Efficacy and safety of serotonin reuptake inhibitors (SSRI) and serotonin noradrenaline reuptake inhibitors (SNRI) for children and adolescents with anxiety disorders: a systematic review and meta-analysis

Abstract

Purpose

To assess the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) in comparison with various control contingencies (e.g. pill placebo and cognitive behavioral treatment) for pediatric anxiety disorders. Additionally, we wanted to investigate whether serious adverse events or adverse events are more common with medication treatment compared with pill placebo.

Materials and methods

Studies were selected if they were randomized controlled trials evaluating SSRIs or SNRIs. Eligible studies included participants aged 17 years or younger. Eleven studies were included, with 2122 participants. Primary outcomes were (1) remission, (2) a continuous scale such as the Social Phobia and Anxiety Inventory for Children and (3) serious adverse events. We also calculated number needed to treat and number needed to harm.

Results

SSRIs and SNRIs are an effective treatment of childhood anxiety disorders and are superior to pill placebo. While the risk of serious adverse events was low with SSRI/SNRI treatment, there was an increased risk of experiencing behavioral activation with SSRI/SNRI treatment.

Conclusion

SSRI and SNRI treatment is effective for childhood anxiety disorders, with positive effect of treatment outweighing the negative effects.

Keywords:

• SSRI
• SNRI
• anxiety disorder
• children
• systematic review

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Íris Harpa Stefánsdóttir

Íris Harpa Stefánsdóttir, MS, is a clinical psychologist.

Tord Ivarsson

Tord Ivarsson, MD, PhD, is an associate professor at the University of Gothenburg and retired senior consultant.

Gudmundur Skarphedinsson

Gudmundur Skarphedinsson, PhD, is a clinical psychologist and professor, Faculty of Psychology, University of Iceland, Reykjavik, Iceland.