Effect of Antidepressant Class, Dose on Pediatric Anxiety Disorders

antidepressants in boys hands
antidepressants in boys hands
Researchers identified 9 trials examining the efficacy of SSRIs or SSNRIs in the treatment of social, generalized and/or separation anxiety disorder in pediatric patients.

According to the findings of a meta-analysis published in the Journal of the American Academy of Child and Adolescent Psychiatry, antidepressant-related improvement in pediatric anxiety disorders occurs early in the treatment course, and selective serotonin reuptake inhibitors (SSRIs) are associated with more rapid and significant improvement compared with selective serotonin-norepinephrine reuptake inhibitors (SSNRIs).

Researchers identified 9 randomized, parallel-group, placebo-controlled studies examining the efficacy of SSRIs or SSNRIs in the treatment of social, generalized, and/or separation anxiety disorder in pediatric patients. Together, these trials captured the effects of 7 medications in 1673 patients. Researchers employed a logarithmic-linear model to assess treatment responses across historical trials. For both SSRIs and SSNRIs, statistically significant improvement in symptoms occurred at week 2 (P <.001 for SSRIs; P =.021 for SSNRIs), although SSRIs resulted in significantly greater improvement by this time (P =.0268). 

For the subsequent 10 weeks of treatment, additional class-related differences in response trajectories and magnitudes emerged between medications. The clinical improvement with SSRIs compared with SSNRIs remained statistically significant through week 12 (P <.03 for each week). For SSRIs specifically, investigators observed earlier improvement with high-dose treatment compared with low-dose treatment, although SSRI dose did not affect overall response trajectory (P >.18 for weeks 1-12).

These data confirm the efficacy of SSRIs as first-line antidepressant treatment in youth with anxiety disorders. However, researchers noted that a meta-analytic evaluation of past studies may not have captured unobserved factors affecting the trajectory of medication response, such as clinician-specific standards of care or patient-specific expectations of treatment. Still, these data may be useful in titrating the pharmacological treatment of anxiety disorders in pediatric patients.

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Disclosures: Dr Strawn has received research support from the National Institutes of Health, as well as Edgemont, Eli Lilly and Co., Forest, Shire, Lundbeck, and Neuronetics. He has received material support from Genesight/Assurex Health, has received royalties from the publication of 2 texts (Springer), and has served as an author for UpToDate and an associate editor for Current Psychiatry. Dr Welge has received support from the Bill and Melinda Gates Foundation and the National Institutes of Health. Dr Mills and Mr Sauley report no biomedical financial interests or potential conflicts of interest.


Strawn J, Mills J, BeauA S, Welge J. The impact of antidepressant dose and class on treatment response in pediatric anxiety disorders: a meta-analysis [published online February 7, 2018]. J Am Acad Child Adolesc Psychiatry. doi: 10.1016/j.jaac.2018.01.015