5.17 PEDIATRIC ANXIETY DISORDERS (PAD) AND PHARMACOLOGIC INTERVENTION: WHICH MEDICATION TO PICK?
Memon RI, Khan M, Khalid K, Quadri GJ, Zeshan M, and Naveed S. 5.17 PEDIATRIC ANXIETY DISORDERS (PAD) AND PHARMACOLOGIC INTERVENTION: WHICH MEDICATION TO PICK? J Am Acad Child Adolesc Psychiatry 2019; 58(10):S250.
J Am Acad Child Adolesc Psychiatry
Objectives: Anxiety disorders are one of the most prevalent and underrecognized mental health disorders in the pediatric population, with a lifetime prevalence of 25–32 percent. A national survey reported an individual prevalence of anxiety disorders among youth (ages 13–17.4 years) as panic disorder (2.3%), agoraphobia (2.4%), specific phobia (19.3%), generalized anxiety disorder (2.2%), separation anxiety disorder (7.6%), and social anxiety disorder (9.1%). Early diagnosis and treatment can improve the treatment outcomes and prognosis for children and adolescents. This article reviews pharmacologic treatment options for children and adolescents. Methods: A search of 2 electronic databases (Scopus and PubMed) initially revealed 274 studies. However, the scope of the review was limited to include only pharmacological treatments of social anxiety disorder, generalized anxiety disorder, panic disorder, social phobia, and separation anxiety disorder. After applying these eligibility criteria, 35 relevant publications were selected. Results: SSRIs are the first-line medications for pediatric anxiety disorders, and when used along with psychotherapy, their effects are further enhanced. This combination treatment strategy has the additional benefit of requiring lower medication doses in comparison to pharmacologic treatment alone. There is favorable evidence for fluoxetine, sertraline, duloxetine, paroxetine, escitalopram, citalopram, atomoxetine, venlafaxine extended-release, and guanfacine extended-release. N-Acetylcysteine was found to be effective in a case report when used in conjunction with sertraline. Conclusions: Pediatric anxiety disorders have a protracted course and, when untreated, can lead to the consequences of other comorbid mental health issues, including mood instability, substance use, and suicidal ideation and attempt. For effective treatment for any anxiety disorder, it is necessary to consider all aspects and trajectories of the biopsychosocial model for maximum benefit. Thus, the knowledge of evidence-based pharmacological interventions for specific anxiety disorders is essential for patient care.