Wang Z, et al. - This research was formulated in order to examine the comparative effectiveness and adverse events of cognitive behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders. The efficacy of CBT and selective serotonin reuptake inhibitors (SSRIs) for reducing childhood anxiety symptoms was supported in this trial. Serotonin-norepinephrine reuptake inhibitors exhibited effectiveness based on less consistent evidence. Head-to-head comparisons between various medications and comparisons with CBT warranted further exploration.

Methods

• Data was extracted from the MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SciVerse Scopus from database inception through February 1, 2017.
• The included studies were randomized and nonrandomized comparative studies that enrolled children and adolescents with confirmed diagnoses of panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, or separation anxiety and who received CBT, pharmacotherapy, or the combination.
• Herein, independent reviewers selected studies and extracted data. The random-effects meta-analysis aided in data cumulation.
• Primary anxiety symptoms (measured by child, parent, or clinician), remission, response, and adverse events were included as the main outcome measure.

Results

• The study cohort comprised of 7,719 patients, selected from 115 studies.
• Among them 4,290 (55.6%) candidates were female, and the mean (range) age was 9.2 (5.4-16.1) years.
• A substantial reduction was noted in the primary anxiety symptoms and increased remission (relative risk, 2.04; 95% CI, 1.37-3.04) and response (relative risk, 1.96; 95% CI, 1.60-2.40) through the selective serotonin reuptake inhibitors (SSRIs), compared with pill placebo.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) considerably reduced clinician-reported primary anxiety symptoms.
• Benzodiazepines and tricyclics did not prominently reduce anxiety symptoms.
• CBT caused a notable improvement in the primary anxiety symptoms, remission, and response, when CBT was compared with wait-listing/no treatment.
• It was noted that cognitive behavioral therapy reduced primary anxiety symptoms more than fluoxetine and improved remission more than sertraline.
• The combination of sertraline and CBT caused a marked reduction in the clinician-reported primary anxiety symptoms and response more than either treatment alone.
• Head-to-head comparisons were sparse, and network meta-analysis estimates were discovered to be imprecise.
• Medications often displayed adverse events but this was not reported with CBT and the adverse events were not severe.
• Nonetheless, studies were too small or too short to gauge the suicidality with SSRIs or SNRIs.
• One trial exhibited a statistically, nonsignificant rise in the suicidal ideation with venlafaxine.
• A link was revealed between the cognitive behavioral therapy with fewer dropouts than pill placebo or medications.