Both cognitive behavioral therapy (CBT) and sertraline (Zoloft) reduce anxiety in children with anxiety disorders.

Combined, they achieve better response rates.

First, the details.

  • 488 children with separation anxiety disorder, generalized anxiety disorder, or social phobia were randomly assigned to treatment.
    • 14 sessions of CBT
    • Sertraline (up to 200 mg per day) for 12 weeks
    • Sertraline + CBT for 12 weeks
    • Placebo for 12 weeks
  • Anxiety severity and impairment were assessed at the start of treatment and at weeks 4, 8, and 12.
  • The Clinician Global Impression–Improvement scale (CGI) was used to measure improvement.

And, the results.

  • A significant percentage of children were “very much” or “much” improved based on CGI.
    • 81% with combination therapy
    • 60% for CBT
    • 55% for sertraline
  • All therapies were significantly better than placebo (24%).
  • On the Pediatric Anxiety Rating Scale, combination therapy was better than CBT, which was equivalent to sertraline.
    • All therapies were superior to placebo.
  • Adverse events, including suicidal and homicidal ideation, were no more frequent with sertraline than placebo.
    • No child attempted suicide.
  • There was less insomnia, fatigue, sedation, and restlessness associated with CBT vs sertraline.

The bottom line?
The National Institutes of Mental Health recommends that if you’re interested in getting psychological treatment for general anxiety disorder, ask if the therapist offers CBT and/or behavioral therapy and is open to using medication if needed.

12/27/08 18:10 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.