Pharmacotherapy of childhood obsessive-compulsive disorder

OCD appears in children and adolescents in virtually the same form as adults. Antipsychotics, anxiolytics, and antidepressants (other than CMI and other serotonergic reuptake blockers) are not consistently helpful in treating OCD. Adult controlled studies have found that CMI, a serotonin reuptake blocker, is selectively and specifically effective for treating OCD. The two controlled studies of CMI in a pediatric sample found that CMI was significantly better than placebo and desipramine in ameliorating the symptoms of OCD. CMI appears to be safe, well tolerated, and effective for OCD at dosages targeting 3 mg per kg per day in children and adolescents. Further studies of its use in long-term maintenance are indicated. Based on anecdotal information, fluoxetine appears to be promising for use in OCD, although it is currently only approved for use as an antidepressant in adults. Fluvoxamine, which has not been tried in a pediatric population, appears to be efficacious for adult OCD. Controlled studies of their safety and efficacy in the pediatric population need to be done. The long-term prognosis for children with OCD is unknown. It appears that all treatment modalities should be utilized, including psychopharmacologic, behavioral, and other psychotherapeutic interventions.