Researchers in the US found that either cognitive behavioral therapy (CBT) or the antidepressant sertraline (brand name Zoloft) were more effective than a placebo drug in treating a range of childhood anxiety disorders, but a combination of Zoloft and CBT worked even better.

The Child/Adolescent Anxiety Multimodal Study (CAMS), which took part in six separate centers across the US, was funded by the US National Institutes of Health’s National Institute of Mental Health (NIMH) and conducted by Dr John Walkup, of Johns Hopkins Medical Institutions, and colleagues. It is published online in the 30 October issue of the New England Journal of Medicine (NEJM).

Cognitive behavioral therapy (CBT), is a type of therapy that helps people think differently about themselves and their situations, to face and manage their fears, and practise changes in behaviour to achieve agreed goals by undertaking specific structured tasks and exercises.

Zoloft (generic name sertraline) is a a selective serotonin reuptake inhibitor (SSRI) that increases the amount of the neurotransmitter serotonin that is available to bind to postsynaptic receptors in the brain and thus help regulate mood and emotion including anger and aggression.

NIMH Director Dr Thomas R Insel said in a statement that anxiety disorders were some of the most common mental disorders among children and teenagers and that:

“Untreated anxiety can undermine a child’s success in school, jeopardize his or her relationships with family, and inhibit social functioning.”

“This study provides strong evidence and reassurance to parents that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective,” added Insel.

For the study, which lasted for a treatment period of 12 weeks, 488 children aged from 7 to 17 years joined one of four treatment groups: (1) CBT only, (2) Zoloft pill only, (2) CBT with Zoloft pill, or (4) Placebo pill.

The children had been diagnosed with a range of moderate to severe disorders, including separation anxiety, generalized anxiety and social phobia. Some of the children also had more than one disorder, including other anxiety disorders, attention deficit hyperactivity disorder and behavior problems.

Walkup and colleagues found that:

  • 81 per cent of the children in the combined treatment group improved.
  • This compared with 60 per cent of the children in the CBT only group and 55 per cent Zoloft only group.
  • In the placebo group, 24 per cent of the children improved.
  • Children taking Zoloft showed no more side effects that children taking placebo and few children withdrew because of side effects.
  • No child attempted suicide, a rare side effect that can sometimes accompany use of antidepressants in children.

The findings reflect other studies that showed Zoloft and other SSRIs were effective treatments for childhood anxiety disorders. But the authors said this study also adds more evidence that high quality CBT, with or without medication, is an effective treatment for childhood anxiety disorders.

Walkup and colleagues concluded that:

“Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate.”

Walkup said that now:

“Clinicians and families have three good options to consider for young people with anxiety disorders, depending on treatment availability and costs.”

A senior investigator on the study, Dr Philip C Kendall, of Temple University, said:

“Further analyses of the CAMS data may help us predict who is most likely to respond to which treatment, and develop more personalized treatment approaches for children with anxiety disorders.”

The study is going through a second phase for another six months of follow up monitoring.

“Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety.”
Walkup, John T., Albano, Anne Marie, Piacentini, John, Birmaher, Boris, Compton, Scott N., Sherrill, Joel T., Ginsburg, Golda S., Rynn, Moira A., McCracken, James, Waslick, Bruce, Iyengar, Satish, March, John S., Kendall, Philip C.
N Engl J Med, Published online October 30, 2008, in Print December 25, 2008.
DOI: 10.1056/NEJMoa0804633

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Sources: Journal Abstract, NIH/National Institute of Mental Health .

Written by: Catharine Paddock, PhD.