Best Anxiety Medication For Children: A Parent's Comprehensive Guide

Children are affected by various types of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder (SAD). Here, we'll take a closer look at the different anxiety medications and treatments available for children and adolescents, along with how to choose the right ones for your child.

Introduction to pediatric anxiety disorders

Anxiety disorders are among the most common mental health disorders in children, with approximately 11% being diagnosed between the ages of 3 and 17.

Anxiety can affect all facets of a child's life, including their social and emotional functioning, physical well-being, and ability to learn. While some anxiety can be a healthy part of typical development, excessive worry can get in the way of daily life. 

If anxiety symptoms persist past two weeks, therapy isn't helping to improve your child’s symptoms and/or general function, and medical conditions are ruled out, then medication may be considered as an add-on to treatment.

There is no such thing as one "best anxiety medication for children." The choice to use anxiety medication for your child is highly personal and nuanced, based on your family history, potential side effects, and the medications available.

Not treating severe anxiety can take a toll on a child’s development and long-term wellbeing. 

First-line medication options for anxiety disorders

Selective serotonin reuptake inhibitors (SSRIs) are typically the first-line option for treating moderate and severe anxiety disorders.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs work by increasing the level of serotonin in your child's brain. Serotonin is a neurotransmitter that helps regulate emotional balance. In children with anxiety, serotonin levels may not be balanced properly. 

SSRIs work by blocking the reuptake of serotonin, which is the brain’s natural process of pulling serotonin back into the neuron. With more serotonin available, the parts of the brain that control emotional regulation can function better.  Over time, this can reduce anxiety symptoms.

Only one SSRI is FDA-approved for pediatric anxiety: escitalopram (Lexapro). This medication is FDA-approved for pediatric patients aged 12 to 17 diagnosed with major depressive disorder and for patients aged 7 to 17 with generalized anxiety disorder.

For children diagnosed with obsessive-compulsive disorder (which is not an anxiety disorder, but commonly co-occurs with anxiety), treatment can require higher doses of SSRIs. The response time can be longer, too. The following SSRIs are approved for use in treating children with OCD.

• Fluoxetine (also known as Prozac) is approved for children 7 years and older. Fluoxetine is often well-tolerated, has an established safety record, and offers flexible dosing. However, it can cause side effects such as nausea, stomachaches, and fatigue. 
• Sertraline (Zoloft) is approved for children 6 years and older. Sertraline is effective for many, especially when used alongside therapy for pediatric OCD. The side effects are similar to Prozac’s, and it also comes with a "black box" warning. Therapeutic benefits may also take several weeks (or even months) to appear fully.
• Fluvoxamine (Luvox) is approved for use in children aged 8 years and older and is used to treat symptoms associated with obsessive-compulsive disorder.

All antidepressants have a "black box" warning for treatment of pediatric depression.

Secondary and situational medications

When first-line treatments like therapy and SSRIs don't work, secondary medicines are a possibility. This includes situations in which your child still has anxiety problems that won't go away or when they have another ailment that other medications can treat.

Serotonin norepinephrine reuptake inhibitors (SNRIs)

An SNRI (serotonin-norepinephrine reuptake inhibitor) is a type of medication that works on two different neurotransmitters in the brain: serotonin and norepinephrine. 

SNRIs differ from SSRIs in that they increase serotonin and norepinephrine. SSRIs like Prozac only affect serotonin levels. These medications can help regulate mood, reduce anxiety, and calm the body’s stress response. However, they tend to have more serious side effects than SSRIs — but everyone’s different.

Duloxetine (Cymbalta) is the only SNRI that’s FDA-approved for generalized anxiety disorder, in ages 7 and up.

FDA-Approval is a costly process that requires extensive studies and is assigned to a medication for a particular age-range and a particular diagnosis. Since there are far fewer studies of medications in children, the ‘off-label’ use of medications is relatively common in pediatric care. Several SSRIs and SNRIs are used ‘off-label’ for management of pediatric anxiety, in part informed by evidence in adults with similar conditions.

Buspirone

Buspirone is an off-label antianxiety option for children whose anxiety has not responded to first-line treatment options. However, its effectiveness has not been conclusively proven in controlled clinical trials. Many parents pick this medicine as a second alternative for treating anxiety because it is safer than other forms, such as benzodiazepines.

