When Therapy Is Not Enough: Choosing the Best Anxiety Medication for Your Child
September 13, 2022
Most mental health experts recommend therapy to treat kids struggling with anxiety — but sometimes therapy alone isn’t an effective treatment. Learn how combining therapy with picking the right anti-anxiety medication can help provide your child with long-term relief.
In most cases, therapy should be the first line of treatment for anxiety. But some children & adolescents with severe anxiety can benefit from medications.
Only a doctor or psychiatric nurse practitioner can decide whether medications are right for your child. But as a parent or caregiver, you should arm yourself with information about:
The types of medications for anxiety for children & adolescents
How to support a child taking medications for anxiety
How to find help evaluating, prescribing and managing medications for anxiety
1. Should medications for anxiety be tried before therapy?
Most mental health experts recommend that children with mild-to-moderate anxiety be treated first with cognitive behavior therapy, or CBT. Medication for anxiety can be added to CBT if:
Does not relieve your child anxiety over time or anxiety is getting worse even with therapy
If your child can’t effectively engage in therapy
Your child’s anxiety is severe
In some severe cases, your mental health professional will recommend medication even before therapy, to help your child get comfortable enough to participate in therapy.
2. What are the best medications for anxiety in children?
Despite the proliferation in the types of anxiety medications available today, antidepressants tend to be the best option for most children and teens who have anxiety. These medications work by impacting chemical neurotransmitters in the brain to help regulate mood.
One type, called SSRIs (selective serotonin reuptake inhibitors) has been shown to be the most effective for treating anxiety in children while having relatively mild side effects. SSRIs increase the amount of serotonin, a chemical in the brain that regulates mood.
Another set of antidepressants that work for anxiety are SNRIs (serotonin-norepinephrine reuptake inhibitors). SNRIs work by increasing the level of two neurotransmitters in the brain — both serotonin and norepinephrine.
Most kids start to see improvement within the first week or two after beginning antidepressants for anxiety. While side effects vary based on the medication and individual child, side effects of SSRIs and SNRIs are relatively mild, compared with other anti-anxiety medications.
For a comprehensive look at the best medications for kids with anxiety, we recommend visiting www.ChildMind.org
3. What other medications treat anxiety in children and teens?
There are a few other categories of medication commonly prescribed to treat anxiety in children and teens. These drugs work differently from antidepressants.
Alpha agonists: Alpha agonists are medications originally developed to lower high blood pressure in adults. But these medications were also found to reduce anxiety symptoms by acting on the sympathetic nervous system, which regulates the body’s fight-or-flight response.
Antihistamines: Antihistamines are medications primarily used to reduce allergic reactions. But they also block some serotonin receptors, which increases serotonin levels and creates a sedative effect. Some clinicians recommend them to reduce anxiety in children for short periods of time.
Benzodiazepines: Benzodiazepines are anti-anxiety medications best used as a “bridge” medication, to offer rapid relief in specific stressful or anxiety-triggering situations, like flying on a plane or going to a doctor. Benzodiazepines reduce the physical symptoms of anxiety, such as rapid heartbeat, trembling and sweating.
Benzodiazepines are not appropriate for long-term use in children, because some patients develop dependence, and experience withdrawal symptoms when they try to stop.
Child and adolescent psychiatrists from the Child Mind Institute confirm that antidepressants are the most effective evidence-based choice of medication for children & adolescents with anxiety.
4. Medications that might not help anxiety
Unfortunately, it’s common for kids with anxiety to be prescribed the wrong medications while trying to treat anxiety symptoms. The following should not be used, or should be used only in very specific situations:
Stimulant medications: Some kids with anxiety have a hard time paying attention due to excessive of worrying. Sometimes, adults only notice the difficulty paying attention, and the child is misdiagnosed with ADHD. Stimulant medications may help anxious children concentrate but could also cause them to have stomachaches, trouble sleeping or increased anxiety.
Alpha-2 Agonists: Alpha agonists, like clonidine or guanfacine, may make anxious children a bit calmer in the moment, but they don’t really treat anxiety effectively. These medications were developed to lower high blood pressure. But they are also prescribed for children with ADHD. They are not recommended for treatment of anxiety.
Antipsychotic medication: Antipsychotics (or other medications) can be added to treatment when different antidepressant trials have not alleviated symptoms. But Antipsychotics should only be used thoughtfully and with careful monitoring for side effects. Antipsychotics also do not treat the underlying cause of anxiety, but rather mood/behavioral symptoms or rigidity that are caused by anxiety.
5. Studies show that a combination of medications with cognitive behavioral treatment is more effective than medication alone.
When searching for the best treatment for your child’s anxiety, the combination of anti-anxiety medication plus a psychological intervention is generally the best choice. Fort Health offers both psychiatry and therapy to give you a complete and personalized solution for your child’s anxiety.
