Psychiatrists Push SSRIs for Childhood Anxiety_NEJM
VERACARE
Promoting Openness, Full Disclosure, and Accountability
http://www.ahrp.org and http://ahrp.blogspot.com
FYI
The New England Journal of Medicine has just published an article [Abstract
below] promoting the expanded use of antidepressants for treating loosely
defined "Childhood anxiety."
All the psychiatrists who authored the study have financial ties to drug
manufacturers.
They promote a failed paradigm of care that relies on
psychopharmacology--even as the evidence, contained in company documents
that were uncovered during litigation--shows that the drugs they recommend
pose serious harm for children.
Indeed, the drug used in the study, Pfizer's Zoloft, carries a Black Box
suicide warning on its label.
The lead author, JOHN WALKUP, MD, is an Associate Professor of Psychiatry,
Director, Division of Child and Adolescent Psychiatry at Johns Hopkins.
He receives grants, research support and honoraria from SmithKline Beecham
and Solvay Pharmaceuticals, Eli Lilly and Wyeth Pharmaceuticals.
He has served as a consultant for Solvay Pharmaceuticals and Janssen
Pharmaceutica. He has also received honorarium from Pfizer Inc.
http://www.mhsource.com/online/walkped/fac.html
http://www.aacap.org/cs/2009_lifelong_learning_institute/faculty
Consultant: Eli Lilly, Cephalon, Jazz Pharmaceuticals, Pfizer.
Grants: Abbott Laboratories, Eli Lilly, Pfizer.
Speaker's Bureau: Cephalon, Eli Lilly, Pfizer.
http://www.softconference.com/AACAP/slist.asp?C=1276
BORIS BRIMAHER, MD, , Director, Child and Adolescent Anxiety Program
Co-Director, Child and Adolescent Bipolar Services Western Psychiatric
Institute and Clinic University of Pittsburgh Medical Center, tells
reporters he receives no industry funds.
But has received Honoraria for participating in forums financed by: Abcomm,
Jazz Pharmaceuticals, Solvay Pharmaceuticals, and
Honoraria & Travel Expenses: American Academy of Child and Adolescent
Psychiatry
http://www.aacap.org/cs/2009_lifelong_learning_institute/faculty
Dr. Birmaher is listed as a co-author of the discredited GlaxoSmithKline
pediatric Paxil study #329 published in the Journal of the American Academy
of Child & Adolescent Psychiatry (AACAP). That report prompted New York
State Attorney General to sue GSK for fraud.
He was a co-author of two highly controversial pharmacological treatment
guidelines for children and adolescents recommending increased use of toxic
psychotropic drugs: The 2005 AACAP Guidelines for Children and Adolescents
With Bipolar Disorder; and the 2007 Texas Children's Medication Algorithm
Project--a drug industry scheme by which taxpayer money is diverted for
ineffective, dangerous and extremely expensive psychotropic drugs.
JOHN MARCH, MD, Director, Program in Child and Adolescent Anxiety, Duke
University Medical Center, receives research support from Pfizer, Solvay,
Eli Lilly, and Wyeth. He is Speaker for and/or consultant to: Solvay,
Pfizer, GlaxoSmithKline, Wyeth, Novartis, and Shire.
See: Current Psychiatry Vol. 2, No. 11 / November 2003
http://www.currentpsychiatry.com/2003_11/1103_ocd.asp
JAMES McCRACKEN, MD, UCLA Neuropsychiatric Institute and Hospital.
He receives Contract Research Support from: Aspect Pharmaceuticals,
Bristol-Myers Squibb, Eli Lilly.
He also receives Consultation Fees from: Pfizer, Sanofi-Aventis, Wyeth.
