41 Some studies have shown benefit from SSRIs;47 yet

CHIR 258 trauma-focused CBT has shown more consistent effectiveness.47 To date, no RCTs have examined medication effects in children or adolescents with panic disorder. Aside from SSRIs, medications with dual inhibiting actions on serotonin and norepinephrine (SNRIs) have also been tested in youth with anxiety disorders. Specifically, venlafaxine XR was examined in two 8-week RCTs in children with GAD. Despite insignificant improvement on a primary measure in one of the trials, pooled results Inhibitors,research,lifescience,medical revealed significantly greater response in the active medication group compared with placebo. 48 Another 16-week RCT of venlafaxine XR in children with social anxiety showed significant benefit beyond placebo.49 However, studies of venlafaxine Inhibitors,research,lifescience,medical in children indicated a risk for elevated blood pressure, decreased growth rate, and increased suicidal ideation, which should be considered with families prior to initiating treatment. A meta-analysis of RCTs examining the tolerability and efficacy of pharmacotherapy for anxiety disorders found that SSRIs and SNRIs showed clear benefit with an overall response rate almost double that of placebo treatment, with SSRIs slightly more beneficial than venlafaxine XR.23 Inhibitors,research,lifescience,medical Due to the lack of comparative head-to-head RCTs

of SSRIs or SNRIs, choice of agent is often based on side-effect profiles, interactions with other medications, and family history of medication response. Furthermore, only short-term

benefits have been evaluated in RCTs, and research findings may not generalize to clinic populations Inhibitors,research,lifescience,medical due to exclusion of youth with medical or psychiatric comorbidities. Inhibitors,research,lifescience,medical Age may also be an important consideration in pharmacotherapy. Despite age-related differences in metabolism and observations that SSRIs may be more effective in the treatment of adolescent depression compared with depressed younger children, findings from RCTs in anxious youth do not show differential effects based on age.23, 50 The evidence base is particularly limited for pharmacologic treatment of anxiety in children under the age of 6.51 Given the limited pharmacologic data, CBT, tailored to developmental level, is considered to be the through first line treatment in children this young. In cases with high acuity unresponsive to psychotherapy, medication treatment may be considered. Safety concerns with SSRIs and SNRIs Heightened concern for the negative effects of SSRIs and SNRIs in youth, particularly for activation and emerging suicidality, have impacted familial willingness and clinical practice to initiate treatment with these agents, particularly for children with anxiety.