title: Long-term outcomes of obsessive-compulsive disorder: follow-up of 142 children and adolescents. Continued cognitive-behavior therapy versus sertraline for children and adolescents with obsessive–compulsive disorder that were non-responders to cognitive-behavior therapy: a randomized controlled trial Six-month follow-up of a randomized controlled trial augmenting serotonin reuptake inhibitor treatment with exposure and ritual prevention for obsessive-compulsive disorder. Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial. Behavior therapy versus clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents. The effect of fluvoxamine and behavior therapy on children and adolescents with obsessive-compulsive disorder. Clomipramine treatment of obsessive-compulsive disorder. II. Biochemical aspects. Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder. Long-term sertraline treatment of children and adolescents with obsessive-compulsive disorder. Clomipramine hydrochloride in childhood and adolescent obsessive-compulsive disorder--a multicenter trial. Paroxetine treatment in children and adolescents with obsessive-compulsive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. Remission status after long-term sertraline treatment of pediatric obsessive-compulsive disorder. Randomized, placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive-compulsive disorder.
abstract: BACKGROUND Obsessive-compulsive disorder ( OCD ) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates . There are few prospect i ve long-term follow-up studies . AIMS To follow up young people with OCD to clarify persistence rates and relevant predictors , presence of other psychiatric disorders , functional impairment , service utilisation and perceived treatment needs . METHOD All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic , Maudsley Hospital , London , were included . Sixty-one per cent ( 142 of 222 ) of all contactable young people and parents completed computerised diagnostic interviews and question naires . RESULTS We found a persistence rate of OCD of 41 % ; 40 % of participants had a psychiatric diagnosis other than OCD at follow-up . The main predictor for persistent OCD was duration of illness at assessment . High levels of baseline psychopathology predicted other psychiatric disorders at follow-up . Functional impairment and quality of life were mildly to moderately affected . Approximately 50 % of participants were still receiving treatment and about 50 % felt a need for further treatment . CONCLUSIONS This study confirms that paediatric OCD can be a chronic condition that persists into adulthood . Early recognition and treatment might prevent chronicity . Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services Expert guidelines recommend cognitive-behavior therapy ( CBT ) as a first-line treatment in pediatric obsessive – compulsive disorder ( OCD ) and the addition of selective serotonin reuptake inhibitors when CBT is not effective . However , the recommendations for CBT non-responders are not supported by empirical data . Our objective was to investigate the effectiveness of sertraline ( SRT ) versus continued CBT in children and adolescents that did not respond to an initial course of CBT . R and omized controlled trial conducted in five sites in Denmark , Sweden and Norway , 54 children and adolescents , age 7–17 years , with DSM-IV primary OCD were r and omized to SRT or continued CBT for 16 weeks . These participants had been classified as non-responders to CBT following 14 weekly sessions . Primary outcomes were the CY-BOCS total score and clinical response ( CY-BOCS < 16 ) . The study was a part of the Nordic Long-Term OCD Treatment Study ( NordLOTS ) . Intent-to-treat sample included 50 participants , mean age 14.0 ( SD = 2.7 ) and 48 % ( n = 24 ) males . Twenty-one of 28 participants ( 75 % ) completed continued CBT and 15 of 22 participants ( 69.2 % ) completed SRT . Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments ( p = .351 ) , the response rate was 50.0 % in the CBT group and 45.4 % in the SRT group . The multivariate χ2 test suggested that there were no statistically significant differences between groups ( p = .727 ) . Within-group effect sizes were large and significant across both treatments . These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial . However , there was no significant between-group differences in SRT or continued CBT at post-treatment OBJECTIVE This article describes the long-term effects of augmenting serotonin reuptake inhibitors ( SRIs ) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder ( OCD ) . METHOD Between November 2000 and November 2006 , 111 OCD patients from 2 academic outpatient centers with partial SRI response were r and omized to the addition of exposure and ritual prevention or stress management training , delivered twice weekly for 8 weeks ( acute phase ) ; 108 began treatment . Responders ( 38 of 52 in the exposure