A J Allen1, H Leonard, S E Swedo. 1. Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892, USA.
Abstract
OBJECTIVE: This report will review the costs, risks, and benefits of potentially useful medications for the treatment of children and adolescents with anxiety disorders and will identify areas where data are limited and additional research is needed. METHOD: A Medline-assisted review of the literature was performed. Attention was given to dosage, response, and side effects of medications. Wherever possible, blinded, controlled medication trials in children with anxiety disorders (diagnosed by structured criteria) were targeted for use as the primary references. Relatively few systematic studies were found, so information from open trials and case reports also was included, as were controlled trials in adult populations. RESULTS: The largest body of work supporting the use of medications for childhood anxiety came from studies of obsessive-compulsive disorder, where clomipramine and fluoxetine have been found effective in systematic studies. In other childhood anxiety disorders, there are conflicting data about the efficacy of medications, such as tricyclic antidepressants, benzodiazepines, serotonin reuptake inhibitors, beta-blockers, and monoamine oxidase inhibitors. CONCLUSIONS: This review of the systematic pharmacological trials for childhood anxiety disorders revealed only 13 controlled studies: 5 for obsessive-compulsive disorder, 4 for school refusal/separation anxiety disorder, and 4 for avoidant/overanxious disorder or mixed diagnostic groups. Medications appear to be helpful for childhood anxiety disorders, although definitive pharmacotherapeutic data are lacking for many conditions. A systematic study of these medications is required to establish safety and efficacy in the pediatric age group. Evolving diagnostic criteria and terminology, the presence of comorbid diagnoses (especially affective disorders), and inadequate medication dosages may be factors hindering research in this field. Until additional research is done, clinicians must carefully consider the relative risk-to-benefit ratio when prescribing these medications.
OBJECTIVE: This report will review the costs, risks, and benefits of potentially useful medications for the treatment of children and adolescents with anxiety disorders and will identify areas where data are limited and additional research is needed. METHOD: A Medline-assisted review of the literature was performed. Attention was given to dosage, response, and side effects of medications. Wherever possible, blinded, controlled medication trials in children with anxiety disorders (diagnosed by structured criteria) were targeted for use as the primary references. Relatively few systematic studies were found, so information from open trials and case reports also was included, as were controlled trials in adult populations. RESULTS: The largest body of work supporting the use of medications for childhood anxiety came from studies of obsessive-compulsive disorder, where clomipramine and fluoxetine have been found effective in systematic studies. In other childhood anxiety disorders, there are conflicting data about the efficacy of medications, such as tricyclic antidepressants, benzodiazepines, serotonin reuptake inhibitors, beta-blockers, and monoamine oxidase inhibitors. CONCLUSIONS: This review of the systematic pharmacological trials for childhood anxiety disorders revealed only 13 controlled studies: 5 for obsessive-compulsive disorder, 4 for school refusal/separation anxiety disorder, and 4 for avoidant/overanxious disorder or mixed diagnostic groups. Medications appear to be helpful for childhood anxiety disorders, although definitive pharmacotherapeutic data are lacking for many conditions. A systematic study of these medications is required to establish safety and efficacy in the pediatric age group. Evolving diagnostic criteria and terminology, the presence of comorbid diagnoses (especially affective disorders), and inadequate medication dosages may be factors hindering research in this field. Until additional research is done, clinicians must carefully consider the relative risk-to-benefit ratio when prescribing these medications.