Navigating Pediatric Anxiety: When Is Medication the Right Choice?

January 22, 2025
By Sumedha Purkayastha, MD Anxiety disorders in children and adolescents are among the most common mental health challenges young people face today. The United States Preventive Services Taskforce (USPSTF) recommends screening for anxiety in children ages 8 to 18 years.

Recognizing Anxiety Disorders in Children and Adolescents

Anxiety disorders in children and adolescents can manifest in various ways, including excessive worry, avoidance behaviors and intense fear. Anxiety may be:
  • Generalized: such as experiencing worries in multiple situations and circumstances
  • Specific: occurring in response to a particular situation such as social anxiety, separation anxiety, or phobias
  • Manifested as irritability and excessive anger
  • Accompanied by physical symptoms such as headaches, stomachaches, increased heart rate, fatigue, insomnia or even elevated blood pressure.
Several factors may play a role in the development of anxiety, including biology, temperament and psychosocial stressors. Some children are more vulnerable to develop anxiety when they experience the following: trauma or stress; violence, abuse, or neglect; being bullied or rejected by other children; or when their own parents have anxiety or depression. When anxiety begins to interfere with a child’s ability to function at home, school, or in social settings, it’s crucial to seek professional guidance.

What Does a Child’s Psychiatric Appointment for Anxiety Entail?

As a child and adolescent psychiatrist, I have been specifically trained in diagnosing and creating tailored treatment plans for anxious children. On my initial encounter with a child who is struggling with symptoms of anxiety, I complete a comprehensive evaluation with the child as well as the parents or guardians. This includes an assessment, based on both interviews as well as objective data obtained from clinically validated assessment scales. Further, I will engage in a conversation of specific goals, environmental and social factors and psychoeducation about anxiety and its treatment options with both parents and the child in a developmentally appropriate manner. I have training in Cognitive Behavioral Therapy (CBT) specific for childhood anxiety as well as medication management, so will tailor my treatment plan based on my assessment and the child as well as family’s preferences.

When to Consider Medication

I consider medication as just one of the tools that the child has in his toolbelt to tackle his concerns, including psychotherapy, social and family support as well as resolution of modifiable stressors. Thus, I approach the treatment of anxiety in a multifaceted manner, and tailor my treatment as per individual needs and goals.

Weighing the Risks and Benefits

Deciding whether medication is the right choice for treating anxiety involves weighing the potential benefits against the risks. When treating anxiety disorders in children and adolescents, a multi-pronged approach is often the most effective. Medication, when necessary, should be viewed as one piece of a larger treatment plan. Combining medication with CBT or other therapeutic interventions maximizes the chances of long-term success in reducing anxiety and building resilience.

The Importance of a Comprehensive Approach

Support from family and educators is also vital. Encouraging open communication about feelings and fostering a supportive environment can help anxious children feel safe and understood. Additionally, involving the child in their treatment decisions whenever possible empowers them to take an active role in managing their mental health.

When to Consider Medication

Early intervention can reduce the long-term impact of anxiety disorders and set children on a path toward healthier emotional regulation. While many anxious children benefit from therapeutic approaches, including CBT, there are situations where medication may be an appropriate and effective addition to their treatment plan. Some children may not respond fully to therapy or may experience anxiety so severe that additional support is needed. In such cases, child and adolescent psychiatrists may recommend medication as part of a comprehensive treatment plan.

Understanding the Effects of SSRIs

Antidepressants, primarily the selective serotonin reuptake inhibitors (SSRIs), are the most commonly prescribed medications for treating anxiety in children and adolescents. SSRIs work by increasing serotonin levels in the brain, which can help regulate mood and reduce the intensity of anxious thoughts. Common SSRIs prescribed and found to be safe and effective for children include Prozac (Fluoxetine), Zoloft (Sertraline), Lexapro (Escitalopram), Luvox (Fluvoxamine) and Cymbalta (Duloxetine). While the thought of side effects may be concerning, untreated anxiety can have long-term consequences for a child’s emotional, social, and physical health. Persistent anxiety can lead to difficulties in school, strained relationships, and even contribute to chronic health issues like high blood pressure later in life. For some children, the benefits of reduced anxiety and improved quality of life far outweigh the risks of temporary side effects. A child and adolescent psychiatrist can guide parents through this decision-making process, ensuring the treatment plan is safe and tailored to the child’s unique needs.

You are Not Alone

Navigating the treatment of anxiety disorders in children and adolescents can be challenging, but there is hope. By combining evidence-based therapies like cognitive behavioral therapy with medication when necessary, many children can overcome their struggles and thrive. The goal is to not only address symptoms in the short term but to equip children with the tools they need to manage anxiety throughout their lives. Families can seek a mental health provider through multiple avenues, including the child’s school, a primary care provider, online reviews or through health insurance. They can also ask for advice from trusted family or friends who may have some experience with providers in the local area. At The Ross Center, we have a dedicated team of child psychiatrists and therapists who are specially trained to work with children and adolescents. We offer age-appropriate treatments and fully engage parents and families, so that decisions are made collaboratively and you are given strategies to reinforce treatment goals. Contact Us if you’d like to learn more about our resources.