Pharmacotherapy for anxiety disorders in children and adolescents

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dc.contributor.authorIpser J.C.
dc.contributor.authorStein D.J.
dc.contributor.authorHawkridge S.
dc.contributor.authorHoppe L.
dc.date.accessioned2011-05-15T16:01:27Z
dc.date.available2011-05-15T16:01:27Z
dc.date.issued2009
dc.description.abstractBackground: Anxiety disorders are a potentially disabling group of disorders which are prevalent in childhood and adolescence. The recognition of the early onset of anxiety disorders, and their successful treatment with medication in adults, has led to the growing interest in using medication for paediatric anxiety disorders. Objectives: To assess the efficacy and tolerability of medication for treating paediatric anxiety disorders. Search strategy: We searched the Cochrane Depression, Anxiety & Neurosis Group specialised register (CCDANCTR-Studies), MEDLINE (via PubMed 1966 to August 2008), EMBASE (1966 to August 2008), and PsycINFO (1972 to August 2008). Various electronic registers were searched for unpublished studies. Reference lists of retrieved articles were searched for additional studies. Selection criteria: All randomised controlled trials (RCTs) of pharmacotherapy in childhood/adolescent anxiety disorders. Data collection and analysis: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. Main results: 22 short-term (<= 16 weeks) RCTs were included in the analysis (2519 participants). The majority of the trials assessed the efficacy of the SSRIs (N = 15). Medication and placebo response occurred in 58.1% and 31.5% of patients, respectively (Number of studies (N) = 14, Number needed to treat (NNT) = 4). Medication was more effective than placebo in reducing overall symptom severity in OCD in a post-hoc comparison (N = 7, Weighted Mean Difference (WMD) = -4.45, 95%CI = -5.94, -2.97, n = 765). Medication was less well tolerated than placebo overall, though the absolute proportion of participants who withdrew due to drug-related adverse events was low (4.9%). Authors' conclusions: Medication treatments can be effective in paediatric anxiety disorders, acting to reduce core symptoms, and should be considered as part of the treatment of these disorders. The greatest number of trials showing efficacy to date have assessed the SSRIs in treating paediatric OCD. There is no clear evidence to show that any particular class of medication is more effective or better tolerated than any other. As quantitative data was only available for the SSRIs and venlafaxine the routine use of benzodiazepines cannot be recommended, especially given concerns of dependency and treatment -related emergent adverse events associated with this class of drugs. Future RCTs could help identify potential clinical moderators of treatment efficacy. Studies of the long-term efficacy of medication treatment, optimal dosage, as well as direct comparisons of pharmacotherapy and psychotherapy are also warranted. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
dc.description.versionReview
dc.identifier.citationCochrane Database of Systematic Reviews
dc.identifier.citation3
dc.identifier.issn1469493X
dc.identifier.other10.1002/14651858.CD005170.pub2
dc.identifier.urihttp://hdl.handle.net/10019.1/11983
dc.subjectbenzodiazepine derivative
dc.subjectplacebo
dc.subjectpsychotropic agent
dc.subjectserotonin uptake inhibitor
dc.subjectanxiety disorder
dc.subjectcell heterogeneity
dc.subjectclinical trial
dc.subjectcognitive therapy
dc.subjectcontrolled clinical trial
dc.subjectdata synthesis
dc.subjectdisease severity
dc.subjectdrug efficacy
dc.subjectdrug tolerability
dc.subjecthuman
dc.subjectinformation processing
dc.subjectmedical research
dc.subjectmorbidity
dc.subjectObsessive-compulsive disorderen_ZA
dc.subjectoptimal drug dose
dc.subjectpsychotherapy
dc.subjectrandomized controlled trial
dc.subjectrating scale
dc.subjectreview
dc.subjectrisk assessment
dc.subjectsensitivity analysis
dc.subjectsuicidal behavior
dc.subjectsystematic review
dc.subjecttreatment outcome
dc.subjecttreatment response
dc.subjectunspecified side effect
dc.titlePharmacotherapy for anxiety disorders in children and adolescents
dc.typeReview
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