Pharmacotherapy Studies
Pharmacological treatment in children and adolescents
is supported by data suggesting the continuity of childhood
anxiety disorders with adult anxiety and depressive
disorders [32-35] and efficacy of a range of antidepressant
medications in the treatment of adult anxiety disorders,
including SSRIs [36]. Prior to CAMS, controlled
trials of SSRIs in childhood anxiety disorders support
the short-term efficacy and safety of these compounds
for the disorders targeted in CAMS, [21-24] as well as
for selective mutism[33] and OCD [35,37].
Setting the stage for the pharmacological protocol
used in CAMS was the Research Units in Pediatric Psychopharmacology
(RUPP) Anxiety Group [23]. These
investigators conducted a randomized, double-blind
comparison of fluvoxamine and pill placebo in children
and adolescents between the ages of 7 to 17 with SAD,
GAD, and SoP. Results showed fluvoxamine (a SSRI)
was significantly more effective than pill placebo in
reducing anxiety symptoms (ES = 1.1). However, limitations
of the RUPP study included use of clinician rather
than independent evaluator ratings of treatment
response and, similar to CBT trials, a substantial portion
of subjects remained symptomatic following treatment.
Despite these and other studies showing the anxiolytic
benefits of SSRIs, concerns with pharmacologic treatments
remain, including the lack of information about
the long-term safety and durability of medication treatments
for children with anxiety disorders. The black
box FDA warnings for the use of SSRI medications in
children and adolescents[38] coincided with the CAMS
trial and underscored the need for careful procedures to
study SSRI safety in children participating in CAMS.