TY - JOUR
T1 - Treating pediatric anxiety
T2 - Initial use of SSRIs and other antianxiety prescription medications
AU - Bushnell, Greta A.
AU - Compton, Scott N.
AU - Dusetzina, Stacie B.
AU - Gaynes, Bradley N.
AU - Brookhart, M. Alan
AU - Walkup, John T.
AU - Rynn, Moira A.
AU - Sturmer, Til
N1 - Funding Information:
Submitted: December 20, 2016; accepted June 15, 2017. Published online: October 31, 2017. Potential conflicts of interest: Dr Bushnell received support from the National Institute of Mental Health as a Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellow (F31MH107085). Dr Bushnell also held a graduate research assistantship with GlaxoSmithKline and was the Merck fellow for the Center for Pharmacoepidemiology (both ended December 2015). Dr Compton receives research support from the National Institute of Mental Health, NC GlaxoSmithKline Foundation, and Mursion; has
Funding Information:
the JournalofConsultingandClinicalPsychology, Scottsdale, Arizona, May 30–June 3, 2016; the assessment and treatment of children and Nordic Long-Term OCD Treatment Study Research 10th Annual Chapel Hill Pharmaceutical Sciences adolescents with obsessive-compulsive Group, and The Centre for Child and Adolescent Conferences, May 12–13, 2016, Chapel Hill, North disorder. J Am Acad Child Adolesc Psychiatry. Mental Health, Eastern and Southern Norway; and Carolina; and the American Academy of Child and 2012;51(1):98–113.PubMed doi:10.1016/j.jaac.2011.09.019 has given expert testimony for Duke University. Adolescent Psychiatry’s 63rd Annual Meeting, Bridge JA, Iyengar S, Salary CB, et al. Clinical Dr Brookhart has received investigator-initiated October 24–29, 2016, New York, New York. response and risk for reported suicidal ideation research funding from the National Institutes of Additional information: MarketScan Commercial and suicide attempts in pediatric Health and through contracts with the Agency Claims and Encounters Database is owned antidepressant treatment: a meta-analysis of for Healthcare Research and Quality’s DEcIDE by Truven Health Analytics an IBM Company. randomized controlled trials. JAMA. program and the Patient-Centered Outcomes Information on acquiring access to the database 2007;297(15):1683–1696.PubMed doi:10.1001/jama.297.15.1683 Research Institute; within the past 3 years, has can be found at http://truvenhealth.com/. Strawn JR, Welge JA, Wehry AM, et al. Efficacy received research support from Amgen and Supplementary material: See accompanying and tolerability of antidepressants in pediatric AstraZeneca and has served as a scientific advisor pages. anxiety disorders: a systematic review and for Amgen, Merck, GSK, Genentech, TargetPharma, meta-analysis. Depress Anxiety. and RxAnte; and owns equity in NoviSci, a data 2015;32(3):149–157.PubMed doi:10.1002/da.22329 sciences company. Dr Walkup has received past Ipser JC, Stein DJ, Hawkridge S, et al. research support for federally funded studies Pharmacotherapy for anxiety disorders in including free drug and placebo from Pfizer in children and adolescents. Cochrane Database 2007 to support the Child Adolescent Anxiety Syst Rev. 2009;(3):CD005170.PubMed Multimodal study, free medication from Abbott in Wehry AM, Beesdo-Baum K, Hennelly MM, et al. 2005 for the Treatment of Early Age Mania study, Assessment and treatment of anxiety disorders and free drug and placebo from Eli Lilly in 2003 in children and adolescents. Curr Psychiatry Rep. for the Treatment of Adolescents with Depression 2015;17(7):52.PubMed doi:10.1007/s11920-015-0591-z study; currently receives research support from Rynn M, Puliafico A, Heleniak C, et al. Advances the Tourette’s Association of America and the in pharmacotherapy for pediatric anxiety Hartwell Foundation; and receives royalties from disorders.DepressAnxiety. 