Pharmacological treatment of obsessive-compulsive disorder in children and adolescents: An overview

Pediatric obsessive-compulsive disorder (OCD) affects 1%-3% of children and adolescents. It is characterized by obsessions, and compulsions and is associated with significant distress and interference with functioning. The first line treatment for pediatric OCD is cognitive-behavioral therapy, specifically exposure response prevention. In situations where there are challenges to meaningful engagement in therapy, accessing therapy or when the illness is severe, pharmacological interventions can be a useful adjunct to treatment. Selective serotonin reuptake inhibitors are established as the initial pharmacological approach. Clomipramine is also an effective medication option, but its use is limited by tolerability concerns. However, a subset of patients does not respond to these first-line interventions of cognitive-behavioral therapy and serotoninergic medication. In these treatment-resistant patients, antipsychotic augmentation can be helpful as the next pharmacological option but should be used cautiously due to potential for side effects. Glutamate modulating agents are an emerging medication class as augmenting options. Newer treatments for pediatric OCD that are effective, safe, and well-tolerated are needed. This comprehensive review outlines the approach to pharmacological treatment of pediatric OCD and the evidence supporting their use.