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Medicines for OCD in Children and Teens

When Should Medicine Be Considered for Children and Teens with OCD?


Medicines should only be considered when there are moderate to severe OCD symptoms.  Both cognitive behavior therapy (CBT) and medicine effectively treat OCD in children and teens.  Their use is supported by the treatment guidelines of the American Psychiatric Association (APA) and the American Academy of CHild and Adolescent Psychiatry (AACAP).  


What Kinds of Medicines Help OCD in Children?


Antidepressants are usually the first kind of medicine that a doctor will try.  Your doctor might refer to these medicines as SSRI's, which stands for "Selective Serotonin-Reuptake Inhibitors", or TCA's, which stands for "Tricyclics."  Here are some names of each of these kinds of medicines: 

SSRI's

  • citalopram (Celexa®)
  • escitalopram (Lexapro®)
  • fluvoxamine (Luvox®)
  • fluoxetine (Prozac®)
  • paroxetine (Paxil®)
  • sertaline (Zoloft®)

TCA's

  • clomipramine (Anafranil®)
 

Will Medicine "Cure" My Child's OCD?  


OCD medicines control and decrease symptoms, but do not "cure" the disorder.  OCD is usually well controlled when the right treatment is in place, but symptoms can often return when the child stops taking the medicine.



How Long Does it Take for OCD Medicines to Work?
   
 
All OCD medicines work slowly.  It is important to not give up on a medicine until it has been taken at the right dose for 10 to 12 weeks.  Studies have also shown that improvement of childhood OCD can continue for at least a year after starting medicine. 

 

Are These Medicines Approved for Use in Children? 


Only four OCD medicines have been approved by the FDA for use in children: clomipramine (Anafranil®), fluoxetine (Prozac®), fluvoxamine (Luvox®), and sertaline (Zoloft®).  But, doctors can prescribe any OCD medicines to children if they feel it is needed.



What Dose is Needed?


The best dose of OCD medicine should be determined on an individual basis.  Children should start at a lower dose than teens, but OCD symptoms often need to be treated with higher, adult-sized doses.  If a child has difficulty swallowing pills, a liquid or other version may be available.  The following dose ranges may be necessary:

  • citalopram (Celexa®): 10-60 mg/day
  • escitalopram (Lexapro®): 10-20 mg/day
  • fluvoxamine (Luvox®): 50-300 mg/day
  • fluoxetine (Prozac®): 10-80 mg/day
  • paroxetine (Paxil®): 10-60 mg/day
  • sertaline (Zoloft®): 50-200 mg/day
  • clomipramine (Anafranil®): 50-200 mg/day   


Which OCD Medicine Should Be Tried First?



No two children respond to OCD medicines in the same way.  In general, clomipramine (Anafranil®) is usually not given first because of its side effects.

Factors that may guide the medicine choice can include:


  • a good response to a certain drug by other family members
  • presence of other disorders
  • potential for side effects
  • cost or availability


How Helpful Are These Medicines?


In the largest child OCD treatment study to date (POTS)1, remission (the absence of any major symptoms) occurred in about 1 in 5 children on medicine and in more than half of those with medicine and CBT.  In addition, many more children had improvement (but not full remission).  Some children will have no response at all to some medicines, but it does not mean that other medicines will not help.


Are There Side Effects?


Every kind of drug has potential side effects.  These side effects must always be weighed against the benefit.  Some common side effects of OCD medicines include: 

  • nausea
  • inability to sit still
  • sleepiness or insomnia
  • a heightened sense of energy

In general, the other drugs are safer than clomipramine (Anafranil®) which has its own side effects, including:

  • drowsiness
  • dry mouth
  • racing heart
  • concentration problems
  • problems with urination
  • weight gain

For all antidepressants in children and teens, the FDA has issued "black box warnings" about suicidal thoughts and urges.  The highest risk period for this is when starting or increasing the dose of the medicine.  However, a recent study found no increase in suicidal thoughts in groups of children with OCD who were studied.

 

Are There Permanent Side Effects? 


These drugs appear very safe with long-term use and side effects reverse when they are stopped.  There is no current evidence that they do permanent damage to the body.



What Happens if the First OCD Medicine Doesn't Work?


It is important to know that if the first medicine does not improve OCD, another one should be tried.  Trying several OCD medicines may be needed.  Many people have better results if CBT is added to drug treatment.  If the combination of one drug and CBT don't work, adding a second or third medicine can also be tried.



Will My Child Have to Take These Medicines Forever?


Many doctors suggest that OCD treatment should continue for at least one year, even after the symptoms have stopped.  Unfortunately, OCD drugs do not "cure" the illness.  When medicine is stopped, symptoms often return within a few weeks to months.  If they return, most patients will respond well after starting to take the medicine again.



By S. Evelyn Stewart, M.D.  
Assistant Professor of Psychiatry, Harvard Medical School
International OCD Foundation Scientific Advisory Board



Medicine for OCD in Adults

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