For Childhood Anxiety, Consider First-Line Cognitive-Behavioral Therapy

Peter M. Yellowlees, MBBS, MD


July 10, 2018

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Childhood anxiety is common. Multiple treatment options are available, but existing guidelines provide inconsistent advice on which to use. Now a team of investigators[1] from the Mayo Clinic in Rochester, Minnesota, have undertaken a systematic review of the literature to evaluate the comparative effectiveness and adverse events of cognitive-behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders. A total of 7719 patients were included from 115 studies.

The researchers found that evidence supports the effectiveness of CBT and selective serotonin reuptake inhibitors (SSRIs) for reducing childhood anxiety symptoms. Serotonin-norepinephrine reuptake inhibitors (SNRIs) also appear to be effective, based on less consistent evidence. Benzodiazepines and tricyclics were not found to significantly reduce anxiety symptoms. The combination of sertraline and CBT significantly reduced clinician-reported primary anxiety symptoms and response more than either treatment alone. The researchers concluded that head-to-head clinical trial comparisons between various medications and comparisons with CBT are needed.

So where does this leave us? Treatment of anxiety in US children in recent years has been primarily focused on pharmacotherapy and has minimized the use of CBT. This study shows that CBT should be given serious consideration as a first-line or combination therapy by most clinicians who treat anxious children. CBT is relatively straightforward to implement and should become part of routine office practice for pediatricians and child psychiatrists. If medications are to be used, and they are still a cornerstone of therapy, then SSRIs and SNRIs are the medications of choice.

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