Cognitive-Behavioral Therapy for Childhood Anxiety and Depression

For both depression and anxiety disorders in youths, there is increasing evidence of clinical benefit from cognitive-behavioral therapy (CBT).

Anxiety disorders

Both SSRIs and CBT individually have been shown to be effective in the treatment of children with anxiety disorders. A recent large randomized controlled trial examined the combined efficacy of these treatments in 488 children and adolescents (aged 7 to 17 years) who had anxiety disorder (separation anxiety disorder, social phobia, or generalized anxiety disorder).1

Patients were randomized to receive sertraline, CBT, sertraline and CBT, or placebo for 12 weeks. Combination treatment was significantly superior to either sertraline or CBT alone. Response rates were 81% for combination treatment, 60% for CBT, 55% for sertraline, and 24% for placebo. The effect size for combination treatment was 0.86 compared with 0.45 for sertraline and 0.31 for CBT. The investigators concluded that children and adolescents who receive combination treatment for anxiety disorders can consistently expect a significant reduction in anxiety severity.

Is CBT effective for young children with anxiety disorders? Typically, anxiety studies include children older than 8 years. Recently, Freeman and colleagues2 compared the efficacy of family-based CBT with family-based relaxation treatment for children aged 5 to 8 years who have ob-sessive-compulsive disorder (OCD). The 12-session CBT treatment was tailored to younger children to address their developmental stage. CBT had a moderate treatment effect (0.53). Half of the children who received CBT obtained clinical remission compared with 20% in the relaxation treatment group. The authors recommended family-based CBT as an important component when addressing early childhood–onset OCD.

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Can Anticonvulsants Help Patients With Anxiety Disorders? What Does the Evidence Show?

Anxiety disorders are chronic conditions that follow a relapsing/remitting course.1 The evidence to support this view comes primarily from cross-sectional and retrospective assessments of duration of illness and, in part, from prospective studies. The waxing and waning nature of panic disorder and generalized anxiety disorder (GAD), for example, has been clearly demonstrated. Much less information is available about the course of illness of social phobia. However, both community studies and patient samples suggest an age of onset of social phobia in mid to late teens with a chronicity that is equal to or greater than that of panic disorder.2 Nevertheless, this recognition has not reshaped our basic treatment approach, which focuses almost entirely on the acute control of symptoms and only secondarily acknowledges relapse prevention.

In addition, the natural history of anxiety disorders is frequently complicated by Axis I and Axis II comorbidity that seems to be significantly higher among patients who seek treatment than in persons in the community who are not in treatment.1 In fact, it has been estimated that 73% of patients with panic disorder had other comorbid conditions that ranged from major depression to substance abuse until the onset of the Axis II disorders, mostly cluster C type 1 to 2. It is, therefore, evident that any long-term anxiolytic treatment strategy must take account of these high rates of comorbidity that appear to develop during the longitudinal phase of the anxiety disorder.

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Brain scans may aid anxious

U.S. researchers suggest brain scans may help predict how anxiety disorders patients react to drug therapy.

"Hopefully we'll be able to use that eventually to determine what kind of treatment to provide to people," lead author Jack Nitschke, of the University of Wisconsin-Madison School of Medicine and Public Health said in a statement.

The study, published in the American Journal of Psychiatry, used functional magnetic resonance imaging to examine patients with generalized anxiety disorder and found high levels of amygdala activity -- a part of the brain involved in memory of emotional reactions

This response in a "safe" lab settings was a disproportionately large response to the idea that something negative might happen, Nitschke said.

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Drug-therapy combo best for anxiety in kids -study

A combination of a common antidepressant and a specialized form of talk therapy offer the best treatment for children and youth with anxiety disorders, U.S. researchers said on Thursday.

The findings come from the largest study of anxiety in children yet and offer much-needed guidance about how best to treat young people with separation anxiety, social phobia and generalized anxiety disorder -- conditions that affect as many as 20 percent of children and teenagers in the United States.

The study "clearly showed that combination treatment is the most effective for these children," Dr. John Walkup of Johns Hopkins University in Baltimore, who worked on the study, said in a statement.

But he said either therapy alone or sertraline alone helped well. Sertraline is the generic name of Pfizer Inc's (PFE.N: Quote, Profile, Research, Stock Buzz) Zoloft, which is one of a class of antidepressants called selective serotonin reuptake inhibitors.

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Anti-Anxiety Medications For Treating Anxiety Disorders

Everyone suffers a bit of anxiety on occasion. But does that mean you need anti-anxiety medication? Not necessarily.

Your palms begin to sweat and your stomach begins to flutter but you're fine. You're experiencing simple cases of nervousness and your body is responding in ways that are manageable. But, anxiety can explode into a serious problem.

Anxiety disorders, in addition to generalized anxiety, include phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. For millions of sufferers anxiety disorders are disruptive, debilitating and often the reason for loss of job and serious problems in family relationships. So what can be done to control anxiety disorders?

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