Anxiety Medication and Kids

The use of medication is just one of the many treatment options available to manage the symptoms of anxiety disorders. Parents are understandably hesitant about putting their children on medications without knowing which ones are appropriate, how they will affect their child, and if and when they are safe to use.

Frequently asked questions* about treating anxiety disorders in children with medication:

1. Which medications are typically used to treat anxiety disorders in children?
2. Are SSRIs safe for my child?
3. How is the clinical need for medication determined?
4. What are the most common side effects of SSRIs?
5. What do I do if my child develops side effects?
6. How can I tell if the medication is working?
7. How long will it take for the medication to work?
8. How long will my child need to take medicine?
9. Will my child become addicted to these medications? Will the medications change my child's personality?
10. What if my child refuses to take the medication?
11. Can SSRIs be used with other medications, including over-the-counter medicines for common illnesses such as a cold or the flu?
12. Are there other treatments available if I don't want to put my child on medication?

1. Which medications are typically used to treat anxiety disorders in children?

The selective serotonin reuptake inhibitors (SSRIs) are currently the medications of choice for the treatment of both childhood and adult anxiety disorders. This group of medications includes fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). Tricyclic antidepressants (e.g. imipramine) and benzodiazepines (e.g. lorazepam) are less commonly used in the treatment of childhood anxiety disorders. Other medications have been used to treat anxiety disorders in adults but require further study in children and adolescents.

The Food and Drug Administration (FDA) has approved the use of fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and clomipramine (Anafranil) for the treatment of pediatric Obsessive-Compulsive Disorder. SSRIs are commonly used in clinical practice to treat youth with other anxiety disorders as well based upon controlled studies that report improvement in symptoms and medication safety in children and adults with anxiety and depressive disorders. Controlled clinical studies provide the necessary information for the FDA to determine whether medications will be approved. Unfortunately, studies of the use of medications in children lag behind studies of adults; more research is definitely needed in this area. Discuss the risks and benefits of all medications prescribed for your child, whether FDA approved or not, with your physician.

2. Are SSRIs safe for my child?

The Food and Drug Administration issued a warning in October 2004 that antidepressant medications, including SSRIs, may increase suicidal ideation and suicidal behaviors in a small number of children and adolescents. The FDA report was based upon review of 24 different short-term (4 to 16 weeks) studies of 9 antidepressant medications (SSRIs and others) involving over 4,400 children and adolescents with major depressive disorder, obsessive-compulsive disorder, or other psychiatric disorders. Analyses of the studies showed that the average risk of suicidal ideation and suicidal behaviors occurred in 4% of patients treated with an antidepressant, compared to 2% of patients who were treated with a placebo (sugar pill). No suicides occurred in any of the studies.