Is Anxiety Medication Safe for Teens?

Anxiety medication may be the best treatment for teenagers.
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All teens experience anxiety sometimes. Feeling nervous before a date, worrying about an exam, and experiencing increased anxiety before a big presentation is normal. But sometimes, teens experience so much anxiety that it impairs their daily functioning.

Parents of anxious teenagers—as well as the teens themselves—are often desperate for help. But, many people worry whether anxiety medication is safe for teens.

Anxiety Medications for Teens

Selective serotonin reuptake inhibitors, also known as SSRIs, are the most commonly prescribed medication for anxiety in children and teens. These may include medications such as Prozac (fluoxetine), Celexa (citalopram), Zoloft (sertraline), and Lexapro (escitalopram).

SSRIs increase levels of serotonin in the brain. Serotonin is a neurotransmitter that carries signals between brain cells. SSRIs block the reabsorption of serotonin in the brain, making it more available.

Serotonin norepinephrine reuptake inhibitors, known as SNRIs, may also be prescribed to adolescents with anxiety. SNRIs may include medication such as Cymbalta (duloxetine) and Effexor XR (venlafaxine).

Like SSRIs, SNRIs impact neurotransmitters in the brain. SNRIs block reabsorption of two neurotransmitters in the brain—serotonin and norepinephrine.

Common Side Effects of SSRIs and SNRIs

Many teens don’t experience any side effects when taking SSRIs or SNRIs.

And the side effects they do experience are often mild and usually go away within the first few weeks of treatment.

The most common side effects include:

  • Dry mouth
  • Nausea
  • Dizziness
  • Excessive sweating
  • Headache

Other possible side effects may include:

  • Loss of appetite
  • Tiredness
  • Constipation
  • Insomnia
  • Changes in sexual function, such as reduced sexual desire, erectile dysfunction, or difficulty achieving orgasm

    It’s important to report any side effects to your teen’s doctor. If one medication isn’t working or it’s causing serious side effects, your teen may need to change medications.

    FDA Warnings About SSRIs and SNRIs

    The FDA issued a warning in 2004 that antidepressant medications, such as many of the SSRIs and SNRIs, that are often used to treat adolescent anxiety, may increase suicidal thoughts and behavior in a small number of children and adolescents.

    No suicides were reported in the studies that led to the warnings. But in clinical trials, the rate of suicidal thinking or suicidal behavior was 4 percent among patients receiving an antidepressant, as compared with 2 percent receiving the placebo.

    To address this concern, a black box warning was added to the prescriptions. Parents and teens are educated about the potential risks and teens are monitored closely with frequent appointments.

    Some experts have been critical of the FDA’s black box warning. Critics warn some people may not get the help they need for fear the medications are unsafe. Consequently, the warning may deter parents from getting help for their children.

    Other Medications for Teens

    Although SSRIs and SNRIs are most commonly used to treat anxiety in teens, other prescriptions may be used.

    Benzodiazepines may be prescribed to teens with severe anxiety. They are usually short-term treatments.

    Benzodiazepines are less commonly prescribed because they have some associated dangers. Teens may grow dependent on them and benzodiazepines may be abused. Stopping them suddenly could lead to withdrawal symptoms or even seizures.

    Occasionally, physicians may prescribe other medications to treat anxiety, such as antihistamines or atypical antipsychotics.

    When to Seek Help for Anxiety

    There are many different types of anxiety, such as social anxiety, separation anxiety, panic disorder, generalized anxiety, and post-traumatic stress disorder.

    There are also many different types of phobias that may impact your teen’s daily life.

    Anxiety becomes problematic when it affects a teen’s social, occupational or educational functioning. Here are a few examples of times when anxiety becomes problematic:

    • A teen thinks everyone is always staring at her. She refuses to eat lunch in the cafeteria and she avoids talking in class.
    • A teen survived a near-fatal car accident on a rainy evening. Several months later, he continues to have nightmares and flashbacks. He refuses to get in a car when it’s raining.
    • A teen has started experiencing panic attacks. She’s worried they will happen when she’s at school. She has started refusing to go to school.

    According to the Child Mind Institute, 80 percent of young people with anxiety don’t get treatment. That’s unfortunate because anxiety is treatable. And sometimes, that treatment includes medication.

    When to Use Medications for Anxiety

    For mild to moderate functional impairments, the American Academy of Child and Adolescent Psychiatry recommends deferring the use of medication.

    Teens and their parents are often educated on anxiety and the best strategies for managing symptoms. They may also be referred for cognitive behavioral therapy. If those strategies aren’t effective in reducing the impairments, or if a teen has moderate to severe anxiety, medication may be used to manage the symptoms.

    As with all medications, prescriptions used to treat anxiety have risks. They are prescribed, however, when a physician or psychiatrist thinks the benefits outweigh those risks.

    How to Help an Anxious Teen

    If your teen is struggling with anxiety, talk to the doctor. Describe your concerns and ask about your treatment options. While some primary care physicians and pediatricians feel comfortable prescribing anti-anxiety medications to teens, others may refer children to psychiatrists. Psychiatrists are specialists who treat mental health disorders.

    If you have concerns about your teen’s diagnosis or treatment plan, seek a second opinion. Talking to another professional can help you decide on the best course of action.

    Always educate yourself about any medications your child is taking. Read the handouts, ask questions, and talk to the doctor and the pharmacist. Monitor your teen’s compliance with taking medication. Make sure she’s taking it as prescribed. Skipping doses or doubling up on pills could be harmful.

    Attend your teen’s appointments. Talk to the doctor about any concerns you have and learn about your teen’s progress.

    Sources:

    American Academy of Child & Adolescent Psychiatry: Psychiatric Medications for Children and Adolescents: Part II – Types of Medications.

    Anxiety and Depression Association of America: Children and Teens.

    Child Mind Institute: Children’s Mental Health Report.

    Garland JE, Kutcher S, Virani A, Elbe D. Update on the Use of SSRIs and SNRIs with Children and Adolescents in Clinical Practice. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2016;25(1):4-10.

    Kodish I, Rockhill C, Varley C. Pharmacotherapy for anxiety disorders in children and adolescents. Dialogues in Clinical Neuroscience. 2011;13(4):439-452.

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