WebMD Health News
Daniel J. DeNoon
Louise Chang, MD
Dec. 24, 2008 - Cognitive behavioral therapy (CBT) and Zoloft are effective
treatments for childhood anxiety disorders -- but the combination works best, a
government-funded study shows.
Anxiety disorders and social phobias limit the lives of at least one in 10
children. Yet up to half of these kids aren't helped by short-term treatment
with psychotherapy alone or medications alone.
That's why Johns Hopkins researcher John T. Walkup, MD, and colleagues led a
multi-institution, government-funded study to see whether combination treatment
The researchers enrolled 488 children and teens age 7 to 17 years. All
separation anxiety disorder,
generalized anxiety disorder, or
There were four different treatment groups:
After 12 weeks:
Walkup and colleagues conclude that all three of the active treatments --
CBT, Zoloft, or the combination -- are effective short-term treatments for kids
with anxiety disorders.
"Among these effective therapies, combination therapy provides the best
chance for a positive outcome," they conclude.
Zoloft treatment worked the fastest, with rapid initial improvement but
little additional improvement after eight weeks of treatment. CBT took eight to
12 weeks to work.
Most kids with anxiety disorders don't get diagnosed or treated, notes an
editorial by Graham J. Emslie, MD, of the University of Texas Southwestern
Medical Center, Dallas.
That's too bad, he says, because research now shows that untreated childhood
anxiety persists into adulthood.
"This trial answers the most compelling question about the treatment of
anxiety disorders: Treatment is indicated," Emslie states.
Zoloft is an SSRI
antidepressant. Like other members of its class, the drug has been linked
suicidal thoughts in children and adults. But in the Walkup study, there
were no more suicidal thoughts in kids taking Zoloft than in kids taking
However, kids taking Zoloft reported more insomnia,
fatigue, sedation, and restlessness than kids in the CBT group.
Zoloft is made by Pfizer. Pfizer provided the Zoloft and placebo pills used
in the study, but did not provide other support for the study and was not
involved in the design or implementation of the study. Walkup and colleagues
report receiving various fees and research support from various pharmaceutical
The study findings, and the Emslie editorial, appear in the Dec. 25 issue of
the New England Journal of Medicine.
SOURCES:Walkup, J.T. New England Journal of Medicine, Dec. 25, 2008; vol 359:
pp 2853-66.Emslie, G.J. New England Journal of Medicine, Dec. 25, 2008; vol 359:
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