and ritual prevention condition , 11 of 52 in the stress management training condition ) entered a 24-week maintenance phase . The Yale-Brown Obsessive Compulsive Scale ( YBOCS ) was the primary outcome measure . RESULTS After 24 weeks , patients r and omized to and receiving exposure and ritual prevention versus stress management training had significantly better outcomes ( mean YBOCS scores of 14.69 and 21.37 , respectively ; t = 2.88 , P = .005 ) , higher response rates ( decrease in YBOCS scores ≥ 25 % : 40.7 % vs 9.3 % , Fisher exact test P < .001 ) , and higher rates of excellent response ( YBOCS score ≤ 12 : 24.1 % vs 5.6 % , Fisher exact test P = .01 ) . During the maintenance phase , the slope of change in YBOCS scores was not significant in either condition ( all P values ≥ .55 ) , with no difference between exposure and ritual prevention and stress management training ( P > .74 ) . Better outcome was associated with baseline variables : lower YBOCS scores , higher quality of life , fewer comorbid Axis I diagnoses , and male sex . CONCLUSIONS Augmenting SRIs with exposure and ritual prevention versus stress management training leads to better outcome after acute treatment and 24 weeks later . Maintenance outcome , however , was primarily a function of OCD severity at entrance . Greater improvement during the acute phase influences how well patients maintain their gains , regardless of treatment condition Rigorously design ed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder ( OCD ) but not in patients below 18 years old . This report describes a r and omized , double-blind , placebo-controlled , fixed-dose ( 20 mg qd ) trial of fluoxetine in 14 children and adolescents with OCD , ages 8 to 15 years old ; the study was 20 weeks long with crossover at 8 weeks . Obsessive-compulsive symptom severity was measured on the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinician 's Global Impression-Obsessive Compulsive Disorder scale ( CGI-OCD ) . The CY-BOCS total score decreased 44 % ( N = 7 , p = .003 ) after the initial 8 weeks of fluoxetine treatment , compared with a 27 % decrease ( N = 6 , p = .13 ) after placebo . During the initial 8 weeks , the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD ( p = .01 ) but not by the CY-BOCS ( p = .17 ) . The most common drug side effects were generally well tolerated . The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD CONTEXT The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder ; however , empirical support for this assertion has been weaker for children and adolescents than for adults . OBJECTIVE To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder . DESIGN R and omized , double-blind , placebo-controlled trial . PATIENTS One hundred eighty-seven patients : 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years r and omized to receive either sertraline ( 53 children , 39 adolescents ) or placebo ( 54 children , 41 adolescents ) . SETTING Twelve US academic and community clinics with experience conducting r and omized controlled trials . INTERVENTION Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy , after which patients continued to receive this dosage of medication for 8 more weeks . Control patients received placebo . MAIN OUTCOME MEASURES The Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive Compulsive Scale ( NIMH GOCS ) , and the NIMH Clinical Global Impressions of Severity of Illness ( CGI-S ) and Improvement ( CGI-I ) rating scales . RESULTS In intent-to-treat analyses , patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS ( adjusted mean , -6.8vs -3.4 , respectively ; P=.005 ) , the NIMH GOCS ( -2.2 vs -1.3 , respectively ; P=.02 ) , and the CGI-I ( 2.7 vs 3.3 , respectively ; P=.002 ) scales . Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study . Based on CGI-I ratings at end point , 42 % of patients receiving sertraline and 26 % of patients receiving placebo were very much or much improved . Neither age nor sex predicted response to treatment . The incidence of insomnia , nausea , agitation , and tremor were significantly greater in patients receiving sertraline ; 12 ( 13 % ) of 92 sertraline-treated patients and 3 ( 3.2 % ) of 95 placebo-treated patients discontinued prematurely because of adverse medical events ( P=.02 ) . No clinical ly meaningful abnormalities were apparent on vital sign determinations , laboratory findings , or electrocardiographic measurements . CONCLUSION Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder OBJECTIVE To compare , via a pilot study , the effectiveness of behavior therapy and of drug treatment in children and adolescents with obsessive-compulsive disorder . METHOD Twenty-two children aged between 8 and 18 years were r and omly assigned to behavior therapy ( n = 12 ) or open clomipramine ( n = 10 ) in a parallel design lasting 12 weeks . Behavior therapy included exposure and response prevention administered in weekly sessions . The mean