do ssris lower pediatric ocd scores by only about 3 points more than placebo?
“On average, SSRIs reduce sidebox scores by about three points more than placebo, not very much.”
a host, a psychiatrist said on The Carlat Psychiatry Podcast, 2026-10-12, at 03:07. hear it in context → the speaker cited: a 2025 study by Cohen and colleagues (meta-analysis of four RCTs).
the episode: How Much Do SSRIs Really Help Kids with OCD? (at 03:07). we link the show's own page; we do not re-host audio.
first, the part that holds
the number is right. a 2025 individual-participant-data meta-analysis of four placebo-controlled trials in children and adolescents with OCD found that SSRIs lowered CY-BOCS scores by 3.0 points more than placebo (95% CI 2.5 to 3.5).
what we found when we went and looked
we read the abstract of the 2025 meta-analysis in the journal of the american academy of child and adolescent psychiatry. it pooled individual data from 4 randomized trials (614 participants) and reports "reduction of 3.0 CY-BOCS points compared with placebo (95% CI 2.5-3.5), corresponding to a small effect size (0.38 Hedges' g)", so the podcast's "about three points" matches. an older meta-analysis of 12 trials (958 patients) found almost the same figure, 3.38 points. the "not very much" framing fits the authors' own wording ("a small effect size"). a 2024 paper from the same research group estimated that clinicians need to see about 5.1 points before they rate a child as even minimally improved.
assertion by assertion
| assertion | verdict | what the record says |
|---|---|---|
| in pooled randomized trial data, SSRIs reduced CY-BOCS scores by about 3 points more than placebo | confirmed | the 2025 IPD meta-analysis reports a 3.0-point reduction versus placebo (95% CI 2.5-3.5), Hedges' g 0.38. this is a between-group average and says nothing about how much any one child improves. [1] |
| the pooled data came from randomized trials in children and adolescents with OCD | confirmed | 4 double-blind, placebo-controlled randomized trials, 614 children and adolescents with OCD. the authors say this is 86% of all participants ever enrolled in such trials. [1] |
| the source is a 2025 meta-analysis of four RCTs by the named author group | confirmed | published 2025 in J Am Acad Child Adolesc Psychiatry 64(7):775-785, doi 10.1016/j.jaac.2025.01.001. the first author matches the name the speaker gave, and the paper is an IPD meta-analysis of 4 RCTs. [1] |
| a 3-point average difference is 'not very much' | confirmed | the authors call the effect small (g 0.38). a 2024 study from the same group, using only 2 trials (n=309), put the minimal important difference at 5.1 CY-BOCS points: 6.4 for moderate-to-severe OCD and 3.3 for mild OCD. how much a difference matters is a judgment call, and the minimal-important-difference figure is for individual change, not a gap between group averages. [1][2] |
| the roughly 3-point figure holds up across the wider trial literature | confirmed | a 2019 meta-analysis of 12 RCTs (958 patients) found a mean CY-BOCS difference of -3.38 (95% CI -4.60 to -2.16), standardized mean difference -0.43. [3] |
both directions
for the speaker: the 2025 abstract gives 3.0 points (95% CI 2.5-3.5) and calls it a small effect (Hedges' g 0.38). it covers 86% of every participant ever enrolled in double-blind placebo-controlled SSRI trials for pediatric OCD. a separate 12-trial meta-analysis found 3.38 points. both estimates sit below the 5.1-point minimal important difference that the same research group derived in 2024, which supports "not very much".
against: "not very much" leaves some things out. the same abstract reports that children on SSRIs had higher odds of meeting response criteria (odds ratio 1.89, 95% CI 1.45-2.45), so the medication beat placebo clearly, even if not by much. an average difference also hides spread: some children improve a lot and some not at all. the abstract found that the milder the baseline symptoms, the more likely a child was to respond. the 3 points is the gap over placebo, not the total improvement on medication, because children in the placebo arms also improved. and the 2024 minimal-important-difference study gives a lower bar for mild OCD (3.3 points), so for milder cases 3 points is close to the threshold.
what this cannot say
the authors say their findings may not generalize because the participants were mostly White and all at North American sites. they could not look at socioeconomic status or comorbid conditions. the trials ran for weeks, not years, so they say nothing about long-term effects. the minimal-important-difference estimate comes from only 2 trials (n=309) and measures individual change, so comparing it with a gap between group averages is a rough heuristic, not a formal test. our method also has limits: pubmed's web page did not load for us, so we read the abstract through NCBI's e-utilities service, not the full text. we did not check the trial-level data or the podcast segment beyond the quote we were given.
sources, each one fetched and read
- Systematic review and meta-analysis of individual participant data: randomized, placebo-controlled trials of selective serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2025;64(7):775-785. doi:10.1016/j.jaac.2025.01.001. PMID 39799995 What we read there: "Meta-analysis showed reduction of 3.0 CY-BOCS points compared with placebo (95% CI 2.5-3.5), corresponding to a small effect size (0.38 Hedges' g)." 4 RCTs, 614 participants, 86% of all participants ever in such trials; response OR 1.89 (95% CI 1.45-2.45); baseline severity a negative modifier of response. Fetched 2026-10-14 (HTTP 203). https://pubmed.ncbi.nlm.nih.gov/39799995/
- Exploring the minimal important difference in the treatment of paediatric obsessive-compulsive disorder using selective serotonin reuptake inhibitors. BMJ Mental Health. 2024 What we read there: "a reduction of 5.1 points on the CYBOCS is required for clinicians to observe minimal improvement"; 6.4 points for CY-BOCS ≥22, 3.3 points for CY-BOCS <22; based on 2 placebo-controlled SSRI trials, n=309. Fetched 2026-10-14 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC11191732/
- The effectiveness of selective serotonin reuptake inhibitors for treatment of obsessive-compulsive disorder in adolescents and children: a systematic review and meta-analysis. Frontiers in Psychiatry. 2019 What we read there: 12 RCTs, 958 patients; mean CY-BOCS difference versus placebo -3.38 (95% CI -4.60 to -2.16), SMD -0.43; "SSRIs are clearly effective compared to placebo for treating OCD in adolescents and children, but the effect size is small." Fetched 2026-10-14 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC6691487/
speakers are described by role, not named. one sentence is quoted under fair use, with attribution and a link to the original at the timestamp; we do not re-host audio or video. nothing on this page is a reason to start, stop or change a medication. if you have the file behind anything marked unverifiable, the research board is where people can answer. adam