Pharmacotherapy for anxiety disorders in children and adolescents

Ipser, Jonathan; Stein, Dan J.; Hawkridge, Susan; Hoppe, Lara

doi:10.1002/14651858.cd005170.pub2

Cited by 115 publications

(108 citation statements)

References 112 publications

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“…With this metric, estimates are that approximately four patients should be using the aforementioned drugs in the anxiety disorders treatment in order to one to achieve clinical response rates (n=14 studies/2,102 patients; medication 58.1% vs. placebo 31.5%; RR = 1.9; NNT = 4). 158 This represents a very strong, robust clinical effect, relative to other conditions. For example, the NNT in either pediatric or adult depression for most medication treatments is not half as potent.…”

Section: Figurementioning

confidence: 95%

“…158 Some trials also support the use of serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine for non-OCD disorders. 158 …”

Section: Medication + Psychoeducationmentioning

confidence: 99%

“…There is no direct evidence that any of these medications offer better responses to treatment or are better tolerated. 158 However, a mixed comparison meta-analysis found that between SSRIs and venlafaxine, venlafaxine was less efficacious than fluvoxamine and paroxetine and less tolerated than fluvoxamine, paroxetine, and sertraline. 160 Besides the SSRIs and venlafaxine, three studies about the use of imipramine among patients with anxiety disorders have demonstrated its effectiveness in non-OCD disorders.…”

Section: Figurementioning

confidence: 99%

“…161 However, TADs are considered secondary choices due to their less favorable adverse effects and the fact that they require continuous monitoring of blood and cardiac irregularities. 158 There is no evidence supporting the use of benzodiazepines in the treatment of pediatric anxiety disorders. 162 It is vital to emphasize that psychoeducation is an essential part of the treatment of anxiety disorders.…”

Section: Figurementioning

confidence: 99%

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Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

Salum

DeSousa

Rosário

et al. 2013

Rev. Bras. Psiquiatr.

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The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.

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Section: Figurementioning

confidence: 95%

“…158 Some trials also support the use of serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine for non-OCD disorders. 158 …”

Section: Medication + Psychoeducationmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 2 more Smart Citations

Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

Salum

DeSousa

Rosário

et al. 2013

Rev. Bras. Psiquiatr.

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“…22 Meta-analysis also suggests that SSRIs may be equally effective in treating children with OCD as adults. 23 Several randomized trials have examined the efficacy of SRIs in the treatment of repetitive behaviors in children with ASD. However, clinical uncertainty remains as to whether SRIs are effective in treating repetitive behavior in children and adults with ASD.…”

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confidence: 99%

Pharmacologic Treatment of Repetitive Behaviors in Autism Spectrum Disorders: Evidence of Publication Bias

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Although several randomized trials have examined the efficacy of serotonin receptor inhibitors in the treatment of repetitive behaviors, there still remains clinical uncertainty as to whether these agents are effective in treating such behaviors in children and adults with autism spectrum disorders. WHAT THIS STUDY ADDS:The goal of this meta-analysis was to examine randomized trials of serotonin receptor inhibitors for treating repetitive behaviors in autism spectrum disorders. Although a small but significant effect of these agents was observed, this effect is likely due to the selective publication of trial results.abstract OBJECTIVE: The goal of this study was to examine the efficacy of serotonin receptor inhibitors (SRIs) for the treatment of repetitive behaviors in autism spectrum disorders (ASD). METHODS:Two reviewers searched PubMed and Clinicaltrials.gov for randomized, double-blind, placebo-controlled trials evaluating the efficacy of SRIs for repetitive behaviors in ASD. Our primary outcome was mean improvement in ratings scales of repetitive behavior. Publication bias was assessed by using a funnel plot, the Egger' s test, and a metaregression of sample size and effect size. RESULTS: Our search identified 5 published and 5 unpublished but completed trials eligible for meta-analysis. Meta-analysis of 5 published and 1 unpublished trial (which provided data) demonstrated a small but significant effect of SRI for the treatment of repetitive behaviors in ASD (standardized mean difference: 0.22 [95% confidence interval: 0.07-0.37], z score = 2.87, P , .005). There was significant evidence of publication bias in all analyses. When Duval and Tweedie' s trim and fill method was used to adjust for the effect of publication bias, there was no longer a significant benefit of SRI for the treatment of repetitive behaviors in ASD (standardized mean difference: 0.12 [95% confidence interval: -0.02 to 0.27]). Secondary analyses demonstrated no significant effect of type of medication, patient age, method of analysis, trial design, or trial duration on reported SRI efficacy.CONCLUSIONS: Meta-analysis of the published literature suggests a small but significant effect of SRI in the treatment of repetitive behaviors in ASD. This effect may be attributable to selective publication of trial results. Without timely, transparent, and complete disclosure of trial results, it remains difficult to determine the efficacy of available medications. Pediatrics 2012;129:e1301-e1310

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