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 Behavior
Therapy Best for Kids With OCD
Combo Therapy Helps Kids With Obsessive Compulsive Disorder,
No Evidence of Suicidal Thoughts, Study Shows.
by Salynn Boyles, WebMD Medical News, October 26, 2004
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Children and
teens with obsessive-compulsive disorder respond better to talk
therapy than to antidepressants alone, but a combination of the
two approaches to treat OCD may work wonders, a
government-funded study group finds.
The findings are being reported less than two weeks after
federal health officials ordered makers of the most widely used
antidepressants to include warnings on their packaging about an
increased risk of suicidal thoughts and behaviors in children
and adolescents who take the drugs.
Medications that were originally approved for treatment of
depression are effective for anxiety disorders. Some of the
newer types of selective serotonin uptake inhibitors, such as
Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram,
are among the SSRIs commonly prescribed for OCD.
Just more than half of the children and adolescents in the
12-week study treated with a combination of behavioral therapy
(talk therapy) and the drug Zoloft for three months had no
evidence of OCD four months later. Nearly two in five children
responded to talk therapy. While one in five participants taking
Zoloft alone had similar responses as did just under one in 20
treated with placebo.
The response rate for cognitive-behavior therapy alone was
slightly lower than for behavior therapy with the
antidepressant, but researchers concluded that either approach
is an appropriate initial treatment. The findings are reported
in the Oct. 27 issue of the Journal of the American Medical
Association.
"The message is that we now have a clearly effective treatment
for obsessive-compulsive disorder in children and it is
cognitive behavior therapy," researcher John March, MD, tells
WebMD. "In a relatively short period of time we have gone from
having no effective treatment to being able to bring half of the
kids with this disorder into the normal range within three
months."
No Evidence of Suicidal Thoughts in OCD Patients
It is estimated that as many as one in 200 children have OCD,
characterized by intrusive thoughts, images, or impulses that
lead to repetitive or compulsive behaviors, such as frequent
hand washing or checking. Between a third and half of adults
with OCD develop the disorder during childhood.
In this study, 97 kids and teens with OCD completed 12 weeks of
treatment with either behavior therapy alone, treatment with
Zoloft alone, a combination of the two, or placebo. Four months
later, just nearly 54% of the kids treated with behavior and
drug therapy were considered to be in remission, meaning they
were not engaging in frequent repetitive behaviors. Remission
rates, defined as an obsessive-compulsive behavioral score of
less than 10, were 39%, 21%, and nearly 4% for those treated
with behavior therapy alone, Zoloft alone, and placebo,
respectively.
There was no evidence of an increase in suicidal thoughts among
the children taking the antidepressant drug Zoloft.
"It is reassuring in this study, as in others, that
[antidepressant] treatment was well tolerated, with no evidence
of treatment-emergent harm to self or others," the researchers
wrote.
The clear superiority of behavior therapy over drugs alone in
this study, along with the FDA warning, should have a major
impact on how OCD in children is treated in the U.S., child and
adolescent psychiatrist Rachel Ritvo, MD, tells WebMD.
"The sad fact is that economic considerations drive child mental
health care today, and treating a child with drugs is much, much
cheaper than psychotherapy," she says. "We have learned that
kids are very responsive to psychotherapy and psychosocial
interventions, probably even more so than adults."
Ritvo says a parent seeking treatment for a child with OCD
should push for psychotherapy, but she acknowledged that finding
a qualified therapist could be a challenge.
"There are fewer than 100 behavioral pediatricians in this
country and only about 7,000 child psychiatrists. That's it,"
she says. "I turn away four or five people a week from my
practice."
March counters that the behavioral therapy techniques used in
the treatment of children with OCD are easily learned and can be
administered by any good psychiatrist, psychologist, or mental
health social worker.
"Cognitive behavior therapy is a lot like physical therapy, but
instead of, say, rehabing a damaged knee you are retraining the
brain," he says. "This is a neurobehavioral illness and there
are skillful and unskillful ways to treat it. The wrong approach
is relying on drugs alone or traditional psychotherapy. The best
treatment is clearly evidence-based cognitive behavior therapy."
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