Childhood Anxiety Symptoms Improved With Combination Therapy

The combination of cognitive behavioral therapy (CBT) and use of selective serotonin reuptake inhibitors (SSRIs) is associated with improved symptoms among children with anxiety disorders, according to a recent meta-analysis. Serotonin-norepinephrine reuptake inhibitors (SNRIs) also effectively improved anxiety symptoms.

Anxiety is common among children. Multiple treatment options exist, but current guidelines do not provide consistent recommendations on which treatment is best.
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To evaluate the efficacy of CBT and pharmacotherapy for childhood anxiety disorders, the researchers assessed 7719 children with a mean age of 9.2 years who had anxiety disorders and were enrolled in 115 studies. Children in the included studies had confirmed diagnoses of panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, or separation anxiety and who had previously received CBT, pharmacotherapy, or both.

Patient data was obtained via multiple online databases from inception to February 1, 2017. The researchers defined the primary outcomes as primary anxiety symptoms, measured by the child, parents, or a clinician, as well as remission, response, and adverse events.

Results indicated that SSRIs had significantly decreased symptoms of primary anxiety and had increased remission and response vs placebo. Additionally, SNRIs had significantly reduced clinician-reported symptoms of primary anxiety. However, anxiety symptoms were not reduced by benzodiazepines or tricyclics.

Ultimately, the researchers found that the combination of CBT and sertraline had significantly improved clinician-reported symptoms of primary anxiety and response more than either treatment alone. However, they also noted that there had been few head-to-head comparisons, and that network meta-analysis estimates had not been precise.

Adverse events had been commonly reported with medication use, but had not been severe. No adverse events had been reported with CBT.

“Evidence supports the effectiveness of CBT and SSRIs for reducing childhood anxiety symptoms,” the researchers concluded. “Serotonin-norepinephrine reuptake inhibitors also appear to be effective based on less consistent evidence. Head-to-head comparisons between various medications and comparisons with CBT represent a need for research in the field.”

—Christina Vogt

Reference:

Wang Z, Whiteside SPH, Sim L, et al. Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: a systematic review and meta-analysis [Published online August 31, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.3036.