Efficacy, suicidality, tolerability, and acceptability of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors for children and adolescents with anxiety disorders: a systematic review and meta-analysis.

IF 2.5 3区医学 Q3 PHARMACOLOGY & PHARMACY

International Clinical Psychopharmacology Pub Date : 2025-07-16 DOI:10.1097/YIC.0000000000000599

Nuntaporn Karawekpanyawong, Chawanun Charnsil, Sirijit Suttajit, Manit Srisurapanont

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Abstract

This systematic review and meta-analysis included randomized controlled trials (RCTs) to compare the efficacy, (treatment-emergent) suicidality, tolerability, and acceptability of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) against placebo in treating children and adolescents with anxiety disorders. We searched multiple electronic databases on July 15 2024. The outcomes included anxiety reduction (efficacy), suicidality rate, dropout rate because of adverse effects (tolerability), and overall dropout rate (acceptability). This study included 15 trials involving 2083 participants (median age = 11.61 years), investigating five SSRIs and two SNRIs. SSRIs/SNRIs significantly reduced anxiety symptoms [14 trials, standardized mean difference = -0.49, 95% confidence interval (CI): -0.65 to -0.33, I2 = 60%], with no significant difference between the two classes. Compared with placebo, they showed a higher risk of suicidal ideation [eight trials, risk ratio = 3.51, 95% confidence interval (CI): 1.51-8.16, I2 = 0%], greater acceptability (15 trials, risk ratio = 0.86, 95% CI: 0.75-0.99, I2 = 0%), and similar tolerability (14 trials, risk ratio = 1.30, 95% CI: 0.68-2.46, I2 = 35%). SSRIs and SNRIs effectively reduce anxiety symptoms in children and adolescents, with good tolerability and acceptability; however, they may increase the risk of suicidal ideation.

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选择性5 -羟色胺再摄取抑制剂和5 -羟色胺-去甲肾上腺素再摄取抑制剂治疗儿童和青少年焦虑症的疗效、自杀倾向、耐受性和可接受性：一项系统综述和荟萃分析

本系统综述和荟萃分析包括随机对照试验（rct），比较选择性5 -羟色胺再摄取抑制剂（SSRIs）和5 -羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）与安慰剂治疗儿童和青少年焦虑症的疗效、（治疗出现的）自杀率、耐受性和可接受性。我们在2024年7月15日检索了多个电子数据库。结果包括焦虑减轻（疗效）、自杀率、不良反应辍学率（耐受性）和总体辍学率（可接受性）。本研究包括15项试验，涉及2083名参与者（中位年龄= 11.61岁），研究了5种SSRIs和2种SNRIs。SSRIs/SNRIs显著减轻焦虑症状[14项试验，标准化平均差= -0.49,95%可信区间（CI）： -0.65 ~ -0.33, I2 = 60%]，两类间无显著差异。与安慰剂相比，它们显示出更高的自杀意念风险[8项试验，风险比= 3.51,95%可信区间（CI）： 1.51-8.16, I2 = 0%]，更高的可接受性（15项试验，风险比= 0.86,95% CI: 0.75-0.99, I2 = 0%），相似的耐受性（14项试验，风险比= 1.30,95% CI: 0.68-2.46, I2 = 35%）。SSRIs和SNRIs可有效减轻儿童青少年焦虑症状，具有良好的耐受性和可接受性；然而，他们可能会增加自杀意念的风险。

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来源期刊

International Clinical Psychopharmacology 医学-精神病学

CiteScore

4.40

自引率

23.10%

发文量

审稿时长

>12 weeks

期刊介绍： International Clinical Psychopharmacology provides an essential link between research and clinical practice throughout psychopharmacology. It reports on studies in human subjects, both healthy volunteers and patients, which relate the effects of drugs on psychological processes. A major objective of the journal is to publish fully refereed papers which throw light on the ways in which the study of psychotropic drugs can increase our understanding of psychopharmacology. To this end the journal publishes results of early Phase I and II studies, as well as those of controlled clinical trials of psychotropic drugs in Phase II and IV. Other topics covered include the epidemiology of psychotropic drug prescribing and drug taking, the sociology of psychotropic drugs including compliance, and research into the safety and adverse effects of these compounds.