Hydroxyzine

Hydroxyzine is an antihistamine that can also help with anxiety symptoms. However, it should not be used long-term in children because there is limited proof of its effectiveness. The potential long-term side effects are also significant.

Beta-blockers

A beta-blocker is a medication that reduces the physical symptoms of anxiety by lowering adrenaline’s effect on the body. They help slow the heart rate and can reduce physical symptoms like trembling. But they don’t treat the emotional aspect of anxiety, just the physical. 

Doctors may occasionally prescribe propranolol and other beta-blockers off-label to older adolescents and teens for performance-related or situational anxiety, such as for medical treatments or school presentations. 

Benzodiazepines

Fast-acting sedative medications called benzodiazepines can help calm the mind and body during intense anxiety episodes. They are central nervous system depressants that slow down nervous system activity. 

They are typically used to treat severe childhood anxiety symptoms for a short time, as-needed during specific situations (such as before a medical or dental procedure). They are also sometimes used short-term for severe symptoms related to panic attacks. They are typically not used as a routine treatment for anxiety. This is due to concerns about dependence, potential for misuse, and side effects.

Why early treatment matters

According to the CDC, almost 1 in 5 children aged 3 to 17 have been diagnosed with a mental, emotional, or behavioral health issue.

Early intervention is important for kids with anxiety and OCD. Starting therapy and medication early can help them grow and thrive.

If these issues are not properly addressed, children may struggle with relationships, perform poorly in school, and have a lower quality of life. Getting help early through effective therapy and the right medications is important for creating a better future for your child. 

The role of therapy with medication

While some parents may opt for just medication and others choose therapy to help their child cope with anxiety, there are many benefits associated with pairing the two together.

While therapy is highly effective, it can take time. However, by using the proper medication treatment, your child can start feeling better, which clears up the emotional space needed for them to benefit from therapy fully.

How to choose the right medication

Medications are not "cures" for your child's condition. Instead, they are part of your child's treatment plan to help their mental health. When used correctly, these medications can help your child function better in school and among peers, as well as help them manage their emotions.

Factors to consider when choosing medication

There are many things to consider when choosing the right medication treatment for your child. This includes

• Your child's symptoms
• The severity of symptoms 
• Their age
• Any other mental health conditions present (such as OCD or depression)
• Side effects and risks

Consultation process with a child psychiatrist

Getting your child evaluated by a knowledgeable primary care provider or a child psychiatrist involves much more than just a conversation. The psychiatrist will review your child's medical, family history, and current emotional patterns and behaviors. They will likely request a physical exam and order lab tests to rule out underlying health problems that could cause anxiety symptoms.

They will use this information to build a treatment plan that is just right for your child. This could mean counseling, lifestyle changes, and, sometimes, medication.

Monitoring, dosing adjustment, and tapering protocols

If your child has been prescribed medication, keep a close eye on them for any side effects. Check in with their psychiatrist if you have any questions. Sometimes dosing adjustments and tapering the medication amount are necessary, especially when starting a new drug or when you need to decrease any side effects.

Potential side effects and safety monitoring

Parents should continue to monitor their child for common side effects, including:

• Headaches
• Insomnia
• Fatigue
• Upset stomach

There is a "black box warning" attached to all antidepressants for youths. This warning concerns a risk of increased suicidal thoughts and behaviors. Parents must monitor for these risks and have an emergency plan in place.

Never suddenly stop your child's medication. It often takes several weeks for a new drug to take full effect. If you have questions about the medication prescribed to your child or if they experience significant side effects, call their doctor.

How Emora Health can help

If you're struggling to find the right solution to help address your child's mental health needs, Emora Health can help. We facilitate multimodal care for anxiety disorders in children by offering specialized therapy and psychiatric medication management services. By offering both in tandem, we can provide you with a holistic and effective treatment approach.

Our integrated treatment teams of therapists and psychiatric providers work closely together to provide coordinated, comprehensive care. With no waitlists, you can start care in as little as 2 days with a vetted therapist who specializes in working with kids with anxiety. Click here to get a personalized cost estimate for services from Emora Health today.