What is the efficacy of pharmacologic treatments for obsessive-compulsive disorder (OCD)?

Updated: May 17, 2018
  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
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Upon further analysis of pooled clinical trial data, suicidality was reportedly increased in children and adolescents being treated with SSRIs for depression (approximately 2% for those treated with placebo vs 4% for those on SSRIs, although no actual suicides occurred in either group). These clinical trials were unfortunately not designed to specifically and clearly assess suicidal thoughts and behaviors and therefore included events that were not readily classified.

The FDA issued a public health advisory in October of 2004 [39] mandating a black box warning for antidepressants. Antidepressant treatment of children and adolescents with depression then significantly decreased over the next 2 years, although apparently so did suicides for this population. In 2007, the FDA extended its warning to young adults. [40]

Currently, evidence does not exist to associate an increased risk of suicide in patients with OCD and/or other anxiety disorders being treated with SSRIs. However, physicians should closely attend to whether treated patients have unusual, uncomfortable adverse reactions (eg, akathisia) or if they might have comorbid bipolar disorder (which may involve only subtle hypomanic episodes), as antidepressant use seems to occasionally be associated with triggering dysphoria and, sometimes, manic episodes in such individuals.

Children, adolescents, and young adults being treated with antidepressants should be closely and frequently monitored, particularly early in treatment, for any suicidal ideation or actions.

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