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Medications are considered when the severity of anxiety symptoms or related impairment makes participation in psychotherapy difficult or treatment with psychotherapy alone results in a partial response. Anxious children and anxious parents may be very sensitive to any worsening of the children's somatic symptoms or development of even mild or transient side effects of medications. Carefully assessing somatic symptoms at baseline prior to starting medication trials is important. A developing evidence base suggests that the selective serotonin reuptake inhibitors (SSRIs) should be considered the first-line pharmacological treatment for pediatric anxiety disorders (Seidel and Walkup 2006). Several randomized, placebo-controlled trials with SSRIs have established the short-term efficacy of SSRIs for the treatment of childhood anxiety disorders (Table 20–12). SAD, GAD, and social phobia often occur together; are treated with similar pharmacological strategies; and are often studied together in medication trials as they have been in CBT trials (Birmaher et al. 2003; Research Units on Pediatric Psychopharmacology Anxiety Study Group 2001; Walkup et al. 2008). Specific anxiety disorders with controlled trials include SM with social phobia (Black and Uhde 1994), social phobia alone (Wagner et al. 2004), and GAD (Rynn et al. 2001).

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Table Reference Number
TABLE 20–12. Placebo-controlled pharmacological treatment studiesa

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