The Impact of Antidepressant Dose and Class on Treatment Response in Pediatric Anxiety Disorders: A Meta-Analysis
Abstract
Objective To determine the trajectory and magnitude of antidepressant response as well as the effect of antidepressant class and dose on symptomatic improvement in pediatric anxiety disorders. Method Weekly symptom severity data were extracted from randomized, parallel group, placebo-controlled trials of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) in pediatric anxiety disorders. Treatment response was modeled for the standardized change in continuous measures of anxiety using Bayesian updating. Posterior distributions for each study served as informative conjugate priors to update subsequent study posteriors. Change in symptom severity was evaluated as a function of time, class and, for SSRIs, standardized dose. Results Data from 9 trials (SSRIs: n=5; SSNRIs, n=4) evaluating 7 medications in 1,673 youth were included. In the logarithmic model of treatment response, statistically—but not clinically—significant treatment effects emerged within 2 weeks of beginning treatment (standardized medication-placebo difference = −0.054, CI: −0.076 to −0.032, p=0.005, approximate Cohen’s d ≤ 0.2) and by week 6, clinically significant differences emerged (standardized medication-placebo difference = −0.120, CI: −0.142, −0.097, p=0.001, approximate Cohen’s d = 0.44). Compared to SSNRIs, SSRIs resulted in significantly greater improvement by the second week of treatment (p=0.0268) and this advantage remained…
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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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