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

Selective serotonin reuptake inhibitors (SSRIs) are considered to be the first-line pharmaco-logical treatment of anxiety disorders in children and adolescents. Selective serotonin noradrenaline reuptake inhibitors (SNRIs) have also been proven to be effective. This study conducts a systematic review and meta-analysis of the literature to assess the efficacy of SSRI and SNRI treatment in comparison with various control contingencies (e.g. pill placebo and cognitive behavioral treatment) for pediatric anxiety disorders. Studies were selected if they were randomized controlled trials evaluating SSRIs or SNRIs. Eligible studies included participants aged 17 years or younger. Ten studies were included, with 894 SSRI/SNRI participants and 829 control participants. The overall results indicated that SSRIs and SNRIs are an effective treatment of childhood anxiety disorders. SSRI/SNRI treatment is 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 compared with pill placebo. Gastrointestinal discomfort symptoms were reported at higher rates for SSRI/SNRI treatment compared with pill placebo, and there was increased risk of abdominal pain and vomiting. The overall results indicate that SSRI and SNRI treatment is effective for childhood anxiety disorders, with positive effect of treatment outweighing the negative effects.Keywords: SSRI, SNRI, adverse events, anxiety, children, adolescents, meta-analysis, systematic review