Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial

Adam M Reid; Joseph P H McNamara; Tanya K Murphy; Andrew G Guzick; Eric A Storch; Wayne K Goodman; Gary R Geffken; Regina Bussing

doi:10.1016/j.jpsychires.2015.10.006

Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial

J Psychiatr Res. 2015 Dec:71:140-7. doi: 10.1016/j.jpsychires.2015.10.006. Epub 2015 Oct 14.

Authors

Adam M Reid¹, Joseph P H McNamara², Tanya K Murphy³, Andrew G Guzick⁴, Eric A Storch⁵, Wayne K Goodman, Gary R Geffken⁶, Regina Bussing⁷

Affiliations

¹ Department of Psychiatry, University of Florida, PO Box 100256 1149 Newell Dr., L4-100, Gainesville, FL 32611, USA; Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Room 3151, Gainesville, FL 32611, USA; Harvard Medical School, Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. Electronic address: reidam@phhp.ufl.edu.
² Department of Psychiatry, University of Florida, PO Box 100256 1149 Newell Dr., L4-100, Gainesville, FL 32611, USA; Department of Psychology, University of Florida, 2014 Turlington Hall, Gainesville, FL 32611, P.O Box 117300, USA. Electronic address: jpm2@ufl.edu.
³ Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL 33613, USA; Department of Pediatrics, University of South Florida, 880 6th Street South, Box 7523, St. Petersburg, FL 33701, USA; All Children's Hospital, John Hopkins Medicine, 600 N Wolfe St # 157, Baltimore, MD 21287, USA. Electronic address: tmurphy@health.usf.edu.
⁴ Department of Psychiatry, University of Florida, PO Box 100256 1149 Newell Dr., L4-100, Gainesville, FL 32611, USA; Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Room 3151, Gainesville, FL 32611, USA. Electronic address: guzick@ufl.edu.
⁵ Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL 33613, USA; Department of Pediatrics, University of South Florida, 880 6th Street South, Box 7523, St. Petersburg, FL 33701, USA; All Children's Hospital, John Hopkins Medicine, 600 N Wolfe St # 157, Baltimore, MD 21287, USA; Department of Health Policy and Management, University of South Florida, 13201 Bruce B. Downs Blvd., MDC56, Tampa, FL 33612, USA; Rodgers Behavioral Health-Tampa Bay, 2002 N Lois Ave, Tampa, FL 33607, USA. Electronic address: estorch@health.usf.edu.
⁶ Department of Psychiatry, University of Florida, PO Box 100256 1149 Newell Dr., L4-100, Gainesville, FL 32611, USA; Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Room 3151, Gainesville, FL 32611, USA; Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL 32607, USA. Electronic address: geffken@ufl.edu.
⁷ Department of Psychiatry, University of Florida, PO Box 100256 1149 Newell Dr., L4-100, Gainesville, FL 32611, USA. Electronic address: rbussing@ufl.edu.

Abstract

Objective: Activation Syndrome (AS) is a side-effect of antidepressants consisting of irritability, mania, self-harm, akathisia, and disinhibition. The current study was conducted to analyze how AS may hinder treatment outcome for multimodal treatment for children and adolescents with Obsessive-Compulsive Disorder.

Methods: Fifty-six children or adolescents were recruited at two treatment sites in a double-blind randomized-controlled trial where participants received Cognitive-Behavioral Therapy and were randomized to slow titration of sertraline, regular titration of sertraline or placebo.

Results: Using a recently developed measure of AS, results suggested that higher average levels of irritability, akathisia, and disinhibition significantly interfered with treatment response and explained 18% of the variance in obsessive-compulsive symptoms during treatment. Interestingly, only session-to-session increases in irritability resulted in a session-to-session increase in obsessive-compulsive symptoms. The observed results were unchanged with the addition of SSRI dosage as a covariate.

Conclusions: Results provide empirical support for the proposed hypothesis that AS may hinder multimodal treatment outcome for pediatric OCD. These findings suggest that dosage changes due to AS do not explain why those with higher AS had worse multimodal outcome. Other possible mechanisms explaining this observed disruption are proposed, including how AS may interfere with Cognitive-Behavioral Therapy.

Trial registration: ClinicalTrials.gov NCT00382291.

Keywords: Activation syndrome; Children; Cognitive-behavioral therapy; Obsessive-Compulsive Disorder; Selective serotonin reuptake inhibitors; Side-effects.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Akathisia, Drug-Induced
Child
Cognitive Behavioral Therapy* / methods
Combined Modality Therapy / adverse effects
Combined Modality Therapy / methods
Double-Blind Method
Emotions / drug effects
Female
Humans
Inhibition, Psychological
Male
Models, Statistical
Obsessive-Compulsive Disorder / therapy*
Selective Serotonin Reuptake Inhibitors / administration & dosage
Selective Serotonin Reuptake Inhibitors / adverse effects*
Sertraline / administration & dosage
Sertraline / adverse effects*
Treatment Outcome

Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial

Authors

Affiliations

Abstract

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