More frequent provider contact is also recommended when there is a history of depression, a strong familial preference, or when compliance is a concern. Standardized rating scales should be used to measure treatment effectiveness. After an effective dose of medication is reached, visit frequency may be reduced. Even after symptom resolution, Inhibitors,research,lifescience,medical cautious treatment calls for medication maintenance for 1 year, followed by a gradual tapering off to allow observation of any recurrence of symptoms.22 Evidence for effectiveness of SSRIs
and SNRIs A limited number of RCTs have evaluated antianxiety agents in children and adolescents. To date, no medications have been approved by the FDA for treatment of non-OCD anxiety in youth. Four medications have been approved for OCD treatment in children and adolescents. Medication and placebo response rates range across studies, which
are difficult to compare due to limited clinical samples and variability Inhibitors,research,lifescience,medical in measures of assessment and clinical response. Yet positive results have been demonstrated for multiple agents in the treatment of anxiety in both youth Inhibitors,research,lifescience,medical and adults, particularly medications targeting serotonin reuptake. A meta-analysis of RCTs examining the tolerability and efficacy of pharmacotherapy for anxiety disorders in youth found that SSRIs and SNRIs showed clear benefit with an overall response rate almost double that of placebo.23 Regarding specific pediatric anxiety subtypes, OCD has the largest number of positive RCTs, which reveal clinical benefit after treatment with sertraline,15, 24 fluoxetine,25, 26 fluvoxamine,27 or paroxetine.28, 29 Evidence for citalopram is limited to open-label
Inhibitors,research,lifescience,medical studies30-32 and comparison with fluoxetine without placebo.33 SSRIs are first-line therapy for pharmacologic management of anxiety disorders in youth, and three of the four medications Inhibitors,research,lifescience,medical approved by the FDA for treatment of OCD in children and adolescents are SSRIs: sertraline (≥6), fluoxetine (≥7), and fluvoxamine (≥=8).3 The highest regarded clinical trial examining the impact of both manualized psychotherapy and medication on symptoms of OCD in youth is the Pediatric OCD Treatment Study (POTS). In this study, sertraline’s effectiveness in pediatric OCD for 12 weeks was compared Florfenicol with CBT, combined treatment, and placebo.13 Each active treatment arm proved superior to placebo, and combined treatment was superior to either CBT or sertraline alone. Another RCT examining sertraline for youth with OCD also found BMS-754807 cost significantly greater improvement after active treatment compared with placebo,24 with lasting effects in 70% of patients who were examined 12 months later.35 A 10-week RCT of pediatric outpatients with OCD showed fluvoxamine to be effective.