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SSRIs superior to SSNRIs for youth with anxiety disorders

Treatment with selective serotonin reuptake inhibitors was associated with more rapid and greater improvement than treatment with selective serotonin-norepinephrine reuptake inhibitors in pediatric patients with generalized, separation and/or social anxiety disorders, according to study findings.

“There are no current recommendations regarding the dosing of SSRIs or the use of SSRIs over [selective serotonin-norepinephrine reuptake inhibitors (SSNRIs)] in pediatric anxiety disorders and it is unknown whether SSRIs are superior to SSNRIs for the treatment of anxious youth,” Jeffrey R. Strawn, MD, department of psychiatry and behavioral neuroscience, University of Cincinnati College of Medicine, and colleagues wrote. “Moreover, the only FDA-approved antidepressant for children and adolescents with anxiety (generalized anxiety disorder, ages 7-17) is the SSNRI duloxetine.”

In their meta-analysis, the investigators examined antidepressant response, and whether class and/or dose improved symptoms in youth with anxiety disorders using weekly symptom severity data from nine randomized, placebo-controlled trials that assessed SSRIs and SSNRIs in pediatric anxiety disorders. The authors created a model to measure treatment response and change in continuous measures of anxiety using Bayesian updating. Then they evaluated change in symptom severity as a function of time, class and for SSRIs, standardized dose.

Seven antidepressant medications in 1,673 children and teenagers were included in this meta-analysis. Analysis of the treatment response model showed statistically significant treatment effects within 2 weeks of treatment initiation (95% CI, –0.076 to –0.032; P = .005) and clinically significant differences by week 6 (95% CI, –0.142 to –0.097; P = .001).

Youth who took SSRIs showed significantly greater improvement by the second week of treatment (P = .0268) compared with those who took SSNRIs. Furthermore, the improvement observed from SSRIs continued to show statistical significance at week 12 (P < .03 for all). High-dose SSRI treatment showed improvement at week 2 (95% CI, –0.103 to –0.072; P = .002) and treatment-related differences at week 8 (P = .025). However, both high-dose and low-dose SSRI treatment resulted in improvements at week 12 compared with baseline (P < .001 and P = .018).

"What we found is that with the SSRIs, compared to SSNRIs, people get better faster and see greater improvement overall. There had been some suggestion of this in some individual studies, but this is the first to evaluate the magnitude and trajectory of treatment, or in other words, how much and how quickly people get better,” Strawn said in a press release. "In research, many findings impact our work in the clinic years down the road, but this type of work potentially changes how we select medications to treat children and adolescents with anxiety disorders today.” – by Savannah Demko

Disclosures: Strawn reports research support from the Edgemont, Eli Lilly and Co., Forest, Lundbeck, Neuronetics, the NIH and Shire. He reports material support from Genesight/Assurex Health, royalties from the publication of two texts, and serving as an author for UpToDate and associate editor for Current Psychiatry. Please see the full study for all other authors’ relevant financial disclosures.