dosage of clomipramine was 2.5 mg/kg ( range = 1.4 - 3.3 mg/kg ) . The main outcome variables were the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Leyton Obsessional Inventory-Child Version ( LOI-CV ) . RESULTS Significant improvement was obtained in both treatment conditions . Behavior therapy produced stronger therapeutic changes than clomipramine on the CY-BOCS ( p < .05 ) , whereas on the LOI-CV no significant differences between the results of the two treatments were found . Five of the nine initial nonresponders showed significant changes after extension of treatment for another 12 weeks . CONCLUSION Behavior therapy is shown to be a good alternative for drug treatment and deserves further study in larger sample s of children with obsessive-compulsive disorder OBJECTIVE The efficacy of medications , consisting of serotonin partial and specific reuptake blockers , and behavior therapy , consisting of exposure and response prevention in addition to social skills training , cognitive therapy , and habit reversal , in the treatment of obsessive-compulsive disorder are well documented . The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy . METHODS Ten children/adolescents who had not previously responded to behavior therapy  were r and omly assigned to two groups : fluvoxamine alone or fluvoxamine with behavior therapy . All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year . RESULTS Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable , the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) . According to the other measurements -National Institute of Mental Health-Global Obses-sive-Compulsive Scale , Clinical Global Impression-Improvement ( assessing level of im-provement from week to week ) , and Clinical Global Impression-Severity of Illness Scale ( as-sessing how ill the patient is from week to week)-improvement was not as evident . According to the CY-BOCS , those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication . At two-year follow-up , all patients continued to improve , with those in the combined approach improving more than those in the medication-alone group . CONCLUSIONS Future studies should determine the specific effect of each treatment group , combined and singularly . Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed . The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy , according to the CY-BOCS 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 OBJECTIVE To compare the effectiveness of group cognitive-behavioral therapy ( GCBT ) and of sertraline in treatment-naïve children and adolescents with obsessive-compulsive disorder . METHOD Between 2000 and 2002 , 40 subjects between 9 and 17 years old were r and omized to receive GCBT ( n = 20 ) or sertraline ( n = 20 ) . GCBT consisted of a manual-based 12-week cognitive-behavioral protocol adapted for groups , and treatment with sertraline involved medication intake for 12 weeks . Subjects were assessed before , during , and after treatment ( at 1 , 3 , 6 , and 9 months after treatment conclusion ) . Primary outcome measure was the Children 's Yale-Brown Obsessive-Compulsive Scale . Repeated- measures analyses of variance were done . RESULTS Both GCBT and sertraline conditions had significant improvement in obsessive-compulsive disorder symptoms as measured by the Children 's Yale-Brown Obsessive-Compulsive Scale after 12 weeks of treatment . After the 9-month follow-up period , subjects in the GCBT condition had a significantly lower rate of symptom relapse than those in the sertraline group . CONCLUSIONS The treatment with GCBT may be effective in decreasing obsessive-compulsive symptoms in childhood obsessive-compulsive disorder and should be considered as an alternative to either individual cognitive-behavioral therapy or a medication , such as sertraline . Results support the effectiveness and the maintenance of gains of GCBT in the treatment of youngsters with obsessive-compulsive disorder OBJECTIVE To evaluate the safety and effectiveness of sertraline in the long-term treatment of pediatric obsessive-compulsive disorder ( OCD ) . METHOD Children ( 6 - 12 years ; n= 72 ) and adolescents ( 13 - 18 years ; n = 65 ) with DSM-III-R-defined OCD who had completed a 12-week , double-blind , placebo-controlled sertraline study were given open-label sertraline 50 to 200 mg/day in this 52-week extension study . Concomitant psychotherapy was allowed during the extension study Outcome was evaluated by the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , National Institute of Mental Health Global Obsessive-Compulsive Scale , and Clinical Global Impression Severity ( CGI-S ) and Improvement ( CGI-I ) scores . RESULTS Significant improvement ( p < .0001 ) was demonstrated on all four outcome parameters on an intent-to-treat analysis for the overall study population ( n = 132 ) , as well as the child and the adolescent sample s. At endpoint , 72 % of children and 61 % of adolescents met