MOIRA RYNN, MD, Columbia University Child and Adolescent Psychiatry
Consultant: Pfizer, Inc., Wyeth
Research Support: AstraZeneca, Forest Laboratories, Neuropharm, Pfizer,
Wyeth
Speaker's Bureau: Pfizer, Wyeth.
http://www.aacap.org/cs/expert_interviews/disclosures
Dr. Rynn has authored articles promoting the use of tricyclic
antidepressants and atypical antipsychotics for off-label uses such as
pain/anxiety.
BRUCE WASLICK MD, Columbia University / NY Psychiatric Institute, Div. Child
and Adolescent Psychiatry.
Dr. Waslick receives grant/research support from Eli Lilly and Johnson &
Johnson.
http://mcpap.typepad.com/mcpap_child_psychiatry_in/files/3rd_annual_conf_on_
child_psychiatry_in_primary_care.doc
Contact: Vera Hassner Sharav
vera...@ahrp.org
212-595-8974
http://content.nejm.org/cgi/content/short/359/26/2753
New England Journal of Medicine
Volume 359:2753-2766 December 25, 2008
Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood
Anxiety
John T. Walkup, M.D., Anne Marie Albano, Ph.D., John Piacentini, Ph.D.,
Boris Birmaher, M.D., Scott N. Compton, Ph.D., Joel T. Sherrill, Ph.D.,
Golda S. Ginsburg, Ph.D., Moira A. Rynn, M.D., James McCracken, M.D., Bruce
Waslick, M.D., Satish Iyengar, Ph.D., John S. March, M.D., M.P.H., and
Philip C. Kendall, Ph.D.
ABSTRACT
Background Anxiety disorders are common psychiatric conditions affecting
children and adolescents. Although cognitive behavioral therapy and
selective serotonin-reuptake inhibitors have shown efficacy in treating
these disorders, little is known about their relative or combined efficacy.
Methods In this randomized, controlled trial, we assigned 488 children
between the ages of 7 and 17 years who had a primary diagnosis of separation
anxiety disorder, generalized anxiety disorder, or social phobia to receive
14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to
200 mg per day), a combination of sertraline and cognitive behavioral
therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered
categorical and dimensional ratings of anxiety severity and impairment at
baseline and at weeks 4, 8, and 12.
Results The percentages of children who were rated as very much or much
improved on the Clinician Global Impression-Improvement scale were 80.7% for
combination therapy (P<0.001), 59.7% for cognitive behavioral therapy
(P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior
to placebo (23.7%). Combination therapy was superior to both monotherapies
(P<0.001). Results on the Pediatric Anxiety Rating Scale documented a
similar magnitude and pattern of response; combination therapy had a greater
response than cognitive behavioral therapy, which was equivalent to
sertraline, and all therapies were superior to placebo. Adverse events,
including suicidal and homicidal ideation, were no more frequent in the
sertraline group than in the placebo group. No child attempted suicide.
There was less insomnia, fatigue, sedation, and restlessness associated with
cognitive behavioral therapy than with sertraline.
Conclusions Both cognitive behavioral therapy and sertraline reduced the
severity of anxiety in children with anxiety disorders; a combination of the
two therapies had a superior response rate. (ClinicalTrials.gov number,
NCT00052078 [ClinicalTrials.gov] .)
Source Information
>From the Johns Hopkins Medical Institutions, Baltimore (J.T.W., G.S.G.); New
York State Psychiatric Institute-Columbia University Medical Center, New
York (A.M.A., M.A.R.); the University of California at Los Angeles, Los
Angeles (J.P., J.M.); Western Psychiatric Institute and Clinic-University of
Pittsburgh Medical Center, Pittsburgh (B.B., S.I.); Duke University Medical
Center, Durham, NC (S.N.C., J.S.M.); the Division of Services and
Intervention Research, National Institute of Mental Health, Bethesda, MD
(J.T.S.); Baystate Medical Center, Springfield, MA (B.W.); and Temple
University, Philadelphia (P.C.K.).
This article (10.1056/NEJMoa0804633) was published at www.nejm.org on
October 30, 2008.
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