Study Finds Antidepressant Effective for Children’s Disorders

Children and adolescents who have social phobias or anxiety disorders could benefit from treatment with the antidepressant fluvoxamine, according to a new study in today's New England Journal of Medicine. Although there is evidence that drugs that selectively inhibit serotonin reuptake work in adults with mood and anxiety disorders, there is "limited data" on such drugs in children, the study says. Researchers gave either fluvoxamine or a placebo to 128 children ages six to 17 who had either a social phobia, a separation anxiety disorder or a generalized anxiety disorder. At the end of an eight-week study period, researchers found that 76% of the children receiving fluvoxamine responded to the treatment, compared to 29% of those in the placebo group. The researchers concluded that fluvoxamine "is an effective treatment for children and adolescents with social phobia, separation anxiety disorder or generalized anxiety disorder" (Walkup et al., New England Journal of Medicine, 4/26). The study was funded by the NIH with "partial support" from Solvay SA, which markets a brand-name version of fluvoxamine called Luvox. Luvox has been approved by the FDA to treat children with obsessive-compulsive disorder (Johannes, Wall Street Journal, 4/26).

Dr. John Walkup, a Johns Hopkins psychiatrist and study co-author, said that although treatment with medication "can be beneficial" for children with certain anxiety disorders, the study results "do not mean doctors would immediately consider the drug ... for extremely worried children." He added that more research is needed to determine how the medication compares to traditional psychiatric counseling and whether the two should be used together (Bor, Baltimore Sun, 4/26). In an editorial accompanying the study, Dr. Joseph Coyle of Harvard Medical School adds that "it is vital to consider whether conditions in children and adolescents are sufficiently serious and disabling to necessitate pharmacologic intervention and whether pharmacotherapy alone is adequate." He writes that although the study participants showed "little response" to three weeks of traditional counseling they received, a "wealth of well-designed studies of adults and children" have shown that "psychological interventions, including relaxation training, anxiety management and especially cognitive behavioral therapy, are effective and may reduce symptoms for at least one year." He concludes that the study leaves "many issues ... unresolved," such as how long a child should remain on a drug treatment regimen and in which situations medication alone should be prescribed as opposed to or in combination with cognitive behavioral therapy (Coyle, New England Journal of Medicine, 4/26).