Generalized Anxiety Disorder Across the Lifespan by Michael E. Portman

Author:Michael E. Portman
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Pharmacological Treatments

There are, unlike in the literature on psychosocial treatments for pediatric anxiety disorders, pharmaceutical agents that have been specifically evaluated for only GAD in this population. Several different classes have been investigated, but antidepressants (SSRIs) are the treatment of choice for children and adolescents with GAD (Beidel & Turner, 2005).

The first study to explore the use of benzodiazepines in OAD (avoidant disorder also included) was by Simeon and Ferguson (1987). In this open-label trial, 58% showed moderate improvement by week 4, and this gain was maintained in a 4-week drug-free period. OAD was not examined separately in this study. In a subsequent placebo-controlled study by Simeon et al. (1992), 30 youths with a mean age of 12.6 years (21 had OAD and 9 had avoidant disorder) were studied, and similar results found improvement in the drug-treated group over placebo at 4 weeks, but not at posttreatment follow-up. In summary, benzodiazepines have been investigated for pediatric anxiety, but mostly in small open-label trials (Reinblatt & Riddle, 2007). Benzodiazepines are used as a last resort for youths (Kratochvil, Kutcher, Reiter, & March, 1999), but may prove helpful with anxiety disorders that have marked somatic symptoms accompanied by functional impairment, or may be used adjunctively with antidepressants in the short term (Rynn & Franklin, 2002).

Buspirone is not a first line treatment for anxious youth. There has been some improvement noted in two open-label trials (Kutcher, Reiter, Gardner, & Klein, 1992; Simeon, Knott, Dubois, & Wiggins, 1994). However, the improvement has not been replicated in any RCTs (Connolly & Bernstein, 2007).

In regard to antidepressants, Birmaher et al. (1994), in a retrospective study, evaluated the efficacy of fluoxetine (mean dose, 25.7 mg) in 21 children and adolescents, aged 11–17. They carried different anxiety disorder diagnoses (OAD, avoidant disorder, social phobia). There was an 81% improvement at 6–8 weeks, as measured by chart review of nurses and patients' mothers. In another open trial by Fairbanks et al. (1997), children having various anxiety disorders (aged 9–18 years) who were nonresponsive to psychotherapy were administered fluoxetine. Improvement was apparent at 6–9 weeks, and lower doses were used when there was less comorbidity. The sample size was 16, and the data were not analyzed for specific diagnoses. Yet, 81% demonstrated a moderate–marked improvement, albeit 62.5% still met diagnostic criteria for an anxiety disorder at posttreatment. In another study by Birmaher et al. (2003), consisting of a 12-week trial, 74 patients with GAD, separation anxiety, and social phobia were randomized fluoxetine or a matching placebo. In this case 61% showed much or very much improvement vs. 35% for placebo, based on treating clinician's ratings. In the case of GAD, 67% improved over 36% for placebo. Further more, children with GAD treated with fluoxetine did not exhibit improvements in functioning over placebo. In other words, symptom relief of anxiety occurred with treatment, but not necessarily enhanced functioning. Unfortunately, 50% of the children were still symptomatic at posttreatment.

In a study by Clark et al. (2005), fluoxetine was once again studied – this time for longer term treatment in various childhood anxiety disorders (GAD, SAD, SP).

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