Children With AnxietyDo Best on CombinationTherapy

Combining antidepressants and cognitive-behavior therapy (CBT) is the most effective treatment for 8 in 10 children and teenagers with anxiety disorders, according to researchers led by John T. Walkup, MD, associate professor of psychiatry and behavioral sciences, and deputy director, division of child and adolescent psychiatry, Johns Hopkins Medical Institutions, Baltimore. Findings of the study were published in the October 30 issue of the New England Journal of Medicine. The study was funded by the National Institute of Mental Health (NIMH).

The researchers randomized 448 children and adolescents aged 7 to 19 years who had received a primary diagnosis of anxiety to 14 sessions of CBT, up to 200 mg/d of sertraline (Zoloft), a combination of CBT and sertraline, or placebo for 12 weeks. Improvement was measured by comparing baseline and week 12 Clinical Global Impression-Improvement Scale scores. Anxiety severity was measured using the Pediatric Anxiety Rating Scale (PARS).

Approximately four-fifths (80.7%) of participants who received combination therapy had a treatment response compared with 59.7% of those treated with CBT alone, 54.9% given sertraline alone, and 23.7% of those given placebo. Results on the PARS were similar in magnitude and pattern of response: combination therapy had a greater response than CBT alone, which was equivalent to sertraline alone, and all therapies were superior to placebo.

Adverse events were not significantly more frequent among the sertraline group than among the placebo group. CBT was associated with less insomnia, fatigue, and restlessness compared with sertraline.

The study findings suggest that for children and adolescents with anxiety, “a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective,” said Thomas Insel, MD, NIMH director.