The best initial treatment for children and teens with obsessive-compulsive disorder (OCD) is cognitive-behavior therapy - either alone or in combination with an antidepressant like Zoloft - the results of a clinical trial show.

OCD is marked by a tendency to perform repetitive acts or ritualistic behaviors to relieve anxiety, which can disrupt children’s lives and cause severe distress. Zoloft, known technically as sertraline, is one of the newer antidepressants called selective serotonin re-uptake inhibitors or SSRIs.

The Pediatric OCD Treatment Study “confirms and extends expert recommendations,” investigators write in this week’s issue of the Journal of the American Medical Association. They say the results should have “a substantial impact on ... the treatment of pediatric OCD.”

Dr. John S. March from Duke University in Durham, North Carolina and colleagues evaluated the efficacy of different initial treatments for 112 patients 7 to 17 years of age suffering from OCD.

The participants were randomly assigned to cognitive-behavior therapy (CBT) alone, Zoloft alone, CBT plus Zoloft, or inactive placebo treatment.

Eighty-seven percent of subjects completed the full 12 weeks of treatment, which shows that the active treatments were well accepted and tolerated, March and colleagues note in their report.

Children treated with CBT alone or with sertraline were substantially more likely to have an improvement in OCD symptoms, the team found, with some evidence that the combination had a slight edge.

“Sertraline alone proved statistically superior to placebo, confirming the efficacy of medication used to treat OCD in youth,” they add.

However, CBT alone was more effective than Zoloft alone.

March’s team concludes that the treatment of children and adolescents with obsessive-compulsive disorder should begin with the combination of cognitive-behavior therapy and a selective serotonin reuptake inhibitor, or CBT alone.

SOURCE: Journal of the American Medical Association, October 27, 2004.