Obsessive-compulsive disorder (OCD) is a common mental health disorder that occurs at all ages, but more commonly in younger people. It affects 1-1.5% of the general population. Many pharmacological therapies have been reported to diminish OCD symptoms, as well as increase the patient's quality of life. So far, several meta-analyses have directly compared such treatment approaches in treatment-responsive and treatmentresistant OCD. This review evaluated all treatment options for OCD in both children and adolescents, and aimed to establish whether existing pharmacological therapies work similarly well, taking into account medical comorbidities such as substance use, anxiety, metabolic disorders, and finally, an overview of issues related to safety and monitoring. Our review included data from 16 meta-analyses and 8 practical guidelines focusing on OCD patients. In adults with OCD, we found that combined therapy shows favorable outcomes versus SRI alone and produced better results. In children with OCD the greatest incremental treatment gains occur early in treatment with selective serotonin reuptake inhibitors (SSRIs). Finally, in treatment-resistant OCD augmentation of SRIs can be regarded as an evidence-based measure in pharmacological therapy. The results of this review mostly support the previous reviews on the pharmacological management of OCD. However, we noted that combination/augmentation of SSRIs significantly improved symptoms in treatment-resistant OCD compared with monotherapy. From a clinical perspective, antipsychotics combination/augmentation of SSRIs should be used in comorbid psychosis, a frequent comorbidity in OCD, especially as the presence of comorbidities is highly associated with treatment resistance in OCD.

Objective: In this concise and systematic review, the trend of using major medication modalities prescribed for refractory obsessive-compulsive disorder (OCD), including serotonin-specific reuptake inhibitors (SSRIs) and second-generation antipsychotics (SGAs) are discussed. Methods:We systematically searched PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) systematically using Mesh terms. OCD is extremely disabling and associated with considerable depression and other serious psychiatric illnesses.Results: Through databases, we found 78 randomized clinical trials (RCTs), which included selective SSRI compared with routine drug therapy or placebo. Out of these 78 studies, 62 studies were conducted on adult patients with OCD, comprising 7920 cases. While only 16 RCTs were performed on children and adolescents with OCD, including 1313 people. We found 24 clinical trial studies related to SGAs, of which were conducted on adult patients with OCD, including 992 cases. Conclusion:As our data showed among the SSRIs, fluvoxamine has been particularly well studied and used in RCTs in both children and adolescents with OCD. According to the summary of our review, it will be better when therapists use SGAs in the early treatment programs of refractory OCD. Thus, considering our reviewed, it seems that the first choice of early treatment programs of refractory OCD is fluvoxamine in combination with quetiapine or aripiprazole.