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Combo Treatment Best for Anxiety Disorder in Kids

Zoloft, cognitive behavior therapy also work well alone, study finds

THURSDAY, Oct. 30 (HealthDay News) -- For children with anxiety disorders, a combination of cognitive behavior therapy and the antidepressant sertraline (Zoloft) works better than either treatment alone, researchers report.

However, Zoloft or cognitive behavior therapy by themselves did work in more than half of the patients, according to a report in the Oct. 30 online edition of the New England Journal of Medicine. The report is being published to coincide with a presentation of the findings at the American Academy of Child & Adolescent Psychiatry annual meeting, in Chicago.

"For children and adolescents with anxiety disorders, there are three effective treatment choices," said study co-author Anne Marie Albano, an associate professor of clinical psychology at Columbia University in New York City. "What's important about this is families, in consultation with their doctors, can think through which is the best option for them to pursue."

Decisions on treatment can also be made on what's available in the local community, Albano said. "Some communities might not have access to some of these treatments," she said. For example, cognitive behavior therapy requires a specialist in the technique.

Another advantage of having several workable treatments is that treatment decisions can be made on the basis of preference, Albano noted. "Some families don't want to do one treatment versus another. So, families can make a decision based on preference. They might want to make the decision to go with both treatments, because the combination treatment did show an added benefit that the individual therapies don't have," she said.

For the study, Albano's team randomly assigned 488 children aged 7 to 17 with anxiety disorders to 12 weeks of treatment with one of four protocols. Some children were given cognitive behavior therapy, and others were given Zoloft. A third group received both cognitive behavior therapy and Zoloft, while a fourth group received a placebo.

The researchers found that 81 percent of the children receiving cognitive behavior therapy plus Zoloft improved, compared with 60 percent who received cognitive behavior therapy alone and 55 percent who received only Zoloft. Among patients receiving placebo, 24 percent showed improvement.

The study also confirmed the safety of Zoloft. There were no more side effects among children taking the drug than there were among those receiving placebo. Moreover, none of the children taking Zoloft attempted suicide, which has been recognized as a rare side effect of the drug in children.

Albano noted that anxiety disorders in children are not just a phase. "These are debilitating disorders that run a long-term course into adulthood," she said. "They lead to other anxiety disorders, and later on, they lead to depression and can lead to substance abuse."

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, thinks that the effectiveness of the combination of Zoloft and cognitive behavior therapy is an important message to both doctors and patients.

"What is perhaps most important here is that the combination was superior to either therapy in isolation," Katz said. "In the modern medical age, we tend to bank heavily on advanced technology and wonder drugs. The use of sertraline, while effective, did not obviate the need for, or benefit of, psychological counseling. There is, it seems, nothing in a pill bottle that fully compensates for the time patient and provider spend constructively together," he said.

Jerilyn Ross, president and CEO of the Anxiety Disorders Association of America, thinks this study can raise awareness of a serious, but treatable problem that should not be ignored.

"This study tells us that we have treatments that work," Ross said. "What this study does is give parents a beacon of hope, knowing that if their child has an anxiety disorder not only can they get treatment, but that there are options available."

Ross noted that childhood anxiety disorders are under-diagnosed. "Anxiety disorders have been grossly under-diagnosed -- not taken seriously enough," she said. "About 10 percent of kids have anxiety disorders. It's the most common mental health problem. Hopefully, this study will encourage parents to get help."

More information

For more on anxiety disorders, visit the U.S. National Library of Medicine.

SOURCES: Anne Marie Albano, Ph.D., associate professor, clinical psychology, Columbia University, New York City; Jerilyn Ross, president and CEO, Anxiety Disorders Association of America, Silver Spring, Md.; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University Medical School, New Haven, Conn.; Oct. 30, 2008, New England Journal of Medicine, online

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