A Comparison of the Anti-Anxiety Effects of Oral Ketamine and Fluvoxamine in Children with Separation Anxiety Disorder Manifesting as School Refusal
Afsaneh Karbasi Amel, Farzaneh Hosseini
Advanced Biomedical Research April 1, 2023 DOI: 10.4103/abr.abr_388_22 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Open-label randomized clinical trial Peer reviewed |
|---|---|
| Sample size | 71 |
| Population | Children aged 6-10 years diagnosed with school-refusal separation anxiety disorder |
| Interventions | Ketamine Fluvoxamine |
| Dose | Ketamine: weekly rising dose of 0.1 to 1 mg/kg; Fluvoxamine: 25 mg/day, could increase to 200 mg/day if necessary |
| Duration | 16 weeks of intervention, with assessments before treatment and at weeks 8 and 16 |
| Measures | SCARED, CATS |
| Topics | Anxiety Esketamine Ketamine |
| Citations | 5 |
| Key findings | Ketamine reduced mean anxiety scores from 31.5 at baseline to 19.7 by week 8, with no further improvement by week 16 (19.4), whereas fluvoxamine showed no significant change at week 8 (36.3 to 36.9) but a significant reduction by week 16 (26.2). The authors conclude ketamine was more successful than fluvoxamine in the first eight weeks and recommend considering combination therapy in early treatment. |
Abstract
Background: Children suffer from a high prevalence of anxiety problems that require prompt treatment. It has been demonstrated that ketamine offers rapid anti-anxiety effects. This study aimed to evaluate ketamine's anti-anxiety impact in the treatment of children with school-refusal separation anxiety disorder.
Materials and Methods: In this open-labeled randomized clinical trial, 71 children (6-10 years) diagnosed with school refusal separation anxiety disorder were randomly assigned to two groups; a case group, who received ketamine at a weekly rising dose of 0.1 to 1 mg/kg; the control group treated with Fluvoxamine (25 mg/day), which could increase to 200 mg/day if necessary. The SCARED and CATS questionnaires were used to assess anxiety before treatment, at the 8 th and 16 th weeks of intervention. The data were analyzed using repeated-measures analysis of covariance.
Results: The mean anxiety scores in the eighth week (19.7 ± 16.1) were significantly lower in the ketamine group than before (31.5 ± 10.8). Until the sixteenth week (19.4 ± 14.6), there was no further decrease in scores in the ketamine group, in the fluvoxamine group, pre-treatment scores (36.3 ± 16.5) and eighth week (36.9 ± 16.6) were not significantly different, but scores decreased significantly in a sixteenth week (26.2 ± 12.5).
Conclusion: In first eight weeks of treatment, ketamine was more successful than fluvoxamine at reducing anxiety disorder, considering the emergence of this disorder and the lack of major adverse effects of ketamine, it seems to be beneficial in early phases of treatment. Due to the quick onset of ketamine in future trials, their combination therapy is recommended during the initial weeks of treatment.
Comparable studies
Other randomized controlled trials on ketamine for anxiety, most cited first.