Treating Pediatric Anxiety
Year: 2017
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Multiple pharmacotherapies for treating anxiety disorders exist, including selective serotonin reuptake inhibitors (SSRIs), the recommended first-line pharmacotherapy for pediatric anxiety. We sought to describe initial antianxiety medication use in children and estimate how long antianxiety medications were continued. METHODS: In a large commercial claims database, we identified children (3-17 years) initiating prescription antianxiety medication from 2004 to 2014 with a recent anxiety diagnosis (ICD-9-CM = 293.84, 300.0x, 300.2x, 300.3x, 309.21, 309.81, 313.23). We estimated the proportion of children initiating each medication class across the study period and used multivariable regression to evaluate factors associated with initiation with an SSRI. We evaluated treatment length for each initial medication class. RESULTS: Of 84,500 children initiating antianxiety medication, 70% initiated with an SSRI (63% [95% CI, 62%-63%] SSRI alone, 7% [95% CI, 7%-7%] SSRI + another antianxiety medication). Non-SSRI medications initiated included benzodiazepines (8%), non-SSRI antidepressants (7%), hydroxyzine (4%), and atypical antipsychotics (3%). Anxiety disorder, age, provider type, and comorbid diagnoses were associated with initial medication class. The proportion of children refilling their initial medication ranged from 19% (95% CI, 18%-20%) of hydroxyzine initiators and 25% (95% CI, 24%-26%) of benzodiazepine initiators to 81% (95% CI, 80%-81%) of SSRI initiators. Over half (55%, 95% CI, 55%-56%) of SSRI initiators continued SSRI treatment for 6 months. CONCLUSIONS: SSRIs are the most commonly used first-line medication for pediatric anxiety disorders, with about half of SSRI initiators continuing treatment for 6 months. Still, a third began therapy on a non-SSRI medication, for which there is limited evidence of effectiveness for pediatric anxiety, and a notable proportion of children initiated with 2 antianxiety medication classes.
DOI: 10.4088/jcp.16m11415
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
Funders: Amgen, Eli Lilly and Company, Pfizer, AstraZeneca, GlaxoSmithKline, North Carolina GlaxoSmithKline Foundation, Patient-Centered Outcomes Research Institute, Israel National Road Safety Authority, University of Oxford, GlaxoSmithKline foundation, Novo Nordisk, National Institutes of Health, Agency for Healthcare Research and Quality, UCB US, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Cancer Institute, National Institute of Child Health and Human Development, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, School of Medicine, University of North Carolina at Chapel Hill, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, H2020 European Research Council
Awards: Methods for Estimating Sex Differences in Safety and Effectiveness of Drugs, G3058828651, Patterns of use, comparative effectiveness, and safety of rotavirus vaccines, G3777675370, North Carolina Translational & Clinical Sciences Institute (NC TraCS), Pediatric anxiety: Pharmacotherapy and psychotherapy utilization and serious adverse outcomes, G5918417455, PROMIS Validation in Prospective Population-based Prostate Cancer Research Study, Propensity Scores and Preventive Drug Use in the Elderly
OpenAlex ID: W2765338764