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:
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
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
Publisher Copyright:
© Copyright 2017 Physicians Postgraduate Press, Inc.
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 - Diseases of the Nervous System
JF - Diseases of the Nervous System
SN - 0160-6689
IS - 1
M1 - 16m11415
ER -