response criteria ( > 25 % decrease in CY-BOCS and a CGI-I score of 1 or 2 ) . Significant ( p < .05 ) improvements were also demonstrated from the extension study baseline to endpoint on all outcome parameters in those patients who received sertraline during the 12-week , double-blind acute study . Long-term sertraline treatment was well tolerated , and there were no discontinuations due to changes in vital signs , laboratory values , or electrocardiograms . CONCLUSION Sertraline ( 50 - 200 mg/day ) was effective and generally well tolerated in the treatment of childhood and adolescent OCD for up to 52 weeks . Improvement was seen with continued treatment Children and adolescents with obsessive compulsive disorder were studied in an 8-week , multicenter , double-blind , parallel groups trial of clomipramine hydrochloride ( CMI ) versus placebo . Efficacy assessment s included the child version of the Yale-Brown Obsessive Compulsive Scale and the National Institute of Mental Health Global rating scale . At the end of 8 weeks , CMI-treated patients showed a mean reduction in Yale-Brown Obsessive Compulsive Scale score of 37 % compared to 8 % in the placebo group . Side effects were typical of tricyclic antidepressants . In a 1-year open label treatment , CMI continued to be effective and well tolerated OBJECTIVE To assess the efficacy and safety of paroxetine for the treatment of pediatric obsessive-compulsive disorder . METHOD Children ( 7 - 11 years of age ) and adolescents ( 12 - 17 years of age ) meeting DSM-IV criteria for obsessive-compulsive disorder were r and omized to  paroxetine  ( 10 - 50 mg/day ) or placebo for 10 weeks . The primary efficacy measure was change from baseline in the Children 's Yale-Brown Obsessive-Compulsive Scale ( CY-BOCS ) total score at week 10 last observation carried forward end point . Safety was assessed primarily through adverse event monitoring . RESULTS A total of 207 patients were r and omized to treatment . Of these , 203 were included in the intention-to-treat population . Adjusted mean changes from baseline at week 10 observation carried forward end point in CY-BOCS total score for patients receiving paroxetine and placebo were -8.78 ( SE=0.82 ) and -5.34 points ( SE=0.77 ) , respectively . The adjusted mean difference , -3.45 in favor of paroxetine , was statistically significant ( 95 % confidence interval=-5.60 to -1.29 , p=.002 ) . Adverse events were generally mild to moderate in intensity . A total of 10.2 % ( 10/98 ) of patients in the paroxetine group and 2.9 % ( 3 of 105 ) in the placebo group discontinued treatment because of adverse events . CONCLUSIONS Paroxetine is an effective and generally well-tolerated treatment for obsessive-compulsive disorder in children and adolescents CONTEXT The extant literature on the treatment of pediatric obsessive-compulsive disorder ( OCD ) indicates that partial response to serotonin reuptake inhibitors ( SRIs ) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy ( CBT ) may provide additional benefit . OBJECTIVE To examine the effects of augmenting SRIs with CBT or a brief form of CBT , instructions in CBT delivered in the context of medication management . DESIGN , SETTING , AND PARTICIPANTS A 12-week r and omized controlled trial conducted at 3 academic medical centers between 2004 and 2009 , involving 124 pediatric out patients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children 's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial . INTERVENTIONS Participants were r and omly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks : 42 in the medication management only , 42 in the medication management plus instructions in CBT , and 42 in the medication management plus CBT ; the last included 14 concurrent CBT sessions . MAIN OUTCOME MEASURES Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30 % or more and demonstrating a change in their continuous scores over 12 weeks . RESULTS The medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures . In the primary intention-to-treat analysis , 68.6 % ( 95 % CI , 53.9%-83.3 % ) in the plus CBT group were considered responders , which was significantly better than the 34.0 % ( 95 % CI , 18.0%-50.0 % ) in the plus instructions in CBT group , and 30.0 % ( 95 % CI , 14.9%-45.1 % ) in the medication management only group . The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies ( P < .01 for both ) . The plus instructions in CBT strategy was not statistically superior to medication management only ( P = .72 ) . The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12 , on average , was estimated as 3 ; for the plus CBT vs the plus instructions in CBT strategy , the number needed to treat was also estimated as 3 ; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25 . CONCLUSIONS Among patients aged 7 to 17 years with OCD and partial response to SRI use , the addition of CBT to medication management compared with medication management alone result ed in a significantly greater response rate , whereas augmentation of medication management with the addition of instructions in CBT did not . