SSRIs vs SNRIs: Efficacy Compared for Pediatric Anxiety Disorders

Researchers analyzed change in symptom severity as a function of time, class, and standardized dose
Researchers analyzed change in symptom severity as a function of time, class, and standardized dose

Findings from a study published in the Journal of the American Academy of Child and Adolescent Psychiatry found selective serotonin reuptake inhibitors (SSRIs) to be more effective than selective serotonin norepinephrine reuptake inhibitors (SNRIs) for the treatment of anxiety in children and adolescents. 

Researchers from the University of Cincinnati extracted weekly symptom data from randomized, parallel group, placebo-controlled trials involving SSRIs and SNRIs in pediatric anxiety disorders. Change in symptom severity was analyzed as a function of time, class, and standardized dose (for SSRIs). 

Five trials involving SSRIs and 4 trials involving SNRIs were included for the meta-analysis (N=1,673). Statistically significant treatment effects were seen within 2 weeks of starting treatment (standardized medication-placebo difference -0.054, 95% CI: -0.076 to -0.032; P=0.005) whereas clinically significant differences appeared by Week 6 (standardized medication-placebo difference -0.120, 95% CI: -0.142, -0.097; P=0.001). 

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The authors noted that treatment with SSRIs led to significantly greater improvement by the second week of treatment vs. SNRIs (P=0.0268); this benefit remained statistically significant through Week 12. While clinical improvement was seen earlier with high-dose SSRIs (P=0.002 at Week 2) vs low-dose treatment (P=0.025 at Week 10), the dose did not affect overall response trajectory. 

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Based on the data, the authors concluded that for pediatric patients with generalized, separation, and/or social anxiety disorders, treatment-related improvement, "occurs early in the course of treatment and SSRIs are associated with more rapid and greater improvement compared to SNRIs."

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