Generalised anxiety disorder in children and adolescents
Generalized anxiety disorder (GAD) is overwhelming, chronic worry about many aspects of life. It affects about 1% of children and 3% of adolescents. In children, it often involves fears about the family and about performing well at school. Children with GAD often have difficulties coping in the home environment, with daily tasks and self-care.
Focus of the review
Cognitive behavioural therapy (CBT) is the best and most evidenced treatment for anxiety disorders. However, for this update, we have decided to focus instead on examining the evidence for medications that have been suggested for use in GAD, either in children or in adolescents. Please see our previous overview (see Generalised anxiety disorders), which included information on the evidence for CBT as well as evidence on interventions to treat GAD in adults.
Comments on evidence
There is some evidence that newer antidepressants such as serotonin re-uptake inhibitors (SSRIs) may help children and adolescents with GAD, but these have side effects. Most of the options that have been proposed have data suggesting that they may work in adults, but no such data are available for children.
Search and appraisal summary
The update literature search for this overview was carried out from the date of the last search, May 2011, to August 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 949 studies. After deduplication and removal of conference abstracts, 417 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 310 studies and the further review of 107 full publications. Of the 107 full articles evaluated, one systematic review was added at this update.
Substantive changes at this update
Antidepressants in children and adolescents One systematic review added. Categorisation unchanged (trade-off between benefits and harms).
INTRODUCTION: Generalised anxiety disorder (GAD) in a child or adolescent is excessive worry and tension about everyday events that the child or adolescent cannot control and that is expressed on most days for at least 6 months, to the extent that there is distress or difficulty in performing day-to-day tasks. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of pharmacological treatments for generalised anxiety disorder in children and adolescents? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS: At this update, searching of electronic databases retrieved 949 studies. After deduplication and removal of conference abstracts, 417 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 310 studies and the further review of 107 full publications. Of the 107 full articles evaluated, one systematic review was added at this update. We performed a GRADE evaluation for six PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for six interventions based on information about the effectiveness and safety of antidepressants, antipsychotics, benzodiazepines, buspirone, hydroxyzine, and pregabalin.
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