Is Anxiety Medication Safe for Teens?

All teens experience nervousness sometimes. Feeling tense before a date, worrying about an exam, and experiencing nerves 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. How do you know when the anxiety rises to the level of requiring treatment? Or maybe you have concerns about whether anxiety medication is safe for this age group.

Keep reading to learn how to tell when anxiety treatment may be necessary for teens. Also, find information about anxiety medication for teens, its potential side effects, and medication-related safety warnings.

When to Seek Treatment for Teen Anxiety

There are many different types of teen anxiety, including:

• Generalized anxiety: Characterized by excessive, persistent, and intrusive worry about a wide variety of topics
• Panic disorder: Characterized by unexpected, recurrent, and intense panic attacks
• Post-traumatic stress disorder (PTSD): A trauma- and stressor-related disorder that leads to intrusive symptoms and feelings of anxiety
• Separation anxiety: An extreme, out-of-proportion fear of being apart from a parent or caregiver
• Social anxiety: Characterized by an excessive fear of social situations that might lead to judgment or embarrassment

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

• The teen thinks everyone is always staring at them. As a result, they refuse to eat lunch in the cafeteria and avoid talking in class.
• The teen survived a near-fatal car accident on a rainy evening. Several months later, they continue to have nightmares and flashbacks. They also refuse to get in a car when it’s raining.
• The teen has started experiencing panic attacks. They're worried a panic attack will happen at school, so they've started refusing to go.

Other signs that a teen might be experiencing symptoms of anxiety include:

• Irritability
• Changes in eating habits
• Physical complaints like headaches and stomach aches
• Fatigue
• Problems concentrating
• Difficulty sleeping or sleeping too much
• Social withdrawal
• Avoiding new situations
• Feeling tense
• Changes in school performance
  

Using Medication to Treat Anxiety

Prescription medications can be useful in the treatment of anxiety disorders. They are also often used in conjunction with CBT.

Research studies show that a combination of CBT and medication works better for children than either treatment alone. That said, when teens have mild to moderate functional impairments, the American Academy of Child and Adolescent Psychiatry recommends deferring the use of medication.

Types of Anxiety Medications for Teens

It can be challenging to find the right anxiety medication that will work for your teen. Here are a few that a physician may prescribe.

SSRIs and SNRIs

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medication for anxiety in children and teens. They improve mood by blocking the reabsorption of serotonin—a neurotransmitter that helps regulate fear, worry, and stress—in the brain.

Common SSRIs used to treat anxiety disorders in teens include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Prozac (fluoxetine)
• Zoloft (sertraline)
• Luvox (fluvoxamine)
• Paxil (paroxetine)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed if SSRIs don't have the desired effect. Like SSRIs, SNRIs impact neurotransmitters in the brain. They block the reabsorption of serotonin and norepinephrine. SNRIs may include medications such as:

• Cymbalta (duloxetine)
• Effexor XR (venlafaxine)
• Anafranil (clomipramine)
• Tofranil (imipramine)

These types of medications can take up to eight weeks to work. If a teen tolerates the medication well but hasn't received the desired results, the dosage may be increased after several weeks.

Benzodiazepines

Although SSRIs and SNRIs are most commonly used to treat anxiety in teens, other prescriptions may be used as well. Benzodiazepines are the second most commonly used type of medication and may be prescribed to teens with severe anxiety.

Medications in this category include:

• Klonopin (clonazepam)
• Valium (diazepam)
• Xanax (alprazolam)
• Ativan (lorazepam)
  

Other Medications

Occasionally, physicians may prescribe other medications off-label to treat anxiety. This might include prescribing drugs such as antihistamines, non-SSRI antidepressants, hydroxyzine, or atypical antipsychotics. The exact medication prescribed can vary based on the teen's diagnosis, the severity of the anxiety, and other factors. Examples of medications that may be prescribed include:

• Buspar (buspirone)
• Unisom (doxylamine)
• Inderal (propranolol)
• Atarax (hydroxyzine)
• Benadryl (diphenhydramine)

Side Effects of SSRIs and SNRIs

Many teens don’t experience side effects when taking SSRIs or SNRIs. Those that do often find that the effects are mild and usually go away within the first few weeks of treatment.

The most common side effects of SSRI and SNRI anxiety medications for teens include:

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

Other possible side effects may include:

• Changes in sexual function
• Constipation
• Insomnia
• Loss of appetite
• Tiredness

Parents and physicians should discuss potential side effects with teens so they know what to expect and can report any side effects they are experiencing. If one medication isn't working or causing serious side effects, your teen may need to change medications.

FDA Warnings

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

Research shows that warnings against antidepressant use for teens may have actually backfired. Prior to the FDA warnings (1990-2002), suicide deaths decreased substantially. Following the warnings (2005-2017), there was an abrupt decline in treatments, yet suicide deaths increased markedly.

To address this concern, a black box warning was added to these medications. Critics of this warning fear that some children and teens may not get the help they need for fear that the medications are unsafe. To combat the added risk for adolescents, parents and teens are educated about the potential risks, and teens are monitored closely with frequent appointments.

Related Conditions

It is not uncommon for anxiety to co-occur alongside other mental health conditions. In some instances, other conditions may contribute to symptoms of anxiety.

Conditions that are associated with anxiety in children and teens include:

• Tourette syndrome and other movement or tic disorders
• Autism spectrum disorder 
• Attention-deficit hyperactivity disorder (ADHD)
• Learning disorders
• Intellectual disability
• Speech, language, or communication disorders
• Substance use disorders
• Depression

Each teen's situation is different. Medications will sometimes be prescribed to treat co-occurring conditions, which may play a role in alleviating feelings of anxiety in some cases.

How to Help a Teen With Anxiety

If your teen is struggling with anxiety, consult a healthcare provider. Describe your concerns and ask about treatment options.

While some primary care physicians and pediatricians feel comfortable prescribing anti-anxiety medications to teens, others may refer children and adolescents to a psychiatrist. Psychiatrists are specialist physicians who treat mental health disorders.

• Always educate yourself about any medications your child is taking. Read the handouts, ask questions, and talk to the prescribing doctor and pharmacist.
• Monitor your teen’s compliance with taking the medication, and make sure they're taking it as prescribed. Skipping doses or doubling up on pills could be harmful.
• Attend your teen’s appointments. Talk to the doctor about your concerns and learn about your teen’s progress.

With the right treatment and monitoring, teens can find relief from anxiety. Medications may be a part of this treatment, but other strategies, including talk therapy, behavioral interventions, and lifestyle modifications, can also be helpful.