• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » How Effective Are Medications for Pediatric Anxiety?

How Effective Are Medications for Pediatric Anxiety?

January 1, 2019
Thomas Jordan, MD.
From The Carlat Child Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Thomas Jordan, MD. Dr. Jordan has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Review of: Strawn JR et al, J Am Acad Child Adolesc Psychiatry 2018;57(4):235–244.e2

Antidepressants are part of the first-line treatment for severe childhood anxiety disorders when removal of stressors and psychotherapy are not enough, but are all antidepressants created equal in this situation?

A recent meta-analysis shows that antidepressants have a moderate effect size of 0.56 for treating anxiety disorders in children (see CCPR, Jan/Feb 2018), but do we have the data to further break that down? Another meta-analysis was recently performed that can further guide us in tailoring our medication choices for pediatric anxiety disorders.

In this meta-analysis, the authors pooled data from 9 randomized placebo-controlled trials that compared either an SSRI or an SNRI to placebo for the treatment of social, generalized, and/or separation anxiety disorders. Total sample size was 1,805 children ages 5–17 years, with 53% male. All studies were done in outpatient clinics and had a mix of federal and industry funding sources. The follow-up periods varied from 8 to 16 weeks, with a median of 10 weeks. Four SSRIs (fluoxetine, fluvoxamine, paroxetine, and sertraline) and three SNRIs (atomoxetine, venlafaxine, and duloxetine) were used in the studies. The primary outcomes were the time it took to see improvement, how treatment response differed between SSRIs and SNRIs, and differences in low-dose vs high-dose SSRIs. Rating scales, most commonly the Pediatric Anxiety Rating Scale (PARS), were administered every 2 weeks.

Overall, children improved quickly compared to placebo, with a statistically significant difference in the rating scales by week 2 (p = 0.005) and a clinically significant difference seen by week 6 (p = 0.001). SSRIs outperformed SNRIs over the entire treatment course, with a statistically significant difference emerging by week 2 (p = 0.021), but both classes of medications resulted in significant improvement compared to placebo by week 2. For the high-dose vs low-dose SSRI comparison, high-dose was considered > 1.5 fluoxetine equivalents (> 49.5 mg) per day. High-dose SSRI treatment resulted in earlier improvement (week 2), while low-dose resulted in later improvement (week 6). However, over time, there was no significant difference (p = 0.638), but the variance was greater for the low-dose group (p < 0.001).

This meta-analysis found that, overall, SSRIs resulted in greater improvement in childhood anxiety disorders than SNRIs, and that high-dose SSRIs led to earlier improvement. The authors postulate that the differences may be due to an underdeveloped noradrenergic system in children compared to the serotonergic system, or due to anxiety disorders themselves being caused by more dysfunction in the serotonergic system.

CCPR’S Take
When making medication decisions, the more information we have, the better. This study confirms that both SSRIs and SNRIs are effective in treating pediatric anxiety disorders. And, all other things being equal, SSRIs may give better results. Unless you have a reason to avoid SSRIs, using them as the first-line medication choice makes sense. High-dose SSRIs may give faster results but may come at a cost of increased side effects. Always be on the lookout for activation (which is generally more common with SSRIs than SNRIs) and other side effects.

Editor’s note: Generally speaking, a moderate effect size tells you that, if you pick randomly from the treated group vs the control group, you have a better than 50% chance that the person responded.
Child Psychiatry
KEYWORDS anxiety research-update
Thomas Jordan, MD.

Does Baclofen Titrated to High Doses Reduce Alcohol Use?

More from this author
www.thecarlatreport.com
Issue Date: January 1, 2019
SUBSCRIBE NOW
Table Of Contents
CME Post-Test - Anxiety in Children and Adolescents, CCPR, January/February 2019
Wilderness Therapy: Dangerous Waste of Money or an Effective Therapeutic Intervention?
Suicide Rates in College Students
How Effective Are Medications for Pediatric Anxiety?
Note From the Editor-in-Chief
What to Do About School Refusal? A Conversation With Two Experts
Anxiety Everywhere: Grappling With a Pervasive Symptom
DOWNLOAD NOW
Featured Book
  • CMFB2e_Cover.png

    Child Medication Fact Book for Psychiatric Practice, Second Edition (2023)

    All the important facts covering child and adolescent psychopharmacology.
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • teen_depression.jpeg
    Child Psychiatry

    Assessment of Non-Suicidal Self-Injury in Children and Adolescents

    Learn how to assess and intervene with NSSI, including ideas for supporting autonomy while addressing the behavior.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.