2011;28(1):76–87.PubMeddoi:10.1002/da.20769 Guilford Press and Oxford Press for multiauthored Leslie LK, Newman TB, Chesney PJ, et al. The books about Tourette syndrome. Dr Rynn has Food and Drug Administration’s deliberations received grant support from Eunice Kennedy on antidepressant use in pediatric patients. Shriver National Institute of Child Health and Pediatrics. 2005;116(1):195–204.PubMed doi:10.1542/peds.2005-0074 Human Development and National Institute of Creswell C, Waite P, Cooper PJ. Assessment and Mental Health; has received research support management of anxiety disorders in children from Eli Lilly, National Institute of Mental Health, and adolescents. Arch Dis Child. and Shire; and has received royalties from the 2014;99(7):674–678.PubMed doi:10.1136/archdischild-2013-303768 American Psychiatric Association Publishing, Walkup J, Labellarte M, Riddle MA, et al; Oxford University Press, and UpToDate. Dr Stürmer Research Units on Pediatric receives investigator-initiated research funding Psychopharmacology Anxiety Study Group. from the National Institutes of Health (principal Treatment of pediatric anxiety disorders: an investigator, R01 AG023178; coinvestigator: R01 open-label extension of the research units on CA174453, R01 HL118255, R21-HD080214); receives pediatric psychopharmacology anxiety study. salary support as Director of the Comparative J Child Adolesc Psychopharmacol. Effectiveness Research Strategic Initiative, NC 2002;12(3):175–188.PubMed doi:10.1089/104454602760386879 TraCS Institute, UNC Clinical and Translational Piacentini J, Bennett S, Compton SN, et al. 24-Science Award (UL1TR001111) and as Director of the and 36-week outcomes for the Child/ Center for Pharmacoepidemiology, Department Adolescent Anxiety Multimodal Study (CAMS). of Epidemiology UNC Gillings School of Global J Am Acad Child Adolesc Psychiatry. Public Health (current members: GlaxoSmithKline, 2014;53(3):297–310.PubMed doi:10.1016/j.jaac.2013.11.010 UCB BioSciences, Merck); receives research American Psychiatric Association. Diagnostic support from pharmaceutical companies (Amgen, and Statistical Manual for Mental Disorders. Fifth AstraZeneca) to the Department of Epidemiology, Edition. Washington, DC: American Psychiatric University of North Carolina at Chapel Hill; does Association; 2013. not accept personal compensation of any kind American Psychiatric Association. Diagnostic from any pharmaceutical company; and owns stock and Statistical Manual for Mental Disorders. in Novartis, Roche, BASF, AstraZeneca, and Novo Fourth Edition, Text Revision. Washington, DC: Nordisk. Drs Gaynes and Dusetzina report no American Psychiatric Association; 2000. financial interests or potential conflicts of interest. Bandelow B, Reitt M, Röver C, et al. Efficacy of Funding/support: Research reported in this analysis.Int ClinPsychopharmacol. treatments for anxiety disorders: a meta-
Funding Information:
Epidemiology, UNC Gillings School of Global Public infrastructure was funded by the Department of Adolesc Psychiatr Clin N Am. 2012;21(4):789–806.PubMed doi:10.1016/j.chc.2012.07.007 Health, the Cecil G. Sheps Center for Health Services Locher C, Koechlin H, Zion SR, et al. Efficacy and Research, UNC, the CER Strategic Initiative of UNC’s safety of selective serotonin reuptake inhibitors, Clinical Translational Science Award (UL1TR001111), serotonin-norepinephrine reuptake inhibitors, and the UNC School of Medicine (Chapel Hill, North and placebo for common psychiatric disorders Carolina). Copyright ©2015 Truven Health Analytics reviewandmeta-analysis. JAMAPsychiatry.among children and adolescents: a systematic
