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Antidepressant Treats Severe Anxiety in Children


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May 29, 2002 -- An antidepressant drug may be just what the doctor ordered for children suffering from disabling anxiety.

"These children are often in therapy [to help them manage their anxiety] but we've never had a good [drug] treatment for generalized anxiety disorder [in children]," researcher Arif Khan, MD, tells WebMD. "[Effexor] seems to be effective," he says.

"It doesn't replace therapy, but when used in combination, it may help break a deadlock so that the family therapy is more effective, and the child is able to function in school and other activities," he adds. Khan is medical director of the Northwest Clinical Research Center in Bellevue, Wash., and adjunct associate professor of psychiatry at Duke University in Durham, N.C. He has been a consultant for Effexor manufacturer Wyeth, which funded the study, but he has no other financial interest in the company.

For most children and adolescents, mild anxiety is a common problem that rarely interferes with school, extracurricular activities, or social life. But approximately 3% of kids and teens suffer from more significant anxiety, a condition called generalized anxiety disorder, which can be truly disabling and trigger high absenteeism from school, excessive shyness, and withdrawal from social activities.

Most often, children with generalized anxiety disorder are treated with various therapies to help them better manage anxiety-provoking situations.

But new research suggests that adding a popular drug called Effexor, currently used to treat depression and generalized anxiety in adults, may also be of benefit in kids. The researchers presented their findings recently at the annual meeting of the American Psychiatric Association in Philadelphia.

The team followed 158 children aged 6-17 with generalized anxiety disorder. The kids were selected at random to receive Effexor or a placebo, adjusting the dose for each child's weight. Levels of disabling anxiety were measured both before and after treatment.

At the end of the study, the children who'd received the drug had far less anxiety than those who hadn't.

Experts are cautiously optimistic. "Parents need to know that this drug has not yet been approved by the FDA for the treatment of this disorder in children," lead investigator Nadia R. Kunz, PharmD, tells WebMD. "However, these are promising data." She is the director of clinical research and development in the neuroscience department of Wyeth Research.

Taking Effexor is not without risks. The drug can cause loss of appetite and weight loss; both of which can be significant health risks in some children, Kunz says.

Many experts are concerned about inappropriately medicating children to treat behavioral problems instead of treating the underlying causes. They want to make sure that only those children who are most in need of drug therapy actually receive it.

"Although [the findings show] a positive effect in this patient population, we need to look more closely to determine how significant this effect really is from a functional perspective, in terms of the lives of the children involved," David Fassler, MD, tells WebMD. Fassler, who was not involved in the study, is trustee of the American Psychiatric Association and a child and adolescent psychiatrist practicing in Burlington, Vt.

"A problem such as an anxiety disorder in children and adolescents needs a comprehensive evaluation," Fassler says. Usually, kids respond to individualized treatment plans that include private counseling, family counseling, and perhaps medications. "Medication only is rarely a sufficient treatment. Although it has a positive effect from a research standpoint, we need further research to understand how to integrate a medication like this into other forms of treatment the child is receiving," he says.

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