722 W 168th St, New York, NY 10032.
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
J Clin Psychiatry. 2018 Jan-Feb;79(1). doi: 10.4088/JCP.16m11415.
Multiple pharmacotherapies for treating anxiety disorders exist, including selective serotonin reuptake inhibitors (SSRIs), the recommended first-line pharmacotherapy for pediatric anxiety. We sought to describe initial antianxiety medication use in children and estimate how long antianxiety medications were continued.
In a large commercial claims database, we identified children (3-17 years) initiating prescription antianxiety medication from 2004 to 2014 with a recent anxiety diagnosis (ICD-9-CM = 293.84, 300.0x, 300.2x, 300.3x, 309.21, 309.81, 313.23). We estimated the proportion of children initiating each medication class across the study period and used multivariable regression to evaluate factors associated with initiation with an SSRI. We evaluated treatment length for each initial medication class.
Of 84,500 children initiating antianxiety medication, 70% initiated with an SSRI (63% [95% CI, 62%-63%] SSRI alone, 7% [95% CI, 7%-7%] SSRI + another antianxiety medication). Non-SSRI medications initiated included benzodiazepines (8%), non-SSRI antidepressants (7%), hydroxyzine (4%), and atypical antipsychotics (3%). Anxiety disorder, age, provider type, and comorbid diagnoses were associated with initial medication class. The proportion of children refilling their initial medication ranged from 19% (95% CI, 18%-20%) of hydroxyzine initiators and 25% (95% CI, 24%-26%) of benzodiazepine initiators to 81% (95% CI, 80%-81%) of SSRI initiators. Over half (55%, 95% CI, 55%-56%) of SSRI initiators continued SSRI treatment for 6 months.
SSRIs are the most commonly used first-line medication for pediatric anxiety disorders, with about half of SSRI initiators continuing treatment for 6 months. Still, a third began therapy on a non-SSRI medication, for which there is limited evidence of effectiveness for pediatric anxiety, and a notable proportion of children initiated with 2 antianxiety medication classes.
治疗焦虑症的药物疗法有很多种，包括选择性 5-羟色胺再摄取抑制剂（SSRIs），这是治疗儿科焦虑症的首选一线药物。我们旨在描述儿童初始抗焦虑药物的使用情况，并估算抗焦虑药物的持续使用时间。
在一个大型商业索赔数据库中，我们确定了 2004 年至 2014 年期间开始服用处方抗焦虑药物的儿童（3-17 岁），这些儿童最近被诊断出患有焦虑症（ICD-9-CM = 293.84、300.0x、300.2x、300.3x、309.21、309.81、313.23）。我们估计了研究期间每个药物类别开始使用的儿童比例，并使用多变量回归来评估与开始使用 SSRIs 相关的因素。我们评估了每种初始药物类别的治疗时间。
在开始服用抗焦虑药物的 84500 名儿童中，有 70%的儿童开始服用 SSRIs（63%[95%置信区间，62%-63%]为 SSRIs 单独使用，7%[95%置信区间，7%-7%]为 SSRIs+另一种抗焦虑药物）。开始使用的非 SSRIs 药物包括苯二氮䓬类药物（8%）、非 SSRIs 类抗抑郁药（7%）、羟嗪（4%）和非典型抗精神病药（3%）。焦虑症、年龄、提供者类型和合并诊断与初始药物类别相关。初始药物续用的儿童比例从羟嗪（95%置信区间，18%-20%）和苯二氮䓬类药物（95%置信区间，24%-26%）的 19%到 SSRIs（95%置信区间，80%-81%）的 81%不等。超过一半（55%，95%置信区间，55%-56%）的 SSRIs 起始者继续接受 SSRIs 治疗 6 个月。
SSRIs 是治疗儿科焦虑症最常用的一线药物，约有一半的 SSRIs 起始者继续治疗 6 个月。尽管如此，仍有三分之一的儿童开始使用两种抗焦虑药物，而这些药物对儿科焦虑症的疗效证据有限，而且有相当一部分儿童开始使用两种抗焦虑药物。
