[Pharmacologic treatment of obsessive compulsive disorder in the child and adolescent]

Although obsessive compulsive disorder (OCD) was considered as a rare and treatment-refractory syndrome, research findings from the past decade have focused new interest on the disorder. Epidemiological studies have shown that prevalence rate of OCD was much higher than previously thought (1% of the general adolescent population), and the discovery of a class of psychiatric drugs specific for OCD has brought new therapeutic options as well as pathophysiological hypotheses for the disorder. Rigorous treatment studies have demonstrated that most OCD patients respond to specific pharmacological therapies. The most studied treatment so far has been clomipramine, which appeared superior to placebo and to other antidepressant drugs (amitriptyline, imipramine, desipramine and clorgyline) in a large number of independent controlled studies. In one placebo-controlled study and one study versus desipramine, clomipramine administered to children and adolescents aged 6 to 18, at mean doses of 141 mg/day and 150 mg/day respectively, was well tolerated and had a significant anti-obsessional effect. The novel antidepressant drugs fluvoxamine and fluoxetine are currently under investigation for the treatment of OCD, especially in children. First results indicate a clinical efficacy similar to that of clomipramine, with lower incidence of side-effects. The few drugs that have been demonstrated to be anti-obsessional share a high potency for the blockade of serotonin reuptake. A serotonergic mechanism has therefore been proposed for anti-obsessional drug action and further strengthened by studies demonstrating correlations between clinical response and changes in several serotonergic markers with clomipramine treatment.(ABSTRACT TRUNCATED AT 250 WORDS)