Editing Antidepressant (section)

====Obsessive–compulsive disorder====
SSRIs are a [[Second-line medication|second-line]] treatment for adult [[obsessive–compulsive disorder]] (OCD) with mild functional impairment, and a first-line treatment for those with moderate or severe impairment.<ref>{{cite journal|vauthors=Soomro GM, Altman D, Rajagopal S, Oakley-Browne M|date=January 2008|title=Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD)|journal=The Cochrane Database of Systematic Reviews|volume=2008|issue=1|pages=CD001765|doi=10.1002/14651858.CD001765.pub3|pmc=7025764|pmid=18253995}}</ref><ref>{{cite journal|vauthors=Fineberg NA, Brown A, Reghunandanan S, Pampaloni I|date=September 2012|title=Evidence-based pharmacotherapy of obsessive-compulsive disorder|journal=The International Journal of Neuropsychopharmacology|volume=15|issue=8|pages=1173–1191|doi=10.1017/S1461145711001829|pmid=22226028|doi-access=free|hdl=2299/216|hdl-access=free}}</ref><ref>{{cite web|title=Paroxetine prescribing information|url=https://www.apotex.com/us/en/products/downloads/pil/paxil_irtb_ins.pdf|url-status=dead|archive-url=https://web.archive.org/web/20150219055046/https://www.apotex.com/us/en/products/downloads/pil/paxil_irtb_ins.pdf|archive-date=19 February 2015|access-date=30 January 2015}}</ref><ref>{{cite web|title=Sertraline prescribing information|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019839s070,020990s032lbl.pdf|url-status=live|archive-url=https://web.archive.org/web/20150616011817/http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019839s070,020990s032lbl.pdf|archive-date=16 June 2015|access-date=30 January 2015}}</ref>

In children, SSRIs are considered as a second-line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects.<ref>{{cite web|url=http://www.nice.org.uk/nicemedia/pdf/cg031niceguideline.pdf|title=Obsessive-compulsive disorder|work=Clinical Guideline 31|publisher=The National Institute for Health and Care Excellence|date=November 2005|url-status=dead|archive-url=https://web.archive.org/web/20081206033654/https://www.nice.org.uk/nicemedia/pdf/cg031niceguideline.pdf|archive-date=6 December 2008}}</ref> Sertraline and fluoxetine are effective in treating OCD for children and adolescents.<ref name="NIHR-2022" /><ref name="Boaden-2020" /><ref name="Correll-2021" />

[[Clomipramine]], a TCA drug, is considered effective and useful for OCD. However, it is used as a second-line treatment because it is less well-tolerated than SSRIs. Despite this, it has not shown superiority to fluvoxamine in trials. All SSRIs can be used effectively for OCD. SNRI use may also be attempted, though no SNRIs have been approved for the treatment of OCD. Despite these treatment options, many patients remain symptomatic after initiating the medication, and less than half achieve [[Remission (medicine)|remission]].<ref>{{cite journal|vauthors=Kellner M|title=Drug treatment of obsessive-compulsive disorder|journal=Dialogues in Clinical Neuroscience|volume=12|issue=2|pages=187–197|date=June 2010|pmid=20623923|pmc=3181958|doi=10.31887/DCNS.2010.12.2/mkellner}}</ref>

Placebo responses are a large component of the benefit of antidepressants in the treatment of depression and anxiety.<ref name="pmid31249537" /><ref name="pmid31573058" /> However, placebo responses with antidepressants are lower in magnitude in the treatment of OCD compared to depression and anxiety.<ref name="pmid31573058" /><ref name="pmid28477500">{{cite journal|vauthors=Sugarman MA, Kirsch I, Huppert JD|title=Obsessive-compulsive disorder has a reduced placebo (and antidepressant) response compared to other anxiety disorders: A meta-analysis|journal=J Affect Disord|volume=218|pages=217–226|date=August 2017|pmid=28477500|doi=10.1016/j.jad.2017.04.068}}</ref> A 2019 meta-analysis found placebo improvement effect sizes (SMD) of about 1.2 for depression, 1.0 for anxiety disorders, and 0.6 for OCD with antidepressants.<ref name="pmid31573058" />