ch7

Cited by 1 publication

(1 citation statement)

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“…Treatment with clomipramine, a tricyclic antidepressant (TCA) that inhibits reuptake of serotonin, was the first option demonstrated to be effective at reducing OCD symptoms (6), and this was later confirmed in a 2003 meta-analysis (7) for the pediatric population. Although clomipramine is an effective option, it cannot be used as a first-line agent for treating OCD in children and adolescents due to its overburdened adverse effect profile (8, 9).…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Selective Serotonin Reuptake Inhibitors for Treatment of Obsessive-Compulsive Disorder in Adolescents and Children: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRIs) 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 Children’s Yale-Brown Obsessive-Compulsive Scale (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 cognitive behavioral therapy (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 National Institute for Health and Care Excellence (NICE) guidelines for choosing CBT as 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.

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