Treatment of anxiety and mood disorders

Original KEYNOTE presentation and abstract by professor John T. Walkup (New York Presbyterian and Weill Cornell Medical College, Division of Child and Adolescent Psychiatry, New York, USA) on treatment of anxiety and mood disorders, held at the ESCAP 2013 Congress in Dublin, Monday 8th July 2013.

Image from the presentation by Dr Walkup.Abstract
Objective: Anxiety disorders in children, and depression in adolescents are very common internalizing conditions (Kessler et al., 2010). If left untreated they can result in considerable impairment that extends into adulthood. At this time there is substantial evidence supporting the efficacy of SSRI treatment and cognitive behavioral approaches to anxiety and depression. This presentation will review the evidence base for the pharmacological and psychological treatment of anxiety and depression in children and adolescents including strategies for partially responsive or refractory cases. Methods: The presentation is based on a literature review of the treatment and related studies of the anxiety disorders and major depression in children and adolescents.
Results: The anxiety disorders commonly present prior to puberty and are extremely common, perhaps the most common disorder in childhood. Depression can present early in life, but most commonly first presents in mid adolescence. Treatment studies for both conditions have demonstrated the benefit of antidepressant medication and cognitive behavioral therapy alone and when used in combination appear to offer the greatest benefit. The Child/Adolescent Anxiety Multimodal Study (CAMS, Walkup et al., 2008) is one of the largest randomized controlled trials in children and adolescents and established the evidence base for the treatment of the non-OCD anxiety disorders. The Pediatric OCD Treatment Study established the evidence base for the treatment of childhood OCD (POTS Team, 2004). For depression, the Treatments of Adolescents with Depression Study (TADS, March et al., 2004); the Treatment of Resistant Depression in Adolescents (TORDIA, Brent et al., 2008); the ADEPT trial (Goodyer et al., 2007) and the Treatment of Adolescent Suicide Attempters (TASA, Brent et al., 2009) form the evidence base for the treatment of depression in teens. For both the anxiety disorders in children and depression in teens the long-term outcome when treatment is optimized results in an 80 % response rate.
Conclusion: The anxiety disorders and major depression are responsive to treatment with cognitive and behavioral therapy and with pharmacotherapy. Combination treatment and strategies to enhance treatment improve outcomes for those who may not initially respond. Much more needs to be done to further optimize and personalize treatment to achieve the goal of precision medicine for anxiety and depression in children and adolescents.

Presentation
View the full presentation here (pdf file, 87 slides).

  • John T. Walkup

    John T. Walkup MD is professor of psychiatry, DeWitt Wallace Senior Scholar, the Vice Chair of Psychiatry, and director of the division of Child and Adolescent Psychiatry, Weill Cornell Medical College and NewYork-Presbyterian Hospital.

  • Dr Walkup has been involved in the development and evaluation of psychopharmacological and psychosocial treatments for the major psychiatric disorders of childhood including anxiety, depression, bipolar disorder, Tourette syndrome and suicidal behaviour and disseminate the benefit of this research to address mental health disparities in Native Americans.
    Dr Walkup has been awarded the Norbert and Charlotte Rieger Award for Academic Achievement in 2009 from the American Academy of Child and Adolescent Psychiatry and 

  • the Blanche F. Ittleson Award for Research in Child Psychiatry in 2011 from the American Psychiatric Association. His collaboration with the Center for American Indian Health at Johns Hopkins was awarded the Bronze Achievement Award from the Institute of Psychiatric Services of American Psychiatric Association in 2012 for pioneering suicide prevention initiatives on the White Mountain Apache Reservation in Arizona.The benefit of this research to address mental health disparities in Native Americans.