Jeffrey R. Strawn, MD

My early work examined the neurophysiology, neurochemistry, and neuroanatomy of anxiety disorders in children and adolescents. In my examination of cortical thickness in adolescents with anxiety, I identified abnormalities in an ensemble of regions responsible for fear learning, fear extinction, reflective functioning (such as mentalization), and regulation of the amygdala. I have also shown that gray matter volumes in youth with anxiety disorders are increased in the dorsal anterior cingulate and decreased in the ventrolateral prefrontal cortex, the cuneus/precuneus, as well as decreased gray matter volumes in the amygdala. These findings align with my functional MRI data demonstrating increased amygdala activation in youth with anxiety disorders, relative to healthy comparison subjects, during a continuous processing task with emotional and neutral distractors.

From a neurochemical standpoint, I have also demonstrated that glutamatergic tone in the anterior cingulate cortex is directly associated with anxiety symptom severity in youth. Collectively, these studies suggest that anxiety disorders are associated with structural, functional, and neurochemical abnormalities within prefrontal–amygdala circuitry. By identifying these abnormalities, this body of work has led to additional studies in youth at risk for developing anxiety disorders and has allowed for the integration of psychopharmacologic treatment studies with neuroimaging evaluations in anxious youth.

In parallel with my work on the neurophysiology of mood and anxiety disorders in children and adolescents, I have worked to expand the evidence base for treatment interventions in youth. Using meta-analysis, I demonstrated that antidepressants are well tolerated in pediatric patients with anxiety disorders, while also identifying important class-specific side effects (such as activation). I have examined the unique tolerability of antidepressants in special populations of adolescents with depressive and anxiety disorders—particularly those at high risk for developing bipolar disorder—and have observed that antidepressants are often poorly tolerated in this group, with the likelihood of adverse events leading to discontinuation being directly related to age.

Additionally, I have extensive experience conducting double-blind, placebo-controlled trials in youth with anxiety disorders. In one such example, my collaborators and I demonstrated the efficacy of duloxetine in a double-blind, placebo-controlled trial, which ultimately contributed to the FDA approval of duloxetine for children and adolescents with generalized anxiety disorder (ages 7–17).