LAUSR

ABSTRACT Introduction Childhood and adolescence represent critical stages for the development of obsessive-compulsive disorder (OCD). According to recent guidelines and meta-analyses, selective serotonin reuptake inhibitors (SSRIs) should be considered as the first-line pharmacological option for pediatric OCD presenting mild-to-moderate symptoms, and second-generation antipsychotic augmentation therapy should be regarded for resistant cases. Areas covered The present paper provides an overview of the most recent evidence that should guide clinicians on the choice of the appropriate first-line drugs and augmentation strategies for pediatric OCD, while considering their adverse effects and attrition rates. Additionally, this paper highlights the gaps of the literature on this topic and the future directions of research. Expert opinion The current literature on the pharmacological treatments of pediatric OCD reveals a series of gaps, mainly deriving from the limited data available in this population that requires special attention, while considering the specificity of its developmental trajectory. Although controversy still exists on whether psychotropic compounds should be used in children, scientific evidence is available on the detrimental effects of untreated OCD in this critical period of the life span.