Pharmacologic Approaches to Medication-Resistant Anxiety in Children and Adolescents

Abstract

Anxiety disorders are extremely common in the pediatric population, with prevalence estimates ranging from 12 to 20% (Achenbach, Howell, McConaughy, & Stanger, 1995; Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; US Surgeon General, 1999). In the last 10 years, important advances in the psychopharmacologic treatment of childhood anxiety disorders include the increasing evidence of the efficacy of selective serotonin reuptake inhibitors (SSRIs) (Birmaher et al., 2003; Research Unit on Pediatric Psychopharmacology Anxiety Study Group, 2001; Rynn, Siqueland, & Rickels, 2001; Walkup et al., 2008). The major pediatric anxiety disorders can be divided into the following four main groups: (1) generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia (SoP), and specific phobia, which are often considered together and is the most common group of childhood anxiety disorders; (2) panic disorder with and without agoraphobia is less common in children, and is considered separately; (3) acute stress disorder and posttraumatic stress disorder (PTSD); and (4) obsessive–compulsive disorder (OCD). Selective mutism has also been included as a childhood anxiety disorder as it may be a form of SoP (Black & Uhde, 1994).