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 .
Clomipramine treatment of obsessive-compulsive disorder. II. Biochemical aspects.
Concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid ( 5-HIAA ) , the dopamine metabolite homovanillic acid , and the noradrenaline metabolite 4-hydroxy-3-methoxyphenyl glycol were measured in CSF before and after three weeks ' treatment of severe obsessive-compulsive disorder with clomipramine hydrochloride . Patients who responded to  clomipramine treatment had significantly higher CSF levels of 5-HIAA before treatment . The amelioration of obsessive-compulsive symptoms was positively correlated to the reduction of CSF concentrations of 5-HIAA during clomipramine treatment but negatively correlated to plasma concentrations of clomipramine . Reduction of CSF concentrations of 5-HIAA , which probably reflects drug action on central serotonin neurons , was maximal at a plasma clomipramine concentration of about 300 nmole/L. At higher levels , the reduction of CSF levels of 5-HIAA was smaller . The antiobsessive effect of clomipramine may be connected to its capacity to inhibit serotonin uptake
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 .