CBT vs meds for childhood anxiety disorder

Clinical Brief – September, 8th

The Brief

In a large analysis of trials, cognitive behavioral therapy (CBT) and meds (SSRI only) were both effective at reducing anxiety symptoms.

CBT was safer than meds, and outperformed fluoxetine (Prozac) for symptom reduction; and sertraline (Zoloft) for improved remission.


What’s childhood anxiety disorder?

In the commentary that came with this study, anxiety disorders were said to be “among the most prevalent pediatric behavioral health conditions, affecting roughly 32% of youths prior to adulthood.”

Treatment options include CBT or meds such as the class of SSRIs. SSRIs include fluoxetine and sertraline.


What did the study find?

The meta-analysis looked through over 100 trials that involved nearly 8,000 patients. The treatments studies included CBT and meds such as SSRIs and other drug classes.

CBT significantly improved primary anxiety symptoms, remission, and response vs wait-listing or no treatment. CBT also reduced primary anxiety symptoms more than fluoxetine and improved remission more than sertraline.

SSRIs also significantly reduced primary anxiety symptoms and increased remission vs placebo.

Two other drug classes, benzodiazepines and tricyclics, didn’t significantly reduce anxiety symptoms vs controls.

Side effects were “common with medications but not with CBT”.


Bottom line

For childhood anxiety disorder, CBT seemed to be generally superior vs meds. However, more research is needed for better management strategies.

“Still, roughly 40% to 50% of anxious children who receive gold standard CBT or SSRI remain symptomatic following acute treatment.”

– Asarnow JR, et al.

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