Psychopharmacology for Pediatric OCD and Related Disorders

Obsessive-compulsive disorder (OCD) is defined by the presence of obsessions and/or compulsions and associated clinical impairment. The prevalence of pediatric OCD, or “early-onset” OCD, is 2–3%. First-line, gold standard treatments include cognitive behavioral therapy, specifically exposure response prevention (ERP), and selective serotonin reuptake inhibitors (SSRIs). Clomipramine, a tricyclic antidepressant, is an effective pharmacological monotherapy, albeit not first-line. Despite effective treatments, up to one-third of those with early-onset OCD do not respond to first-line interventions. Early-onset OCD is associated with high rates of co-occurring conditions. When there are co-occurring tics, OCD symptoms tend to be less responsive to SSRIs. Antipsychotic augmentation can be helpful, particularly in those with co-occurring tics, but should be used cautiously given the side effect profile and lack of randomized controlled data in pediatric patients. Augmentation with certain glutamate-modulating agents may show modest benefit. It is imperative to identify new treatments for pediatric OCD that are effective, safe, and well-tolerated.