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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

No Evidence of Suicidal Thoughts in OCD Patients continued...

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.

Too Reliant on Drugs

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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