Fluoxetine and CBT show similar outcomes in pediatric anxiety trial

A 24-week randomized trial (SMART design) compared starting treatment for pediatric anxiety disorders with fluoxetine versus exposure-based CBT, and tested whether nonremitters after 12 weeks benefited more from optimizing the initial treatment or adding the other modality. The trial reported no significant difference in symptom improvement based on initial treatment choice, and combination therapy did not significantly outperform continued monotherapy among week-12 nonremitters overall, though the authors note non-Hispanic White youths appeared to benefit more from continuing fluoxetine while racial and ethnic minority youths appeared to benefit more from transitioning to combination therapy after week 12.

Most relevant for: Youths aged 8-17 with anxiety disorders, including those with high sociodemographic disadvantage and co-occurring diagnoses, being treated in primary care or mental health clinic settings.

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