Treatment of obsessive-compulsive disorder in children and adolescents^*

CBT: cognitive-behavioral therapy; CBT-ERP: cognitive-behavioral therapy with exposure and response prevention; CY-BOCS: Children's Yale-Brown Obsessive Compulsive Scale; DBS: deep brain stimulation; OCD: obsessive-compulsive disorder; SSRI: selective serotonin reuptake inhibitor; TMS: transcranial magnetic stimulation.

* This algorithm reviews our treatment choices for pharmacologic management of non-tic-related OCD in youth. Refer to UpToDate for further discussion of tic-related OCD.

¶ Our choice of SSRI is based on several factors including side effect profile, drug-drug interactions, past response, preference, and family history. Refer to UpToDate content for choosing SSRI in the treatment of OCD in youth.

Δ We consider a full therapeutic trial to be for at least 12 weeks with at least 6 weeks at the maximum-tolerated dose within the therapeutic range.

◊ CBT treatment includes 14 hour-long sessions over 12 weeks. Refer to UpToDate content for description of CBT in children.

§ We monitor symptoms using standardized scales such as the CY-BOCS. Refer to UpToDate content for discussion of clinical rating scales in youth with OCD.

¥ Refer to UpToDate for further discussion on longer-term psychotherapy for youth who do not respond to initial 12-week trial of psychotherapy.

‡ Our preference is to offer two full trials of an SSRI prior to trying other pharmacologic strategies. For those that have already been on an SSRI (eg, earlier in the algorithm), we give only one more trial.

† Refer to UpToDate content for initiation, titration, adverse effects, and monitoring during treatment with clomipramine.

** Refer to UpToDate content for discussion of titration, monitoring and adverse effects of augmentation with second-generation antipsychotic medications in youth with OCD.

¶¶ We are cautious in combining clomipramine with other serotonergic medications due to increase in side effects including serotonin syndrome. Refer to UpToDate content for discussion of combining serotonergic medications.