University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center.
Carl H. Lindner College of Business, University of Cincinnati.
J Am Acad Child Adolesc Psychiatry. 2018 Apr;57(4):235-244.e2. doi: 10.1016/j.jaac.2018.01.015. Epub 2018 Feb 8.
To determine the trajectory and magnitude of antidepressant response as well as the effect of antidepressant class and dose on symptomatic improvement in pediatric anxiety disorders.
Weekly symptom severity data were extracted from randomized, parallel group, placebo-controlled trials of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) in pediatric anxiety disorders. Treatment response was modeled for the standardized change in continuous measures of anxiety using Bayesian updating. Posterior distributions for each study served as informative conjugate prior to distributions update subsequent study posteriors. Change in symptom severity was evaluated as a function of time, class and, for SSRIs, standardized dose.
Data from 9 trials (SSRIs: n = 5; SNRIs, n = 4) evaluating 7 medications in 1,673 youth were included. In the logarithmic model of treatment response, statistically, but not clinically, significant treatment effects emerged within 2 weeks of beginning treatment (standardized medication-placebo difference = -0.054, credible interval [CI] = -0.076 to -0.032, p = .005, approximate Cohen's d ≤ 0.2) and by week 6, clinically significant differences emerged (standardized medication-placebo difference = -0.120, CI = -0.142 to -0.097, p = .001, approximate Cohen's d = 0.44). Compared to SNRIs, SSRIs resulted in significantly greater improvement by the second week of treatment (p = .0268), and this advantage remained statistically significant through week 12 (all p values <.03). Improvement occurred earlier with high-dose SSRI treatment (week 2, p = .002) compared to low-dose treatment (week 10, p = .025), but SSRI dose did not have an impact on overall response trajectory (p > .18 for weeks 1-12).
In pediatric patients with generalized, separation, and/or social anxiety disorders, antidepressant-related improvement occurred early in the course of treatment, and SSRIs were associated with more rapid and greater improvement compared to SNRIs.
确定抗抑郁药反应的轨迹和幅度，以及抗抑郁药类别和剂量对儿童焦虑障碍症状改善的影响。
从选择性 5-羟色胺再摄取抑制剂（SSRIs）和选择性 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）治疗儿童焦虑障碍的随机、平行组、安慰剂对照试验中提取每周症状严重程度数据。使用贝叶斯更新对焦虑的连续度量标准变化进行治疗反应建模。每个研究的后验分布作为信息共轭先验，以更新后续研究的后验分布。症状严重程度的变化作为时间、类别和 SSRIs 标准化剂量的函数进行评估。
纳入了 9 项试验（SSRIs：n=5；SNRIs，n=4）的数据，共评估了 1673 名青少年的 7 种药物。在治疗反应的对数模型中，虽然在统计学上但不是临床上有意义的治疗效果在开始治疗后 2 周内出现（标准化药物-安慰剂差异= -0.054，可信区间 [CI] = -0.076 至 -0.032，p=.005，近似 Cohen's d ≤ 0.2），到第 6 周时出现了临床显著差异（标准化药物-安慰剂差异= -0.120，CI = -0.142 至 -0.097，p=.001，近似 Cohen's d = 0.44）。与 SNRIs 相比，SSRIs 在治疗的第二周就导致了显著更大的改善（p=.0268），并且这种优势在第 12 周时仍然具有统计学意义（所有 p 值均<.03）。高剂量 SSRI 治疗（第 2 周，p=.002）比低剂量治疗（第 10 周，p=.025）更早出现改善，但 SSRI 剂量对整体反应轨迹没有影响（第 1-12 周时所有 p 值均>.18）。
在患有广泛性、分离性和/或社交焦虑障碍的儿科患者中，抗抑郁药相关的改善在治疗早期发生，与 SNRIs 相比，SSRIs 与更快和更大的改善相关。
