Therapy better than meds for kids, teens with OCD

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While both psychotherapy and medication can be effective for children and adolescents with Obsessive-Compulsive Disorder, therapy may be the best choice, according to a new report.

Such non-drug treatment, specifically a process involving exposure and response prevention (ERP), is not as widely available as medication, but it appears to be associated with fewer residual symptoms, a team of Mayo Clinic researchers report.

“(ERP) is more effective in the short term and it lasts longer” than medication, stud Dr. Jonathan S. Abramowitz told. He explained that “ERP gives kids with OCD skills that no one can ever take away from them for life, whereas with medication they’re relying on the pill.”

Obsessive-Compulsive Disorder affects about 1 percent of all children and adolescents and up to 3 percent of adults. In fact, researchers have found that when symptoms go untreated during the early years they usually persist throughout adulthood.

The cause of the condition is unknown. Symptoms such as frequent handwashing and fear of germs or frequent checking (of locked doors, for example) and fear of mistakes or disasters can appear at any age, but are not usually recognized until around age 5.

Cognitive-behavioral therapy involving exposure and response prevention (ERP) is the preferred treatment for children and adolescents, according to 1997 Expert Consensus Guidelines, but few therapists are trained in its use.

Individuals treated with ERP are taught to face their fears by engaging in repeated and prolonged confrontation with whatever stimuli evokes their obsession, and refraining from responding with compulsive behavior.

For example, those who frequently wash their hands after opening doors - because of their fear of germs would practice touching doorknobs without washing their hands afterwards. Or, those with an irrational fear of bad luck associated with the number 13 may repeatedly be taken to the 13th floor of a building.

Medication, on the other hand, most commonly Selective Serotonin Reuptake Inhibitors (SSRI’S) such as fluoxetine, is the more widely available treatment for OCD. Patients may experience relapse upon discontinuation of their medication, however, so SRI treatment is typically long-term.
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Fluoxetine
Fluoxetine, an antidepressant (mood elevator), is used to treat depression, obsessive-compulsive disorders, and some eating disorders.

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Abramowitz and his colleagues reviewed 18 studies that examined either SRI or ERP treatment for patients aged 13 to 15 years who were diagnosed with obsessive-compulsive disorder. Patients treated with the ERP psychotherapy met daily or weekly and their treatment included parental assistance and homework.

In each study, after undergoing treatment for anywhere from 10 to 14 weeks, the teenagers reported substantial improvement in their OCD symptoms. Both ERP psychotherapy and the SRI medication were effective, but there were fewer residual symptoms among those treated with psychotherapy, the report indicates.

“If you roll the dice, you are more likely to have less symptoms after an ERP trial than after a medication trial,” Abramowitz said.

He and his colleagues concluded that the results of their analysis their “generally support the clinical recommendations of the OCD Expert Consensus Guidelines that ERP is the first-line treatment approach for children and adolescents with this disorder.”

ERP psychotherapy does not cure Obsessive-Compulsive Disorder, however. Also, some parents may be reluctant to allow their children to undergo the difficult process involved in facing their fears, and even when they are willing to do so, they may find it much more difficult to locate an ERP specialist than it is to find a physician.

Thus, when ERP therapy is unavailable, refused, or does not have the intended effect, “SRIs represent a viable treatment strategy,” Abramowitz and his team note.

What’s the bottom line? “If you have OCD (or) if your kid has OCD, there’s help,” Abramowitz said. 

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