Treatment for teen anxiety

Study shows a particular treatment for childhood anxiety disorders could be beneficial

August 25, 2020

Science Daily/University of Cincinnati

Anxiety disorders are the most common mental illness in the U.S., with approximately 4.4 million children and adolescents affected, according to the Centers for Disease Control and Prevention.

"These disorders are not only common in children and teens, but, if untreated, result in considerable personal and economic cost over the lifetime," says Jeffrey Strawn, MD, associate professor and anxiety expert in the Department of Psychiatry and Behavioral Neuroscience at the University of Cincinnati.

In a new National Institute of Mental Health-funded study, led by Strawn and published in the Journal of Clinical Psychiatry, UC researchers took a first look at one particular medication for treatment of these disorders in pediatric patients to see if it was beneficial.

"Psychotherapy and medications reduce symptoms for many children and adolescents with anxiety disorders," says the UC Health physician. "In particular, the selective serotonin reuptake inhibitors, or SSRIs, have shown benefit in numerous trials."

Strawn says SSRIs work by increasing serotonin in the brain. Serotonin is one of the chemical messengers that nerve cells use to communicate with one another. These medications block the reabsorption of serotonin into nerve cells, making more serotonin available to improve transmission of messages between neurons.

"However, up to two in five children don't completely improve with existing medication treatments," he says. "While SSRIs represent the first line medication for anxious youth, predicting treatment response is difficult.

"Improvement varies considerably from patient to patient, often resulting in a trial-and-error process of medication selection and dosing. Additionally, clinicians have limited data to help them to determine which patients will respond to what treatments."

"To help predict which patients would improve most with one SSRI, called escitalopram, my colleagues and I compared its use to a placebo in adolescents with generalized anxiety disorder."

Fifty-one patients aged 12-17 were randomly chosen to be treated with either escitalopram or a placebo for eight weeks. Their anxiety symptoms and overall improvement were evaluated in addition to how well they tolerated the medication. They also had their blood drawn to assess how medication blood levels impacted their outcomes.

"We found this particular SSRI to be superior to a placebo in reducing anxiety," Strawn says. "Also, differences in how adolescents break down the medication affected blood levels, and these blood levels predicted certain side effects, like restlessness, jitteriness and insomnia. Understanding how blood levels vary could help us determine dosage."

Strawn and his collaborators also found that some patients improved more quickly than others. Patients who were slower metabolizers of the medication had better outcomes and improved faster when compared to patients who had increased metabolism of the medication.

Strawn says this is the first controlled study of this SSRI for pediatric anxiety disorders and the first to assess the impact of metabolism on escitalopram blood levels in adolescents. He says a larger study with a more diverse population is needed.

"For clinicians treating anxious adolescents, this study provides preliminary answers to important questions about the effectiveness of this treatment. It may also help clinicians predict how quickly patients respond and identify which patients may be less likely to get better. This would help us select alternative treatments for patients who are less likely to respond," he says. "We hope this will open the door for more studies and eventually become a more effective treatment for patients in the future."

https://www.sciencedaily.com/releases/2020/08/200825133130.htm

A quarter of problematic pot users have anxiety disorders, many since childhood

Regional data also suggest some teens who abuse pot outgrow habit in adulthood

October 24, 2017

Science Daily/Duke University Medical Center

About a quarter of adults whose marijuana use is problematic in early adulthood have anxiety disorders in childhood and late adolescence, according to new data from Duke Health researchers.

The findings, publishing this week in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry, also shed light on an estimated 4 percent of adults who endured childhood maltreatment and peer bullying without resorting to chronic marijuana abuse, only to develop problems with the drug between the ages of 26 and 30.

"Given that more states may be moving towards legalization of cannabis for medicinal and recreational purposes, this study raises attention about what we anticipate will be the fastest growing demographic of users -- adults," said lead author Sherika Hill, Ph.D., an adjunct faculty associate at the Duke University School of Medicine. "A lot of current interventions and policies in the U.S. are aimed at early adolescent users. We have to start thinking about how we are going to address problematic use that may arise in a growing population of older users."

The findings are based on data from 1,229 participants in the Great Smoky Mountains Study, a long-term study of residents in 11 counties near the Appalachian Mountains in western North Carolina, where Hispanics and Latinos are underrepresented and Native Americans are overrepresented compared to the rest of the U.S.

A cohort of children in the study were enrolled as young as age 9 and have now reached their 30s. From 1993 to 2015, researchers tracked data in numerous areas of interest, including mental health, education, work attainment, and use of drugs and alcohol.

The researchers defined problematic cannabis or marijuana use as daily consumption or a habit that meets diagnostic guidelines for addiction. They tracked participants' patterns of use from the college years (ages 19-21) into adulthood (ages 26-30).

They found more than three-fourths (76.3 percent) of participants didn't use or develop a problem with marijuana during this period.

The remaining quarter developed problems that researchers grouped into three profiles -- those with limited problems, persistent problems and delayed problems.

Limited users (13 percent)

·     Limited problematic users had trouble with marijuana either while in school before age 16 or in their late teens and early 20s, but their habits dropped off as they aged.

·     Researchers were somewhat surprised that this group reported the highest levels of family conflict and instability during childhood as compared to others in the study; these factors are often associated with more drug use.

·     "When this group of children left home, they seemed to do better," Hill said. "They didn't have as many children at a young age, and they went further in their education when they were 19 to 21 compared to those with persistent and delayed profiles."

Persistent users (7 percent)

·     This group had trouble with marijuana beginning as young as 9 years old and their chronic use continued into their late 20s and early 30s, the data showed.

·     Large portions of this group had anxiety disorders in both childhood (27 percent) and at ages 19-21 (23 percent).

·     They had the highest rates of psychiatric disorders and involvement in the criminal justice system, and most said the majority of their friends were drug users, too.

·     "This suggests that a focus on mental health and well-being could go a long way to prevent the most problematic use," Hill said.

Delayed users (4 percent)

·     This was a small but unique group that made it through adolescence and early adulthood without problematic marijuana use, only to become habitual users between ages 26 and 30.

·     Blacks were five times as likely as whites to be delayed problematic users in the late 20s and early 30s after not having trouble with the between the ages 19-21 -- a peak time for most marijuana users.

·     More than half of delayed users were both bullied by peers and mistreated by caregivers as children, yet also had lower rates of anxiety, alcohol use, and other hard drug use compared to persistent users.

·     "What we don't yet understand is how childhood maltreatment didn't prompt earlier problematic use of cannabis between ages 19 and 21 -- how individuals could be resilient to that kind of adverse experience for so long," Hill said. "One theory is that they were somewhat protected by having fewer peers in late adolescence who were substance users, but this is one of the questions we will continue to seek answers for."

https://www.sciencedaily.com/releases/2017/10/171024141720.htm