Combined antidepressants and psychotherapy most effective for childhood anxiety

Treatment that combines cognitive behavior therapy (CBT) with an antidepressant medication is most likely to help children with anxiety disorders, but each of the treatments alone is also effective, according to a new study funded by the National Institutes of Health's National Institute of Mental Health (NIMH).

"Anxiety disorders are among the most common mental disorders affecting children and adolescents. Untreated anxiety can undermine a child's success in school, jeopardize his or her relationships with family, and inhibit social functioning," said NIMH Director Thomas R. Insel, MD "This study provides strong evidence and reassurance to parents that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective."
The Child/Adolescent Anxiety Multimodal Study (CAMS) randomly assigned 488 children ages 7 years to 17 years to one of four treatment options for a 12-week period:
* Cognitive behavioral therapy (CBT), a specific type of therapy that, for this study, taught children about anxiety and helped them face and master their fears by guiding them through structured tasks;
* A Selective Serotonin Re-Uptake Inhibitor (SSRI) class antidepressant (sertraline [Zoloft®]);
* CBT combined with sertraline;
* pill placebo (sugar pill).
The children, recruited from six regionally dispersed sites throughout the United States, all had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia. Many also had coexisting disorders, including other anxiety disorders, attention deficit hyperactivity disorder, and behavior problems.
The six CAMS sites were Duke University; New York State Psychiatric Institute/Columbia University Medical Center; Johns Hopkins University; Temple University/University of Pennsylvania; University of California, Los Angeles; and the Western Psychiatric Institute and Clinic/University of Pittsburgh Medical Center.
John Walkup, MD, of Johns Hopkins Medical Institutions, and colleagues found that among those in combination treatment, 81 percent improved. Sixty percent in the CBT-only group, and 55 percent in the sertraline-only group improved. Among those on placebo, 24 percent improved. A second phase of the study will monitor the children for an additional six months.
"CAMS clearly showed that combination treatment is the most effective for these children. But sertraline alone or CBT alone showed a good response rate as well. This suggests that clinicians and families have three good options to consider for young people with anxiety disorders, depending on treatment availability and costs," said Walkup.
Results also demonstrated that the treatments were safe. Children taking sertraline alone showed no more side effects than the children taking the placebo and few children discontinued the trial due to side effects. In addition, no child attempted suicide, a rare side effect sometimes associated with antidepressant medications in children.
CAMS findings echo previous studies in which sertraline and other SSRIs were found to be effective in treating childhood anxiety disorder. The study's results also add more evidence that high-quality CBT, with or without medication, can effectively treat anxiety disorders in children, according to the researchers.
"Further analyses of the CAMS data may help us predict who is most likely to respond to which treatment, and develop more personalized treatment approaches for children with anxiety disorders," concluded Philip C. Kendall, PhD, of Temple University, a senior investigator of the study. "But in the meantime, we can be assured that we already have good treatments at our disposal."

Depression Medications Not Linked To Birth Defects

Pregnant mothers can safely use prescribed antidepressant medications during their first trimester, according to a new study from the Universit de Montr al and Ste. Justine Hospital published in the May edition of the British Journal of Psychiatry.
Dr. Anick B rard and her team found that antidepressants have no effect on foetal development. “This is the first study to investigate the impact of antidepressant use during the first trimester of pregnancy in mothers with psychiatric disorders,” she said. “In terms of birth malformations in this population, we found no difference between women who used antidepressants and those who did not use antidepressants during their first trimester.”
The research team used data from the Quebec Pregnancy Registry, established by their group, to analyze the records of 2,329 new mothers diagnosed with a psychiatric disorder and treated with antidepressants for at least 30 days before pregnancy. Also included in the registry were women who delivered liveborn and stillborn children, while birth defects were considered anything from facial malformations to heart anomalies.
“The duration of antidepressant use in the first trimester of pregnancy was not associated with an increased risk of birth malformations,” explained Dr. B rard. “We hope these findings help clinicians and women decide whether to continue antidepressant therapy during pregnancy.”
eMaxHealth Editor’s note: It should be studied to see if there is a relationship betwee the use of medications for the treatment of depression during pregnancy and preterm birth, as another study links preterm birth to birth defects and long term survival.

