Using the Cochrane methodology , and as measures of effect size mean difference and Hedge 's g , SRIs proved to be superior to drug placebo , with a modest effect size .
From direct comparisons of CBT and SRI treatments , we conclude that CBT has the superior efficacy .
COMBO versus CBT shows that SRI treatment adds little to concomitant CBT , while COMBO shows favourable outcome versus SRI alone .
In pre-trial partial treatment responders , those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI .
Those who failed CBT treatment did as well with continued CBT as with switching to a SRI .
Serotonin reuptake inhibiting drugs ( SRI ) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years .
Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial.
CONTEXT The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder ; however , empirical support for this assertion has been weaker for children and adolescents than for adults . OBJECTIVE To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder . DESIGN R and omized , double-blind , placebo-controlled trial . PATIENTS One hundred eighty-seven patients : 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years r and omized to receive either sertraline ( 53 children , 39 adolescents ) or placebo ( 54 children , 41 adolescents ) . SETTING Twelve US academic and community clinics with experience conducting r and omized controlled trials . INTERVENTION Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy , after which patients continued to receive this dosage of medication for 8 more weeks . Control patients received placebo . MAIN OUTCOME MEASURES The Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive Compulsive Scale ( NIMH GOCS ) , and the NIMH Clinical Global Impressions of Severity of Illness ( CGI-S ) and Improvement ( CGI-I ) rating scales . RESULTS In intent-to-treat analyses , patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS ( adjusted mean , -6.8vs -3.4 , respectively ; P=.005 ) , the NIMH GOCS ( -2.2 vs -1.3 , respectively ; P=.02 ) , and the CGI-I ( 2.7 vs 3.3 , respectively ; P=.002 ) scales . Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study . Based on CGI-I ratings at end point , 42 % of patients receiving sertraline and 26 % of patients receiving placebo were very much or much improved . Neither age nor sex predicted response to treatment . The incidence of insomnia , nausea , agitation , and tremor were significantly greater in patients receiving sertraline ; 12 ( 13 % ) of 92 sertraline-treated patients and 3 ( 3.2 % ) of 95 placebo-treated patients discontinued prematurely because of adverse medical events ( P=.02 ) . No clinical ly meaningful abnormalities were apparent on vital sign determinations , laboratory findings , or electrocardiographic measurements . CONCLUSION Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder
Using the Cochrane methodology , and as measures of effect size mean difference and Hedge 's g , SRIs proved to be superior to drug placebo , with a modest effect size .
From direct comparisons of CBT and SRI treatments , we conclude that CBT has the superior efficacy .
COMBO versus CBT shows that SRI treatment adds little to concomitant CBT , while COMBO shows favourable outcome versus SRI alone .
In pre-trial partial treatment responders , those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI .
Those who failed CBT treatment did as well with continued CBT as with switching to a SRI .
Serotonin reuptake inhibiting drugs ( SRI ) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years .