Treatment of childhood anxiety disorders: what is the place for antidepressants?

Introduction: Anxiety disorders represent one of the most prevalent forms of psychopathology among children and adolescents. As these problems tend to persist and have a negative impact on young people's development, there is a need for evidence-based interventions. Cognitive-behavioral therapy (CBT) is at present the treatment of first choice, but pharmacotherapy and in particular antidepressant medication may be a viable alternative or adjunct to CBT. Areas covered: This paper provides a detailed overview of controlled treatment outcome studies on the efficacy of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and serotonin--noradrenaline reuptake inhibitors (SNRIs) in children and adolescents with anxiety disorders. Further, a discussion is provided on how clinically anxious youths should be preferably treated, with special focus on the position of pharmacotherapy in the treatment process. Expert opinion: The short-term efficacy of antidepressants in anxious youths is good, and this is particularly true for SSRIs. Therefore, this type of medication should be viewed as a viable treatment option, in particular for youths with obsessive-compulsive disorder (OCD) or other severe and pervasive anxiety disorders. More research is needed on the long-term effects, the consequences of prolonged use of this type of medication for children's developing brains and the efficacy of an intervention in which CBT and SSRIs are combined.