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective: Multiple pharmacotherapies for treating anxiety disorders exist, including selective serotonin reuptake inhibitors (SSRIs), the recommended first-line pharmacotherapy for pediatric anxiety. We sought to describe initial antianxiety medication use in children and estimate how long antianxiety medications were continued. Methods: In a large commercial claims database, we identified children (3-17 years) initiating prescription antianxiety medication from 2004 to 2014 with a recent anxiety diagnosis (ICD-9-CM = 293.84, 300.0x, 300.2x, 300.3x, 309.21, 309.81, 313.23). We estimated the proportion of children initiating each medication class across the study period and used multivariable regression to evaluate factors associated with initiation with an SSRI. We evaluated treatment length for each initial medication class. Results: Of 84,500 children initiating antianxiety medication, 70% initiated with an SSRI (63% [95% CI, 62%-63%] SSRI alone, 7% [95% CI, 7%-7%] SSRI + another antianxiety medication). Non-SSRI medications initiated included benzodiazepines (8%), non-SSRI antidepressants (7%), hydroxyzine (4%), and atypical antipsychotics (3%). Anxiety disorder, age, provider type, and comorbid diagnoses were associated with initial medication class. The proportion of children refilling their initial medication ranged from 19% (95% CI, 18%-20%) of hydroxyzine initiators and 25% (95% CI, 24%-26%) of benzodiazepine initiators to 81% (95% CI, 80%-81%) of SSRI initiators. Over half (55%, 95% CI, 55%-56%) of SSRI initiators continued SSRI treatment for 6 months. Conclusions: SSRIs are the most commonly used first-line medication for pediatric anxiety disorders, with about half of SSRI initiators continuing treatment for 6 months. Still, a third began therapy on a non-SSRI medication, for which there is limited evidence of effectiveness for pediatric anxiety, and a notable proportion of children initiated with 2 antianxiety medication classes.
AB - Objective: Multiple pharmacotherapies for treating anxiety disorders exist, including selective serotonin reuptake inhibitors (SSRIs), the recommended first-line pharmacotherapy for pediatric anxiety. We sought to describe initial antianxiety medication use in children and estimate how long antianxiety medications were continued. Methods: In a large commercial claims database, we identified children (3-17 years) initiating prescription antianxiety medication from 2004 to 2014 with a recent anxiety diagnosis (ICD-9-CM = 293.84, 300.0x, 300.2x, 300.3x, 309.21, 309.81, 313.23). We estimated the proportion of children initiating each medication class across the study period and used multivariable regression to evaluate factors associated with initiation with an SSRI. We evaluated treatment length for each initial medication class. Results: Of 84,500 children initiating antianxiety medication, 70% initiated with an SSRI (63% [95% CI, 62%-63%] SSRI alone, 7% [95% CI, 7%-7%] SSRI + another antianxiety medication). Non-SSRI medications initiated included benzodiazepines (8%), non-SSRI antidepressants (7%), hydroxyzine (4%), and atypical antipsychotics (3%). Anxiety disorder, age, provider type, and comorbid diagnoses were associated with initial medication class. The proportion of children refilling their initial medication ranged from 19% (95% CI, 18%-20%) of hydroxyzine initiators and 25% (95% CI, 24%-26%) of benzodiazepine initiators to 81% (95% CI, 80%-81%) of SSRI initiators. Over half (55%, 95% CI, 55%-56%) of SSRI initiators continued SSRI treatment for 6 months. Conclusions: SSRIs are the most commonly used first-line medication for pediatric anxiety disorders, with about half of SSRI initiators continuing treatment for 6 months. Still, a third began therapy on a non-SSRI medication, for which there is limited evidence of effectiveness for pediatric anxiety, and a notable proportion of children initiated with 2 antianxiety medication classes.
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U2 - 10.4088/JCP.16m11415
DO - 10.4088/JCP.16m11415
M3 - Article
C2 - 29099547
AN - SCOPUS:85046846809
VL - 79
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
SN - 0160-6689
IS - 1
M1 - 16m11415
ER -