By BENEDICT CAREY
Children and adolescents with disabling anxiety are most likely to recover when treated with a combination of talk therapy and an antidepressant medicine, according to the largest study to date of anxiety disorders in this age group.
The government-financed study, which tracked nearly 500 patients, found that 8 in 10 children who received the combined therapy improved significantly, compared with less than 6 in 10 who had either the drug or the talk therapy (known as cognitive behavior therapy) on its own.
The study, released online Thursday by The New England Journal of Medicine, clarifies the treatment picture for these young patients and should increase interest in combined therapy, experts said. Up to half of children and adolescents struggling with chronic anxiety do not seem to improve much in treatment, psychiatrists estimate.
The researchers reported no increase in serious side effects from Zoloft, the antidepressant used in the study; the drug belongs to a class of medications that has been associated with a small risk of suicidal thinking and behavior in young patients.
“It’s surprising that they found such a dramatic difference between combined treatment and the others,” said Dr. Sanjiv Kumra, director of the child and adolescent psychiatry program at the University of Minnesota, who was not involved in the research. “I think this should be reassuring for parents interested in finding good treatment for a child, and it should send a message to third-party payers.”
In the new report, from a continuing study financed by the National Institute of Mental Health, researchers recruited children ages 7 to 17 whose anxiety over separation from parents, social situations or other things was causing problems.
The doctors split the youngsters into four groups: one receiving Zoloft; another engaging in cognitive therapy; a third receiving both; and a group receiving dummy pills and monitoring by the psychiatrist. In the talk treatment, therapists teach children to identify the thoughts that amplify their worries, and then defuse or moderate them; parents help reinforce the lessons.
After 12 weeks, 80 percent of children receiving the combined therapy had either shaken their anxiety or improved very much. Similar improvements were found in about 60 percent of those getting talk therapy alone; 55 percent of those receiving Zoloft alone; and less than a quarter of those taking dummy pills.
“All of the treatment options employed may be recommended, taking into consideration the family’s treatment preferences” as well as cost and availability, concluded the study authors, led by Dr. John T. Walkup of Johns Hopkins and Dr. Philip C. Kendall of Temple University.