Does my child need child anxiety medication?

This page should help provide some guidelines to help you decide whether or not to use child anxiety medication for your child.

Generally Cognitive Behavioral Therapy (CBT) should be tried prior to medication, except in extreme circumstances where child's functioning is seriously impaired and must be quickly gotten under control. When evaluating whether or not to use child anxiety medicine for your child consider the following issues:

  • Has your child's therapy provided both you and your child with education about anxiety and what cognitive behavioral therapy can do to help?
  • Have you and your child received therapy and education about managing physical symptoms of the anxiety?
  • Have you and your child received therapy and education about challenging false ideas and worries?
  • Has your child’s therapist encouraged you to help your child face the things they are afraid of and tried to work with your child to conquer that fear?
  • Has your therapist discussed working with the school to assist your child?
  • If the answer to all these questions is yes, and your child’s symptoms have not improved significantly, it may be time to consider child anxiety medication. If your child’s symptoms have improved but continue despite therapy to interfere with success at home, school, or with friends, you should also consider medication.

    Is CBT the Only Therapy That Works?

    Keep in mind that although we know CBT works it may be somewhat difficult to use with young children. A three year old will not be capable of participating in traditional cognitive behavioral therapy. It is also important to remember that other techniques may work also. CBT is not the only therapy, it is just the best researched therapy. We know children who receive it generally make improvements. The important thing is that you feel your child has received the benefit of good therapy prior to trying medication.

    Selective Serotonin Reuptake Inhibiters (SSRI's), Tricyclic Antidepressents(TCA's), and Benzodiazepines

    Even though I’m not a psychiatrist, I can read and understand the research, and so can you. The most up to date research at this time shows that SSRI's can be successful at helping anxious children. Click here to find out more about SSRI’s. Unfortunately, SSRI’S have been given a black box warning for depressed children and adolescents. SSRI’s have been shown to increase depressive symptoms, including suicidal ideation, in a small percent of these children and adolescents. Also there have been no research studies done on the long term effects of SSRIS on anxious children (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007).

    Here are some of SSRI's

    • fluoxetine or Prozac
    • sertraline or Zoloft
    • paroxetine or Paxil
    • fluvoxamine or Luvox
    • citalopram or Celexa
    • escitalopram or Lexapro

    Only a doctor can prescribe and advise you on child anxiety medicine, but you can be informed enough to ask questions about SSRI’S or any other choices of medications.

    A doctor may prescribe something other than an SSRI, or in combination with an SSRI as a child anxiety medication. If your child’s doctor makes a different choice, ask why. There are two other classes of drugs utilized to treat child and adolescent anxiety. Tricyclic Antidepressants ( TCA’s) and benzodiazepines. TCA’s generally have more serious side effects and need to be monitored more closely . ( (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007) . Click here for information on TCA’s and benzodiazepenes.

    Educate Yourself and Your Child about the Child Anxiety Medicine They Take

    If you and your doctor have decided to try a child anxiety medication, carefully monitor your child for any changes in their behavior. I also recommend children be told medication is being prescribed, regardless of how young they are, and that they know the names and doses of their medications. Parents need to check in regularly with their child when medication is prescribed to get the child’s opinion of how they feel and how it may be helping or hurting.

    This page does not apply to Obsessive Compulsive Disorder (OCD) or Post Traumatic Stress Disorder ( PTSD). These diagnoses require different consideration when examining questions about medication (AACAP OFFICIAL ACTION Clinical Report, February 1, 2007).

    AACAP OFFICIAL ACTION Clinical Report. (February 1, 2007). Practice Parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolesecent Psychiatry , 267-283.



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