Fluoxetine in acute treatment of children and adolescents with obsessive–compulsive disorder: a systematic review and meta-analysis

Abstract

Background: Obsessive–compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Previous evidence suggests that fluoxetine is effective in the treatment of OCD in children and adolescents. However, those studies had small sample sizes. As a result, a systematic review, which is a more powerful method to calculate the true effect size, can be applied to examine the efficacy, acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents.

Objectives: The aims of this study were to review the efficacy, acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents.

Study appraisal and synthesis methods: The titles and abstracts collected from electronic databases were evaluated. Then, the full-text versions of relevant studies were thoroughly assessed and extracted.

Results: A total of 188 randomized patients in three RCTs of fluoxetine versus placebo and one RCT of fluoxetine versus citalopram were included in this review. Considering efficacious outcomes, the pooled mean change score of the CY-BOCS in the fluoxetine-treated group was significantly greater than that in the placebo-treated group. Additionally, the CGI-S in the fluoxetine-treated group and the pooled mean change score of the NIMH-OC were also significantly different from those in the placebo-treated group.

Limitation: This review included studies with small sample sizes.

Conclusions and implications of key findings: Fluoxetine is associated with a significantly greater reduction in OCD severity, as measured by the CY-BOCS, NIMH-OC and CGI-S, in children and adolescents. Additionally, it is well tolerated in children and adolescents. The acceptability is comparable to that of the placebo-treated group. Nonetheless, further large prospective trials should be conducted to confirm these outcomes.

Keywords:

• The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
• the National Institute of Mental Health Global OCD Scale (NIMH-OC)
• Clinical Global Impressions-Severity (CGI-S)
• efficacy
• acceptability
• tolerability

Author contributions

All the authors conceptualized the idea, developed the review protocol, prepared the manuscript for publication and affirmed the manuscript in its current form. N. M. and B. M. searched for articles from the databases, extracted the data and analyzed the data.

Systematic review registration number: CRD 42019140426.

Disclosure statement

N. M. received travel reimbursement from Lundbeck and Pfizer. B. M. received honoraria and/or travel reimbursement from Lundbeck, Pfizer and Servier. N. K., P. W. and S. W. have no potential conflict of interest. M. S. has received honoraria, consultancy fees, research grants, and/or travel reimbursement from AstraZeneca, GlaxoSmithKline, Pfizer, Janssen-Cilag, Johnson & Johnson, Lundbeck, Thai-Otsuka, Sanofi-Aventis and Servier.

Additional information

Funding

This review received support by Chiang Mai University (Grant no. CMU 016/2562/4).

Notes on contributors

Narong Maneeton

Narong Maneeton is Professor of Psychiatry at Chiang Mai University and has been working with children and adolescents and done research concerning children and adolescents for many years.

Benchalak Maneeton

Benchalak Maneeton is Professor of Psychiatry at Chiang Mai University and has been working with liaison patients and done several research concerning general psychiatry, including children and adolescents for many years.

Nuntaporn Karawekpanyawong

Nuntaporn Karawekpanyawong is Lecturer at Chiang Mai University and has been working with general psychiatric patients for many years.

Pakapan Woottiluk

Pakapan Woottiluk is Assistant Professor of Psychiatric Nursing at Chiang Mai University and has been working with general psychiatric patients for many years.

Suwannee Putthisri

Suwannee Putthisri is Associate Professor of Psychiatry at Mahidol University and has been working with children and adolescents and done research concerning children and adolescents for many years.

Manit Srisurapanon

Manit Srisurapanon is Professor of Psychiatry at Chiang Mai University and has been working with general psychiatric patients and done several research concerning general psychiatry, including children and adolescents for many years.