Cognitive-behavioral therapy plus sertraline is more effective than either treatment alone for children and adolescents with obsessive-compulsive disorder (OCD), according to a study in the October 27th issue of the Journal of the American Medical Association.

Epidemiologic data suggest that approximately 1 in 200 young people have symptoms of obsessive-compulsive disorder, which in many cases severely disrupts academic, social, and vocational functioning. Among adults with the disorder, one third to one half develop the disorder during childhood or adolescence, which suggests that early intervention in childhood may prevent long-term illness in adulthood.

Previous research has shown the effectiveness of short-term cognitive-behavioral therapy or medical management with a selective serotonin reuptake inhibitor such as sertraline. However, little is known about relative and combined efficacy.

In the current study, John S. March, MD, MPH, and members of the US Pediatric OCD Treatment Study (POTS) team, evaluated the efficacy of cognitive-behavioral therapy (CBT) alone, medication management with the selective serotonin reuptake inhibitor sertraline alone, or combined treatment consisting as initial therapy for children and adolescents with the disorder.

POTS, a randomized controlled trial, was conducted at three academic centers in the U.S. and included 112 patients age 7 through 17 years. Patients were recruited between September 1997 and December 2002. Participants were randomized to cognitive - behavioral therapy alone, sertraline alone, combined therapy, or pill placebo for 12 weeks.

Ninety-seven of 112 patients (87 percent) completed the full 12 weeks of treatment. The researchers found that “patients treated with cognitive-behavorial therapy either alone or in combination with medication showed a substantially higher probability of improvement, with the edge going to combination treatment over cognitive-behavioral therapy alone in one site but not in the other.

Sertraline alone proved statistically superior to placebo, confirming the efficacy of medication used to treat obsessive-compulsive disorder in youth; however, the effect size of cognitive-behavioral therapy alone was larger than that for sertraline alone, and more patients receiving cognitive-behavioral therapy alone entered remission than did those receiving sertraline alone (39.3 percent vs. 21.4 percent, respectively), though these differences did not reach statistical significance. Thus, we conclude that children and adolescents with obsessive-compulsive disorder should begin treatment with CBT alone or with CBT plus an SSRI.”

The three active treatments proved acceptable and well tolerated, with no evidence of treatment-emergent harm to self or to others.

“… the POTS carries significant public health implications for the management of OCD in youth and for future directions in research. Pediatric OCD is a common, chronic, and often undiagnosed psychiatric disorder that, if not adequately treated, is associated with considerable morbidity extending into adulthood. As illustrated by the fact that the overwhelming majority of POTS patients completed treatment as intended using treatment protocols intended for use by frontline clinicians, POTS treatments are both acceptable and practical in routine clinical practice,” the authors wrote.