Answers to questions about medications for children with anxiety
Your child’s doctor has recommended an SSRI for the treatment of his or her anxiety. Here are answers to the top ten questions that parents have:
What is an SSRI?
SSRI stands for selective serotonin reuptake inhibitor. This group of medications increases the amount of serotonin available to neurons. Serotonin is a brain chemical that is thought to help regulate anxiety and mood.
What are SSRIs used for?
SSRIs are considered the first-choice medications for most of the anxiety disorders, including generalized anxiety disorder, social anxiety disorder, and panic disorder as well as related disorders like OCD and PTSD. SSRIs are also used for other emotional disorders, like depression.
Which SSRI is right for my child?
There are six SSRIs: fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil). In general, they are equally effective and safe, but only four are FDA approved for use in children (escitalopram, fluoxetine, fluvoxamine, and sertraline). Your child’s doctor will select an SSRI based on several factors, such as whether the medication is available in liquid form if necessary, the side effect profile, the disorder being treated, and a family history of medication response.
What are the side effects?
The most common side effects are nausea, headache, drowsiness, and restlessness. Fortunately, these side effects usually go away within a few weeks. In rare instances, children and adolescents with Major Depressive Disorder (MDD) may develop new or worsening suicidal thoughts – be sure to tell your child’s doctor right away if this occurs. Your child’s doctor may also review other, rare side effects with you.
How long will my child need to take an SSRI?
It can take up to six weeks for an SSRI to take full effect, but most people notice some benefit in the first two to four weeks. Your child’s doctor will likely recommend treatment for at least six to twelve months to ensure fullest symptom recovery. However, symptoms may return after an SSRI is discontinued, so your child’s doctor might recommend longer-term treatment.
Will my child become dependent on an SSRI?
SSRIs are not addictive. They have a negligible potential for abuse, and they are not used recreationally.
Are there any alternatives?
Although SSRIs are considered the first-line medications, anxiety and related disorders can be treated using other classes of medications. Sometimes, your child’s doctor may recommend talk therapy (such as cognitive behavioral therapy) instead of or in addition to an SSRI.
How much do SSRIs cost?
SSRIs are among the most affordable medications. All of the SSRIs are available in the generic form, and most insurance companies cover SSRIs without requiring special paperwork. Even without insurance coverage, many pharmacies provide SSRIs at a low retail cost.
How do I administer an SSRI?
All SSRIs come in pill form, and some are also available as a liquid. Most are given in a single daily dose. They do not need to be taken with food, but taking them with food can reduce upset stomach if that side effect develops.
How will my child stop his or her SSRI?
When it’s time to stop an SSRI, your child’s doctor will probably recommend decreasing the dose slowly over time. This will prevent a potentially unpleasant, albeit harmless “discontinuation syndrome,” characterized by headache and a general sense of unwellness.
Dr. Distler, with an MD and PhD from the University of Chicago, specializes in anxiety disorders. She supervises psychiatry residents in CBT and medication management. She treats college students with mental illness, is Associate Medical Director at UCLA's Aftercare program for first-episode schizophrenia, and helps administer the Anxiety Disorders Clinic at the West Los Angeles Veterans Affairs hospital while developing residency curricula. Her PhD focused on anxiety's genetic and molecular basis, and she conducted clinical and basic research on anxiety and depression during her UCLA residency.