A has found that sertraline, combined with cognitive behavior therapy, can help a lot of kids with serious problems:
CHICAGO – A popular antidepressant plus three months of psychotherapy dramatically helped children with anxiety disorders, the most common psychiatric illnesses in kids, the biggest study of its kind found.
The research also offers comfort to parents worried about putting their child on powerful drugs — therapy alone did a lot of good, too.
Combining the drug sertraline, available as a generic and under the brand name Zoloft, with therapy worked best. But each method alone also had big benefits, said Dr. John Walkup, lead author of the government-funded research. It’s estimated that anxiety disorders affect as many as 20 percent of U.S. children and teens.
In many cases, symptoms almost disappeared in children previously so anxious that they wouldn’t leave home, sleep alone, or hang out with friends, said Walkup, a Johns Hopkins Hospital psychiatrist.
Here’s what the study found:
The study involved 488 children aged 7 to 17 treated at six centers around the country. They were randomly assigned to one of four 12-week treatments: up to 200 milligrams daily of sertraline; 14 hour-long sessions of psychotherapy alone; both treatments together; or dummy pills.
In the combined treatment group, 81 percent of children were much improved by three months, compared with 60 percent in the therapy-only group, 55 percent in the sertraline-only group, and 24 percent in the placebo group.
I have so many problems with this study it’s hard to know where to start. First, IMO it should be unethical to give kids drugs alone when the longterm efficacy and effects are unknown and effective non-pharmaceutical therapies are available. Said another way, I don’t think this study should ever have taken place.
Second, note that almost half of the kids weren’t helped by sertraline alone. That’s important when you consider what the likely implications for insurance will be. Since it’s almost undoubtedly cheaper to give the kids sertraline than psychotherapy, that’s probably all the insurance companies will pay for and that’s all that will happen. Consequently, docs will be giving drugs to kids who won’t be helped by them because that’s what their insurance will pay for.
Third, longterm use of sertraline needs to be studied before you start giving it to somebody who might be using it for a lifetime. The implications of giving a drug to a 70 year old and a 7 year old are different. What are the developmental implications? Cognitive implications? Reproductive implications? Nobody knows.
Fourth, I acknowledge that there are kids whose problems are severe enough that giving them sertraline is probably warranted, preferably in combination with psychotherapy. I’m concerned that kids whose problems are a lot less severe will be treated pharmaceutically. Which is a greater problem, the overmedication or the undermedication of pre-teenagers? I’m really asking.
Finally, why do kids have serious anxiety disorders in the first place? I think we might consider trying to prevent them rather than treating them after the problems have arisen.
A few months back my sister-in-law’s best friend, her husband and two of their kids were murdered by their remaining kid. He’s 16, being tried as an adult, and is looking at life without parole. So in some cases maybe some meds might be helpful.
I think we always need to be very careful with meds, especially with kids. But in addition to the urge to overmedicate, we have a counterbalancing pressure to undermedicate. People don’t want to admit they or their family have problems. Or they don’t want it on their records. Or there’s a cost factor. Or they have a Whole Foods view of all meds as inherently bad, even inoculations. The pressure goes both ways.
We hesitated a long time over trying Ritalin for our daughter. It came down to either going on Ritalin or pulling her out of school. On Ritalin she suffered no negative side-effects and vastly improved in her school work. But the flip side of that is that she’s off Ritalin now, she’s being homeschooled, (we’re living in Italy at the moment) and still doing well learning, albeit with a level of involvement impossible to maintain in a school setting.
Nothing’s simple in any of this, as you know.
“half of the kids weren’t helped by sertraline alone.” Is that fully accurate? Presumably if the sertraline alone group had been given the placebo, then 24% of them would have been much improved. So sertraline really helped the additional 31%.
One other thing, I believe the standard form of cognitive behavior therapy is to teach how to recognize and cope with anxiety. I assume the pills work by masking anxiety. The long term effects and costs may be very different.