Comparative efficacy and acceptability of exposure and response prevention therapy, selective serotonin reuptake inhibitors and their combinations for the treatment of obsessive-compulsive disorder in children and adolescents: a systematic review and network meta-analysis.

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects many children and teenagers. It causes people to have unwanted, repeating thoughts, images, or urges, which are called obsessions. To try and control these obsessions, they feel a strong need to perform certain actions or rituals over and over again, known as compulsions. For example, someone might have an obsessive fear of germs and feel compelled to wash their hands constantly. OCD can be very distressing and get in the way of school, friendships, and family life, affecting about 1 to 2 out of every 100 young people. Currently, there are two main treatments for OCD in children and adolescents. One is a type of medication called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs block the reuptake, or "recycling," of serotonin, a chemical messenger used by certain brain cells to communicate with each other. SSRIs leave more serotonin in the tiny space between nerve cells, keeping the signal strong and reducing OCD symptoms. The other is a kind of talk therapy called Exposure and Response Prevention (ERP) therapy, where a person learns to face their fears without performing their compulsive rituals. These treatments can also be used together.

Although we know these treatments can help, it is not clear which one is the most effective or which one is easiest for young people to stick with. Many individual studies have been done, but they often compare only one or two treatments at a time, such as SSRI versus a placebo (a treatment with no active drug). This makes it hard for doctors and families to know which option is truly best overall. Our research will bring together all the existing evidence to provide a clearer answer.

To do this, we will conduct a systematic review, which is a highly organized search for all the best scientific studies, called Randomised Controlled Trials (RCTs), that have ever tested these OCD treatments in people under 18. We will then use a special statistical method called a network meta-analysis. This powerful tool lets us combine results from all the different studies and compare treatments against each other, even if they were never directly tested in the same study. To measure how well the treatments work, we will look at their efficacy, which is how much they reduce OCD symptoms. We will also assess their acceptability by seeing how many patients drop out of a treatment, which shows how well-tolerated it is.

By combining all this information, our project will rank the treatments from most to least effective and acceptable. This will create clear, reliable guidance to help doctors, young people, and their families make the best possible decisions for managing OCD, leading to better health and quality of life.