title: Efficacy and tolerability of antidepressants in pediatric anxiety disorders: a systematic review and meta-analysis.
abstract: BACKGROUND
  Randomized controlled trials have demonstrated that antidepressants are efficacious in the treatment of anxiety disorders in youth. However, there are no recent, systematic analyses of the efficacy, safety, or tolerability of these medications in pediatric anxiety disorders.
  
  
  METHODS
  A systematic review and meta-analysis of prospective, randomized, parallel-group, controlled trials of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) in pediatric patients with non-obsessive compulsive disorder (OCD) anxiety disorders was undertaken using a search of PubMed/Medline (1966-2014). The meta-analysis utilized random-effects models to evaluate change in the Pediatric Anxiety Rating Scale or similar anxiety scale, suicidality, and adverse events. Additionally, pharmacologic variables were explored with regard to effect size, although no correction for multiple comparisons was made with regard to these relationships.
  
  
  RESULTS
  Nine trials involving 1,673 patients and six medications were included. All SSRI/SSNRIs evaluated demonstrated efficacy, and the meta-analytic estimate of effect was of moderate magnitude (Cohen's d = 0.62, confidence interval [CI]: 0.34-0.89, P = .009) and there was evidence of modest heterogeneity (I(2) = 0.29, P = .103). Activation trended toward being more likely with antidepressant treatment (OR: 1.86, CI: 0.98-3.53, P = .054), but no increased risk was observed for nausea/abdominal symptoms (P = .262), discontinuation as a result of an adverse event (P = .132), or suicidality (OR: 1.3, CI: 0.53-3.2, P = .514). Finally, the effect size correlated with the serotonergic specificity of the agent (R = .79, P = .021).
  
  
  CONCLUSIONS
  Data for nine SSRI/SSNRIs suggest superiority of antidepressants relative to placebo for the treatment of pediatric anxiety disorders with a moderate effect size.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Strawn
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Welge
authors.forename: Anna M
authors.initials: AM
authors.lastname: Wehry
authors.forename: Brooks
authors.initials: B
authors.lastname: Keeshin
authors.forename: Moira A
authors.initials: MA
authors.lastname: Rynn
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D006801:Humans; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D059020:Suicidal Ideation
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors
keywords: GAD; antidepressants; anxiety; anxiety disorders; child/adolescent; generalized anxiety disorder; pharmacotherapy; separation anxiety