Psychopharmacology interventions for pediatric anxiety disorders: A research update

During the past 2 decades, significant progress has been made in a variety of treatment approaches for youth who have anxiety disorders. Simple short-term, randomized clinical trials (RCTs) have been designed and completed demonstrating that pharmacotherapy approaches and psychosocial interventions are potentially safe and effective for youth who have a variety of anxiety disorders. Recently, collaborations between pharmacotherapy researchers and psychotherapy researchers have led to a new generation of comparative RCTs comparing monotherapies (psychotherapy or medication alone) with each other and with combination treatments (psychotherapy plus medication therapy). This article presents the recent progress made in research studies attempting to understand therapeutic approaches to the various pediatric anxiety disorders, with the primary focus on medication modalities. The spectrum of pediatric anxiety disorders, based on the Diagnostic and Statistical Manual-Fourth Edition, Text Revision (DSM-IV-TR) [1], are reviewed, with the exception of specific phobia, which generally does not require pharmacologic management in clinical practice. This article relies on recent RCTs to examine the efficacy, risks, and adverse events associated with each medication class. The goal is to provide a solid foundation of information for practitioners to make evidence-based decisions regarding treatment strategies for anxious children and adolescents. The focus here is on published studies, because such reports have generally passed through the peer review process that may be absent in posters or preliminary presentations at scientific meetings. Additionally, gaps in current knowledge and suggestions for future research efforts are provided.