Add-on antidepressants do not boost CBT effect on anxiety in youths

A short-term course of antidepressants does not appear to do much in improving the efficacy of cognitive behavioural therapy (CBT) for treating anxiety in children and teens, according to a study.

The study included 99 young people aged 7–15 years with an anxiety disorder. They were randomized to undergo CBT with either sertraline or matching placebo for 12 weeks.

Assessments were conducted using a structured diagnostic interview and parent- and child-reported questionnaires at week 13 and at 6 months following the completion of treatment. The primary outcome was the remission of anxiety disorders. Secondary outcomes included the clinical severity rating (CSR) of the primary anxiety disorder, Clinical Global Impressions scale, Spence Children's Anxiety Scale (SCAS), the Short Mood and Feelings Questionnaire (SMFQ), and Child Anxiety Life Interference Scale.

All participants showed excellent adherence to the medication treatment protocol (CBT + sertraline: 92.4 percent; CBT + placebo: 95.67 percent). The mean daily dosage at the final psychiatrist visit was 50.53 mg in the sertraline group and 50.00 mg in the placebo group.

At both week 13 and month 6, remission of primary anxiety disorder or all anxiety disorders was similar in the two treatment groups. Likewise, there were no significant differences noted in rates of change in diagnostic severity, parent-reported anxiety symptoms, child-reported anxiety symptoms, or life interference due to anxiety.

In terms of safety, four children (three in the sertraline group) discontinued treatment due to increased symptoms or parental concerns around side effects. Weekly symptoms and adverse events were similar in the two treatment groups. However, children in the placebo group reported greater mean irritability symptoms (p=0.026) and emotional outbursts (p=0.031).

The present data indicate that adding an antidepressant to CBT is not a worthwhile endeavour.