Table 4.
Pharmacological treatment descriptions and evaluation findings
| Medication [daily dose]* (diagnoses) |
Sample size (country) |
Ages | Duration | Child anxiety outcomes (diagnostic rates)† | Child adverse events |
| D-cycloserine [50 mg] (SP)w52 |
37 (Australia) |
6–14 years | Single dose | ↓ 2 of 2 symptoms‡ | Headache 39%; left study due to adverse events 0% |
| Fluvoxamine [50–300 mg] (SoP, SpAD, GAD)w53 |
128 (USA) |
6–17 years | 2 months | ↓ 2 of 2 symptoms | Abdominal discomfort 49%§; headache 43%; left study due to adverse events 8% |
| Fluoxetine I¶ [40 mg] (SAD)w54 |
139 (USA) |
7–17 years | 3 months | ↓ SAD diagnoses (79% vs 97%) ↓ 4 of 8 symptoms |
Nausea % NR§; left study due to adverse events 0% |
| Fluoxetine II [10–20 mg] (GAD, SoP, SpAD)w55 |
74 (USA) |
7–17 years | 3 months | ↓ 1 of 6 symptoms | Abdominal pain or nausea 46%§; drowsiness 44%§; headaches 14%§; left study due to adverse events 14% |
| Fluoxetine III¶ [10–60 mg] (SoP, GAD, SpAD)w56 |
62 (Australia) |
11–16 years | 6 months | • AD diagnoses (68% vs 77%) • 4 of 4 symptoms |
Left study due to adverse events 5% |
| Imipramine I [100–200 mg] (NR)** w57 |
42 (USA) |
6–14 years | 1.5 months | ↓ 8 of 8 symptoms | Drowsiness 62%; dry mouth 50%§; constipation 31%; dizziness 25%; left study due to adverse events % NR |
| Imipramine II [75–275 mg] (SpAD)w58 |
21 (USA) |
6–15 years | 1.5 months | • 29 of 29 symptoms†† | Dry mouth 46%; irritability 27%; changes in ECG % NR§; left study due to adverse events 0% |
| Paroxetine [10–50 mg] (SAD)w59 |
322 (USA, South Africa, Canada Belgium) |
8–17 years | 4 months | ↓ 6 of 6 symptoms | Insomnia 14%§; left study due to adverse events 6% |
| Sertraline I [50 mg] (GAD)w60 |
22 (USA) |
5–17 years | 2.25 months | ↓ 6 of 7 symptoms | Drowsiness 73%; dry mouth 55%; restlessness 55%; leg spasms 36%; left study due to adverse events 0% |
| Sertraline II¶ [25–200 mg] (SpAD, GAD, SoP)w61 |
488 (USA) |
7–17 years | 3 months | ↓ 2 of 4 symptoms NR 2 of 4 symptoms |
Insomnia 8%; fatigue 6%; sedation 5%; restlessness 4%; fever 1%‡‡; left study due to adverse events 6% |
| Venlafaxine [37.5–225 mg] (SAD)w62 |
293 (USA) |
8–18 years | 4 months | ↓ 2 of 2 symptoms | Nausea 23%§; anorexia 22%§; weakness or loss of energy 20%§; sore throat 19%§; weight loss 11%§; dilated pupils 4%§; abnormal behaviour 4%§; heart rate increase % NR§; PR interval decrease % NR§; pulse rate increase % NR§; blood pressure increase % NR§; left study due to adverse events 4% |
↓ Denotes statistically-significant reductions in symptoms favouring medication over placebo.
• Denotes medication did not show statistically-significant benefit over placebo.
* Reported doses include widest range that children received at point therapeutic dose achieved; dosing is not equivalent across medications.
† Diagnostic rates for medication versus placebo.
‡ Assessed 1 week after medication was administered.
§ Adverse event(s) experienced by significantly more children on medication than placebo.
¶ Medication was also compared with a psychosocial treatment, as described in text
** All participating children were refusing to attend school or were doing so with marked distressed.
†† One outcome favoured placebo over medication.
‡‡ All adverse events were experienced by significantly more children on sertraline than children participating in cognitive-behavioural therapy.
AD, anxiety disorder; ECG, electrocardiogram; GAD, generalised anxiety disorder; NR, not reported; PD, panic disorder; SAD, social anxiety disorder; SoP, social phobia; SP, specific phobia; SpAD, Separation anxiety disorder.