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00074815 OBJECTIVE To determine the safety and efficacy of fluvoxamine for the treatment of children and adolescents with obsessive-compulsive disorder ( OCD ) with a double-blind , placebo-controlled , multicenter study . METHOD Subjects , aged 8 to 17 years , meeting DSM-III-R criteria for OCD were recruited from July 1991 to August 1994 . After a 7- to 14-day single-blind , placebo washout/screening period , subjects were r and omly assigned to fluvoxamine 50 to 200 mg/day or placebo for 10 weeks . Subjects who had not responded after 6 weeks could discontinue the double-blind phase of the study and enter a long-term , open-label trial of fluvoxamine . Analyses used an intent-to-treat sample with a last-observation-carried-forward method . RESULTS Mean Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) scores with fluvoxamine were significantly ( p < .05 ) different from those with placebo at weeks 1 , 2 , 3 , 4 , 6 , and 10 . Significant ( p < .05 ) differences between fluvoxamine and placebo were observed for all secondary outcome measures at all visits . Based on a 25 % reduction of CY-BOCS scores , 42 % of subjects taking fluvoxamine were responders compared with 26 % taking placebo . Forty-six ( 19 fluvoxamine , 27 placebo ) of 120 r and omized subjects discontinued early . Adverse events with a placebo-adjusted rate greater than 10 % were insomnia and asthenia . CONCLUSIONS Fluvoxamine has a rapid onset of action and is well tolerated and efficacious for the short-term treatment of pediatric OCD BACKGROUND Despite its high chronicity , few studies have evaluated the effectiveness of long-term treatment for pediatric obsessive-compulsive disorder ( OCD ) . The goal of the current analysis is to evaluate remission among children and adolescents with OCD treated with sertraline  for 12 months . METHODS Children ( 6 - 12 years old , n = 72 ) and adolescents ( 13 - 18 years old , n = 65 ) with Diagnostic and Statistical Manual of Mental Disorders ( third edition , revised ) OCD , who had completed a 12-week , double-blind , placebo-controlled sertraline study , were administered open-label sertraline  50 - 200 mg for 52 weeks . Full remission was defined by a Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) score of 8 or less , and partial remission was defined as a CY-BOCS score of 15 or less . RESULTS Using an last observation carried forward analysis , 47 % of patients achieved a full remission , and an additional 25 % achieved a partial remission . Among study completers , full remission was achieved by 55 % of patients and partial remission by 31 % . Two thirds of patients with severe OCD at baseline ( CY-BOCS of 26 or greater ) achieved full or partial remission . Children were more likely to achieve a full remission than adolescents . CONCLUSION Sertraline is effective in the treatment of childhood and adolescent OCD , with initial acute response converting to remission and improved functional status in a substantial proportion of patients . More research is needed to develop pharmacologic and psychotherapeutic strategies that facilitate the achievement of full remission in the remaining patients suffering from this chronic and disabling illness BACKGROUND To examine the efficacy of sequential sertraline and cognitive-behavioral therapy ( CBT ) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive-compulsive disorder ( OCD ) . METHODS Forty-seven children and adolescents with OCD ( Range = 7 - 17 years ) were r and omized to 18-weeks of treatment in one of three arms : 1 ) sertraline at st and ard dosing + CBT ( RegSert + CBT ) ; 2 ) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT ( SloSert + CBT ) ; or 3 ) pill placebo + CBT ( PBO + CBT ) . Assessment s were conducted at screening , baseline , weeks 1 - 9 , 13 , and 17 , and post-treatment . Raters and clinicians were blinded to sertraline ( but not CBT ) r and omization status . Primary outcomes included the Children 's Yale-Brown Obsessive-Compulsive Scale , and response and remission status . Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent/Child , Children 's Depression Rating Scale-Revised , Multidimensional Anxiety Scale for Children , and Clinical -Global Impressions-Severity . RESULTS All groups exhibited large within-group effects across outcomes . There was no group by time interaction across all outcomes suggesting that group changes over time were comparable . CONCLUSIONS Among youth with OCD , there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT . CLINICAL TRIALSGOV IDENTIFIER NCT00382291
target: 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 .
background: Serotonin reuptake inhibiting drugs ( SRI ) have been used in the treatment of paediatric obsessive-compulsive disorder over the past 30 years .