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Long-Term Outcomes in Children with Anxiety Disorders

February 20, 2014

Long-Term Outcomes in Children with Anxiety Disorders

  1. Barbara Geller, MD

Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome.

  1. Barbara Geller, MD

Children with anxiety disorders (social phobia, separation anxiety, generalized anxiety) showed good acute response to treatment in a randomized, placebo-controlled study (sertraline + cognitive-behavioral therapy [CBT], 81%; CBT, 60%; sertraline, 55%; pill placebo, 24%; NEJM JW Psychiatry Oct 30 2008). To learn about long-term outcomes, researchers conducted a follow-up study with in-person or telephone interviews of children and parents at a mean of 6 years after randomization. Remission was defined as lack of any of the three study diagnoses.

The 288 participants at follow-up (mean age, 17) included 59% of the original sample and were significantly more likely than nonparticipants to be female and have higher socioeconomic status and less likely to be Hispanic. Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%).

Comment

The specter of long-term sleeper effects of medication has been raised by an animal study showing increased upregulation of the serotonin transmitter after adolescent exposure to an antidepressant (Am J Psychiatry 2014 Jan 31 [e-pub ahead of print]). However, in the current study, outcomes were similar across treatment assignments, suggesting the absence of medication sleeper phenomena. Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.

  • Disclosures for Barbara Geller, MD at time of publication Nothing to disclose

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