Çocuk ve Ergenlerde Anksiyete Bozukluğunun Tedavisinde Farmakolojik Yaklaşımlar
Özet
Çocuk ve ergenlerde anksiyete bozukluğu, işlevselliği belirgin ölçüde bozan, beklenenden daha şiddetli ve uzun süreli yaşanan adaptif bir emosyon olarak tanımlanmaktadır. Hafif vakalarda bilişsel davranışçı terapi (BDT) ön plana çıkarken, orta ve ağır dereceli olgularda farmakoterapi veya her iki yöntemin kombinasyonu tercih edilmektedir. Pediatrik anksiyete bozukluklarının farmakolojik tedavisinde ilk seçenek, etkinliği ve güvenilirliğine dair kapsamlı bilimsel kanıtlar bulunan seçici serotonin geri alım inhibitörleridir (SSGİ). Bu grupta yer alan fluoksetin, sertralin, paroksetin, fluvoksamin, sitalopram ve essitalopram gibi ilaçların anksiyete belirtilerini, sosyal fobiyi ve ayrılık kaygısını azaltmada plaseboya göre anlamlı üstünlük sağladığı gösterilmiştir. SSGİ’lere yanıt alınamayan durumlarda serotonin ve noradrenalin geri alım inhibitörleri (SNGİ) alternatif olarak kullanılabilmekle birlikte, venlafaksin gibi ilaçların kullanımında suisidalite riskine karşı dikkatli olunmalıdır. Trisiklik antidepresanlar yan etki profillerinin fazlalığı, benzodiazepinler ise bağımlılık ve kötüye kullanım riskleri nedeniyle pediatrik popülasyonda sınırlı alanlarda veya sadece akut durumlarda tercih edilmektedir. Buspiron, pregabalin ve propranolol gibi diğer ajanların çocuklardaki etkinliğine dair ise henüz yeterli kontrollü çalışma bulunmamaktadır. Sonuç olarak, çocuk ve ergen yaş grubunda BDT, SSGİ öncelikli ilaç tedavileri ve bunların kombinasyonu en etkili yaklaşımlardır.
Anxiety disorder in children and adolescents is defined as an adaptive emotion experienced more severely and for a longer duration than expected, causing significant impairment in functionality. While cognitive behavioral therapy (CBT) comes to the fore in mild cases, pharmacotherapy or a combination of both methods is preferred in moderate and severe cases. Selective serotonin reuptake inhibitors (SSRIs) are the first choice in the pharmacological treatment of pediatric anxiety disorders, with extensive scientific evidence regarding their efficacy and safety. Drugs in this group, such as fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram, have been shown to provide significant superiority over placebo in reducing anxiety symptoms, social phobia, and separation anxiety. In cases where there is no response to SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs) can be used as an alternative, though caution must be exercised against the risk of suicidality with drugs like venlafaxine. Tricyclic antidepressants are limited due to their high side effect profiles, and benzodiazepines are restricted because of the risk of dependence and abuse, being preferred only in acute situations. There are not yet sufficient controlled studies on the efficacy of other agents such as buspirone, pregabalin, and propranolol in children. Consequently, CBT, SSRI-priority drug treatments, and their combination represent the most effective approaches in the child and adolescent age group.
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