Medication

Medication for Anxiety in Children

This information is provided for education purposes only and does not represent a treatment recommendation. Please consult with a health care professional.

While cognitive behavioral therapy (CBT) is often the first and most helpful treatment for anxiety in children, medication can be an important part of your child’s care. Whether or not you decide to use medication, we recommend talking to your child’s pediatrician or other health care provider about whether medication might be helpful in your child’s treatment. A medication evaluation with a child psychiatrist may also be helpful.

What Medication Can Help if My Child Has Anxiety?

Many studies have shown that selective serotonin reuptake inhibitors (SSRIs), medications that are used to treat both anxiety and depression, are generally safe and effective for children and adolescents. Serotonin is a natural chemical in the brain that helps to regulate anxiety and mood. SSRIs work by helping the brain “hang onto” the serotonin it makes naturally so that it can keep doing its job. SSRIs are considered a first-line response, which means they are most commonly recommended as a starting point for medication treatment.

Examples of SSRIs include

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Fluvoxamine (Luvox)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

 

In addition to SSRIs, several other medications have been shown helpful for adults with anxiety, including gabapentin (Neurontin), bupropion (Wellbutrin), and benzodiazepines. However, due to safety concerns, these medications should rarely be used with children and adolescents, and then only with extreme caution. More commonly, gabapentin and benzodiazepines may be used in the short term on an as-needed basis for difficult periods or severe or debilitating anxiety episodes. Such episodes may be more likely to occur in the early stages of SSRI treatment when the medication is still building up in your child’s system.

Gabapentin (Neurontin) and benzodiazepines both regulate the level of another brain chemical involved in anxiety: GABA. Benzodiazepines are only used in extreme cases, as they have shown limited effectiveness in children and can have undesirable effects in this age group, often causing increased agitation and upset. They are also sedating and interfere with learning, so taking them during CBT treatment is generally not recommended. Finally, benzodiazepines are habit-forming, causing a physical and psychological dependence when used on a daily basis long-term. Examples of benzodiazepines include: clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax). Again, these are very rarely recommended for children and should only be used under careful supervision of your child’s doctor.

Please consult your child’s doctor or a board-certified child psychiatrist before giving any medication to children. NEVER give a child medication prescribed to you or to anyone else.

How Do I Decide if My Child Needs Medication?

Discuss and weigh the risks and benefits of medication with your child’s psychiatrist. It is equally important to think about the risks and benefits of not using a medication. If your child is making limited progress with therapy alone, if your child is suffering and overwhelmed by the anxiety, or if the anxiety is getting in the way of your child’s doing the things that are important for a child to do during development (relating to family, making friends, succeeding in school, participating in activities), medication can be critical. The research studies published on child anxiety show that children treated with a combination of CBT and SSRI medication fare better than those treated with SSRI medication alone.

Talk to your child’s doctor about specific concerns you may have regarding medication. Your child can do the same. Remember that it is important for you to share with your child’s provider any family history of anxiety and/or depression as well as any treatment others in the family may have used or currently be using.

If you, your child, and your child’s doctor decide to try medication, it may be helpful to remind yourself that by agreeing to try a medication, you are not agreeing that your child will take it for life. Ideally, the goal is to use the medication to help a child get well, then after a period of stability (at least one year, according to relapse research), gradually taper the medication while practicing therapy skills to prevent relapse. SSRI medications are generally well tolerated and safe for long-term use. If a medication has an undesirable side effect or doesn’t work, it can be stopped.

Are There Side Effects to SSRI Medication?

Side effects are usually mild and short-term during the first few days while the body adjusts to the medication. Many children do not complain of any side effects during this treatment. While taking medication, your child’s doctor will meet with you and your child regularly to make sure that the medication is working well and not causing side effects. Dose changes can often remedy these issues. While SSRIs are not habit-forming or addictive, stopping them should be done gradually with the help of the doctor. Rapid changes can make your child feel physically or psychologically unwell for several days.