No long-term studies are available for use in children, but benzodiazapines are noted to have potential for psychological and physical dependence in adults:64 Several other agents have been used in clinical practice, but have more limited support in the literature. Buspirone, a SCH727965 purchase partial agonist of serotonin receptors, demonstrated effectiveness at 2 weeks with no adverse effects compared with placebo in a small placebo-controlled study with mixed anxiety disorders.65 Central α-agonists, guanfacine and clonidine,

have been considered in treatment of youth with PTSD and deregulated behavior.66 However, Inhibitors,research,lifescience,medical controlled research supporting the use of these agents is lacking. A small open-label study of clonidine in patients aged 3 to 6 with PTSD was shown to decrease arousal, aggression, and anxiety.67 Mirtazapine is

an antidepressant with some evidence of efficacy for treating anxiety in adults.68 Evidence in youth Inhibitors,research,lifescience,medical is limited, with one positive open-label study for social phobia.69 This agent may be a consideration to capitalize on its sedating and appetite-stimulating properties for patients with insomnia or low appetite who are unresponsive to Inhibitors,research,lifescience,medical SSRIs. Propranolol is another agent with some evidence of effectiveness in adults, but lacks systematic data to support its use in children and adolescents. A crossover pilot study of propranolol in 11 pediatric patients with PTSD also showed improvements relative to placebo in treating symptoms of hyperarousal and Inhibitors,research,lifescience,medical intrusivity in the majority of patients.70 There are also a variety of other agents that are occasionally used despite the lack of controlled evidence. For example,

buproprion, an inhibitor Inhibitors,research,lifescience,medical of dopamine and norepinephrine, has not been studied in children or adolescents with anxiety. Similarly, gabapentin has limited evidence of improvement in anxiety symptoms in adults,71, 72 but has not been tested in youth. Another intriguing possibility is D-cycloserine, a partial agonist at the N-methyl-D-aspartate receptor that is thought to potentiate gains from exposure therapy. Two RCTs have supported its use as an augmentation strategy for youth with OCD73 and social anxiety disorder.74 While D-cycloserine does not have direct benefits in the absence of other treatments, it is thought to increase the efficacy of psychotherapy by facilitating Cell Host & Microbe mechanisms of neuroplasticity.75 Complementary and alternative remedies are often tried by families prior to seeking psychiatric treatment. One study found that “anxiety and stress” was the third most common reason for the use of complementary and alternative medicines in children and adolescents.76-77 While rigorous evidence is lacking to support the use of naturopathic medications, the plant Kava has some evidence of effectiveness in multiple treatment trials.