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The question

Kids worry. Situations at home, at school or with friends can cause anxious moments for children and adolescents. Sometimes, the anxiety becomes excessive and persists. Does treatment help?

This study

The researchers analyzed data from 115 studies that included 7,719 youths, 5 to 16 years old (average age, 9), who had been diagnosed with general anxiety, social anxiety, separation anxiety, panic disorder or a phobia (such as fear of dogs, flying or riding in an elevator). Treatments included medication, cognitive behavioral therapy (CBT, a type of talk therapy aimed at changing thinking and behavior) or both, usually compared with a placebo.

Among those given medication, anxiety symptoms declined the most and remission was most likely with antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. Tricyclic antidepressants did not reduce anxiety symptoms, nor did treatment with benzodiazepines, drugs commonly prescribed to adults for anxiety. Some benefit was found for another type of antidepressant — serotonin and norepinephrine reuptake inhibitors or SNRIs — but the researchers described the results as inconsistent.

Anxiety symptoms improved, as did the likelihood of remission, for youths treated with CBT vs. those not given this therapy. Comparing CBT with the SSRI fluoxetine, anxiety symptoms declined more with CBT. CBT also was more likely to lead to remission than was treatment with sertraline, another SSRI. Combining an SSRI with CBT was more effective overall than either treatment alone.

Side effects were described as common but not serious among youths taking medications but not common among those participating in CBT.

Who may be affected?

Children and adolescents with serious anxiety symptoms, which have been estimated to affect 15 to 25 percent of this age group. Anxiety disorders that go untreated put youths at risk for poor performance in school, missed social experiences and an increased likelihood of substance abuse.

Caveats

The researchers noted that the studies involving antidepressants were too small or too short to assess risk for suicidal thoughts, a known risk for youths taking some antidepressants. Also, the researchers suggested that more “head-to-head comparisons between various medications and comparing with CBT” are needed.

Find this study

Online Aug. 31 in JAMA Pediatrics (jamapediatrics.com; click “New Online”).

Learn more

Information on anxiety that affects children and adolescents is available at kidshealth.org (enter Parents site; search for “anxiety”) and adaa.org (search for “childhood anxiety”).

The research described in Quick Study comes from credible, peer-reviewed journals.