Antidepressants Increase Suicidal Thoughts in People Under 25

People under the age of 25 who take antidepressants have a higher risk of suicide, but adults older than that do not run the same risk according to a new Food & Drug Administration (FDA) analysis. In October 2004, the U.S. FDA directed the manufacturers of all antidepressant medications to add a "black box" warning that describes the increased risk of suicidal thoughts and behavior in children and adolescents. This "black box" warning is the strongest prescription drug labeling that the government can order.
For decades, some physicians have suspected that young people may have increased thoughts of suicide when they first began taking antidepressants however; many psychiatrists have criticized the warnings, saying they scare people away from effective treatment for depression, which is the leading cause of suicide.
The FDA analysis by Dr Marc Stone, Dr Thomas Laughren and colleagues, involved a review of data from eight different drug makers on 372 clinical trials involving nearly 100,000 adults. Basically they found the risk of suicide was "strongly age-dependent," with higher risks in people under 25 and lower risks in people 65 and older. They also support the concept that antidepressant drugs can have two distinct effects. That is, in some patients, they can promote suicidal thoughts and this risk seems to lessen with age. In others, the drugs provide relief from depression, reducing the risk of suicide. Researchers suggest more research is needed to understand these differences.
The FDA is trying to take steps to make people under 25 who take antidepressant safe. In addition to the black box warning, the FDA has also announced that it is in the process of developing a user-friendly patient medication guide which will be given to people taking these drugs. In addition, because antidepressants increase suicidal thoughts in people under 25, parents will be advised to look for warning signs in children, including worsening depression, agitation, irritability, and unusual changes in behavior.
Scientist who stand behind the FDA study suggest that it doesn't mean that these drugs shouldn't be given to young adults, rather, people need to think about the risks and the benefits. The findings of this study suggest that antidepressants increase suicidal thoughts in people under 25 so to watch people carefully. If someone on antidepressants talks of being suicidal, it may actually be due to the drugs and the prescribing physician may have to change the dosage or discontinue the medication.
If you know of someone who is suicidal please contact your local mental health agency.

New York Campaign Addresses High Rates Of Depression In Latinas

The Health Department launched a new awareness campaign to help de-stigmatize mental health problems and promote positive coping strategies among young Latinas, who suffer from depression at higher rates than other groups. This fall the Health Department began distributing posters, palm cards and compact mirrors with the tag line,
“Don’t keep it in – talk to us” in both English and Spanish. In addition to public middle schools and high schools, the campaign will enlist shelters, health clinics, beauty salons, community-based organizations and the Health Department’s District Public Health Offices.
Latina teens who are struggling with mental health issues are urged to call 311 and ask for LIFENET or AY DESE, a service of the Mental Health Association of New York City, for free confidential multilingual help and referrals.
“Depression is a treatable illness,” said Dr. David Rosin, Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene. “Too many young Latinas have unaddressed mental health issues and are hurting themselves. We hope this campaign will reach these young women and encourage them to call for help if they are feeling sad or overwhelmed.”
A 2005 survey of New York City public high school students suggests that Latina teens suffer disproportionately from depression. Some 46% (versus 31% of white and Asian girls) reported feeling sad for at least two of the past four weeks. While the number of actual suicides among teen girls are very low, 14% of Latinas had attempted suicide during the past year versus 8% of white girls.
When interviewed in small groups, many Latina teens report high levels of stress at work, home and school. Those who are recent immigrants with limited English may be overwhelmed with taking care of siblings at home or helping parents navigate life in New York City, even as they struggle to adjust and fit in themselves. Although some Latina teens report talking with friends and family about their problems, that is not always enough.
“Getting professional help, outside an immediate circle of family and friends, can help with the problems teen girls are facing,” said Dr. Rosa Gil, founder of the Hispanic Mental Health Association and founder and President of Comunilife, Inc., which provides community-based mental health, rehabilitation services and housing to patients of diverse populations. “Doctors and therapists who work with young Latinas or recent immigrants in similar situations can help young women realize they are not alone and help them feel better.”