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Pediatric Treatment-Resistant Obsessive Compulsive Disorder: Treatment Options and Challenges

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Abstract

Pediatric obsessive-compulsive disorder (OCD) is a chronic, potentially debilitating psychiatric condition. Although effective treatments exist, at least 10% of youth do not achieve remission despite receiving first-line treatments. This article reviews the extant, albeit limited, evidence supporting treatment approaches for youth with treatment-resistant OCD. A literature search for articles addressing pediatric treatment-resistant OCD was conducted through April 11, 2024. These results were augmented by searching for treatment-resistant OCD in adults; treatment strategies discovered for the adult population were then searched in the context of children and adolescents. In general, intensive treatment programs and antipsychotic augmentation of an antidepressant had the most substantial and consistent evidence base for treatment-resistant youth with OCD, although studies were limited and of relatively poor methodological quality (i.e., open trials, naturalistic studies). Several pharmacological approaches (clomipramine, antipsychotics [e.g., aripiprazole, risperidone], riluzole, ketamine, D-cycloserine, memantine, topiramate, N-acetylcysteine, ondansetron), largely based on supporting data among adults, have received varying levels of investigation and support. There is nascent support for how to treat pediatric treatment-resistant OCD. Future treatment studies need to consider how to manage the significant minority of youth who fail to benefit from first-line treatment approaches.

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  1. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA

    Sana Younus, Lauren Havel, Jordan T. Stiede, Catherine E. Rast, Kirti Saxena, Wayne K. Goodman & Eric A. Storch

  2. Texas Children’s Hospital, Houston, TX, USA

    Sana Younus, Lauren Havel & Kirti Saxena

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Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number P50HD103555 for use of the Clinical and Translational Core facilities, as well as the International OCD Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the International OCD Foundation.

Conflicts of interest

Drs Younus, Havel, Stiede, and Saxena, and Ms Rast have no financial disclosures to report. Dr Goodman receives research fundings from NIH, IOCDF, Biohaven, and the McNair Foundation. He receives royalties from Nview, LLC and OCDscales, LLC. Dr Storch discloses the following potentially competing interests: he was formerly a consultant (in the last 12 months) for Biohaven Pharmaceuticals and Brainsway. He received book royalties from Elsevier, Springer, American Psychological Association, Wiley, Oxford, Kingsley, and Guilford. He has stock options valued at less than $5000 from NView. His institution receives research support for his work from NIH, IOCDF, Ream Foundation, and Texas Higher Education Coordinating Board.

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Dr Younus and Dr Stiede conducted the literature review with supervision from Drs Havel, Saxena, Goodman and Storch. All authors contributed to the writing and critical review/revision of the manuscript. Additionally, all authors read and approved the final manuscript, and agree to be held accountable for this work.

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Younus, S., Havel, L., Stiede, J.T. et al. Pediatric Treatment-Resistant Obsessive Compulsive Disorder: Treatment Options and Challenges. Pediatr Drugs 26, 397–409 (2024). https://doi.org/10.1007/s40272-024-00639-5

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