Hopkins study finds combination therapy best for child anxiety

The Baltimore Sun

Researchers led by Johns Hopkins doctors have found that three popular treatments for childhood anxiety disorders are all effective, but that combining an antidepressant with behavioral therapy is the superior treatment.

It is estimated that as many as 20 percent of children suffer from anxiety disorders - the most common psychiatric illness in children - which can cause serious problems in school and in relationships. The authors of the study, released online yesterday by The New England Journal of Medicine, said they hope their work will give doctors confidence about the treatments they prescribe and raise awareness of the seriousness of the disorders.

"[A]nxiety disorders in childhood remain underrecognized and undertreated," the authors wrote. "An improvement in outcomes for children with anxiety disorders would have important public health implications."

In the study of 488 children age 7 to 17 done at six institutions across the country, researchers found that, over a 12-week period, 81 percent improved using therapy and medication, 60 percent improved on therapy alone, 55 percent improved when taking the antidepressant Zoloft and 24 percent improved when taking a placebo. A second phase of the study will monitor the children for an additional six months. It is the largest study of its kind.

Some studies have shown antidepressants don't work significantly better than placebos. In this short-term study, medication was clearly the better option.

The children studied all had moderate-to-severe separation anxiety, generalized anxiety disorder or social phobia. Separation anxiety often means children are afraid to be alone, sometimes following their parents around the house, balking at going to school or even having a baby sitter. Generalized anxiety disorder patients are often characterized as "worrywarts," worrying about the future and the past to a problematic degree. Those with social phobia are very self-conscious in social situations, often refusing to speak in school or answer the phone at home.

If left untreated, doctors say, these disorders can lead to more severe anxiety or depression as the child gets older.

"People tend to think of anxiety as part of childhood. Children worry and have fears," said Dr. John Walkup, a child psychiatrist at the Johns Hopkins Children's Center and lead author of the study. "This is much more serious than that. They're debilitated by their anxiety."

Now, he said, parents can know they "have lots of flexibility, lots of choices" when it comes to treating their children.

Antidepressants have come under scrutiny for potentially triggering suicide in some children. In this study, no child attempted suicide.

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