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Psychotherapy, Medications Best for Youth With Obsessive Compulsive Disorder
Children and adolescents with Obsessive Compulsive Disorder (OCD) respond best to a combination of both psychotherapy and an antidepressant, a major clinical trial has found. Supported by the National Institutes of Health's (NIH) National Institute of Mental Health, the study recommends that treatment begin with cognitive behavior therapy (CBT), either alone or with a serotonin reuptake inhibitor (SSRI) antidepressant. The research spotlights the need for improved access to CBT, since most young people with OCD currently receive only the antidepressant, often combined with an antipsychotic medication. John March, M.D., Duke University, Edna Foa, Ph.D., University of Pennsylvania, and colleagues report on the findings of the Pediatric OCD Treatment Study (POTS) in the October 27, 2004 Journal of the American Medical Association (JAMA).
Ninety-seven 7-17 year-olds with OCD completed 12 weeks of treatment with either CBT, the SSRI sertraline, the combination treatment, or a placebo. Independent evaluators, blind to their treatment status, assessed each patient every four weeks. Patients in the study were typical of patients seen in clinical practice. For example, while industry-sponsored trials commonly exclude patients with more than one condition, 80 percent of study participants had at least one additional psychiatric disorder.
Combining sertraline and CBT was more effective than treatment with just one or the other. CBT alone did prove superior to sertraline, which, in turn, was better than a placebo. By the end of the trial, the remission rates were 53.6 percent for combined treatment, 39.3 percent for CBT, 21.4 percent for sertraline, and 3.6 percent for placebo.
CBT alone was more effective in the University of Pennsylvania site than at Duke University site, but the combination treatment was equally effective at both sites, suggesting that it may be less susceptible to setting-specific variations. The strong showing of CBT at the University of Pennsylvania led the researchers to recommend it as "a first line option" for initial treatment. They point out, however, that "only a small minority" of children and adolescents with OCD receives such state-of-the-art care.
"In the Treatment of Adolescents with Depression Study, which compared CBT with an SSRI and combination treatment, for teens with depression, the medication proved superior to CBT. In this case the reverse was true, but in both studies, combination was superior. This underscores that different disorders in adolescents respond to different treatments," noted NIMH Director Thomas Insel, M.D.
"We believe that the results of this study will contribute to the appreciation by non-physician mental health clinicians of the strengths and limitations of pharmacological treatments and to the appreciation by physicians of the evidence-based psychosocial treatments," states the article. "It is imperative that the focus of research turn to identifying and testing dissemination strategies for CBT," the researchers add.
There were no episodes of mania, suicidality, or other serious adverse events during the course of the study.
Also participating in the study were Pat Gammon, Ph.D., Allan Chrisman, M.D., John Curry, Ph.D., David Fitzgerald, Ph.D., and Kevin Sullivan, BA, all from Duke University Medical Center; Martin Franklin, Ph.D., Jonathan Huppert, Ph.D., MoiraRynn, M.D., Ning Zhao, Ph.D., and Lori Zoellner, Ph.D., from the University of Pennsylvania; and Henrietta Leonard, M.D., Abbe Garcia, Ph.D., and Jennifer Freeman, Ph.D., from Brown University. The principal statistician was Xin Tu, Ph.D. (University of Pennsylvania).
Source: National Institute of Mental Health
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