EFFICACY AND TOLERABILITY OF ANTIDEPRESSANTS IN PEDIATRIC ANXIETY DISORDERS: A SYSTEMATIC REVIEW AND META-ANALYSIS: Research Article: Pediatric Anxiety Meta-Analysis
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BACKGROUND: Randomized controlled trials have demonstrated that antidepressants are efficacious in the treatment of anxiety disorders in youth. However, there are no recent, systematic analyses of the efficacy, safety, or tolerability of these medications in pediatric anxiety disorders. METHODS: A systematic review and meta-analysis of prospective, randomized, parallel-group, controlled trials of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) in pediatric patients with non-obsessive compulsive disorder (OCD) anxiety disorders was undertaken using a search of PubMed/Medline (1966-2014). The meta-analysis utilized random-effects models to evaluate change in the Pediatric Anxiety Rating Scale or similar anxiety scale, suicidality, and adverse events. Additionally, pharmacologic variables were explored with regard to effect size, although no correction for multiple comparisons was made with regard to these relationships. RESULTS: Nine trials involving 1,673 patients and six medications were included. All SSRI/SSNRIs evaluated demonstrated efficacy, and the meta-analytic estimate of effect was of moderate magnitude (Cohen's d = 0.62, confidence interval [CI]: 0.34-0.89, P = .009) and there was evidence of modest heterogeneity (I(2) = 0.29, P = .103). Activation trended toward being more likely with antidepressant treatment (OR: 1.86, CI: 0.98-3.53, P = .054), but no increased risk was observed for nausea/abdominal symptoms (P = .262), discontinuation as a result of an adverse event (P = .132), or suicidality (OR: 1.3, CI: 0.53-3.2, P = .514). Finally, the effect size correlated with the serotonergic specificity of the agent (R = .79, P = .021). CONCLUSIONS: Data for nine SSRI/SSNRIs suggest superiority of antidepressants relative to placebo for the treatment of pediatric anxiety disorders with a moderate effect size.
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The adverse effect profiles of antidepressant medications are well known, and any potential adverse events from psychological therapies remain underinvestigated.
“However, the adverse effect profiles of antidepressant medications are well known (Strawn 2015;Wang 2017), and any potential adverse events from psychological therapies remain underinvestigated.”
From Exercise for the treatment of anxiety in children and adolescents (2022) · cites this paper as Strawn 2015
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- Authors
- Strawn, J. R., Welge, J. A., Wehry, A. M., Keeshin, B., & Rynn, M. A.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- University of Cincinnati (US)
- University of Utah (US)
- New York State Psychiatric Institute (US)
- Corresponding author
- Strawn, Jeffrey R.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2014-11-28
- Volume
- 32
- Issue
- 3
- Pages
- 149-157
- ISSN
- 1091-4269 (ISSN-L)
- PMC
- PMC4514767
- OpenAlex
- W2125405058
- Cited by
- 183
- References
- 48
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 17 · 2023: 17 · 2022: 10 · 2021: 15 · 2020: 15 · 2019: 17 · 2018: 22 · 2017: 24 · 2016: 21 · 2015: 6
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH106037)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- antidepressants, childhood anxiety disorders, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, treatment efficacy, tolerability, adverse events, suicidality, placebo comparison
- MeSH terms
- Serotonin and Noradrenaline Reuptake Inhibitors, Adolescent, Antidepressive Agents, Anxiety, Anxiety Disorders, Child, Humans, Prospective Studies, Psychiatric Status Rating Scales, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors, Suicidal Ideation
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