Pharmacotherapy of social anxiety disorders in children and adolescents
Abstract
Abstract Background Social anxiety disorder (SAD) is one of the most common psychiatric disorders in Japan, with teenagers being the most common age of onset, although the recently published Japanese guidelines for SAD 1 are intended for adults and not for children and adolescents. Aims & Objectives Review placebo-controlled drug trials for SAD in children and adolescents. Method Placebo-controlled trials in children and adolescents with SAD published from April 1986 to August 2023 were reviewed and summarized. Results There were one randomized placebo-controlled trial (RCT) of paroxetine 2, one of venlafaxine 3, and one of fluoxetine plus psychotherapy versus placebo 4 in children and adolescents. There have been no further RCTs in child and adolescent subjects reported since the earlier National Institute for Health and Care Excellence (NICE) clinical guidelines reviewed them in 20135. The three RCTs showed efficacy with mild to moderate effect sizes compared to placebo in the treatment of SAD, but all agents had significantly more side effects, including gastrointestinal symptoms, compared to placebo. In addition, for paroxetine and venlafaxine, suicidal ideation, which was not reported with placebo, was reported in the actual drug group. Psychotherapy was more effective than fluoxetine. Other than RCTs, one open- label study each of sertraline 6 and escitalopram 7 have been reported. Open trials have also shown efficacy, but severe side effects have been reported:…
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