When your child is struggling with anxiety, the thought of starting medication can be stressful. You want the best for them, but you need to know the treatment is safe and worthwhile. Medication is a serious step, and it should always fit into a comprehensive plan discussed with your psychiatrist and therapist.
This guide provides clear, factual information about the safety, side effects, and monitoring of anxiety medications for children and teens. Our goal at ReACH Psychiatry is to blend expert advice with official guidelines, giving you the practical tools needed for confident conversations with your prescriber.
It is important to remember that medication is rarely the first step. For most childhood anxiety, Cognitive Behavioral Therapy (CBT) is the main, starting treatment. CBT teaches children specific skills to understand and manage their worries.
So, when is medication used? It's typically added when CBT alone hasn't been enough, isn't available, or when anxiety is so severe that it keeps the child from functioning normally at school or at home. Medication helps reduce the intensity of the anxiety so that the skills learned in therapy can work.
The medications most often used for children's anxiety are those that have been studied the most and proven to be the safest. The doctor's choice usually depends on your child’s age and their specific anxiety disorder.
1. SSRIs: The Most Common Choice
Selective Serotonin Reuptake Inhibitors (SSRIs) are the type of medication most frequently prescribed and most effective for pediatric anxiety. They work by simply helping the brain manage a chemical messenger called serotonin, which helps control mood, fear, and worry.
2. Other Options
If SSRIs do not work or cause too many side effects, a doctor might consider a different class, like a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) (such as duloxetine or venlafaxine). Giving medication to very young children (under 8) is less common and is usually handled by specialists.
Class
Examples
Typical Use Status
SSRIs (First Line)
Fluoxetine, Sertraline
Most studied and common starting point.
SNRIs (Second Line)
Venlafaxine, Duloxetine
Used if SSRIs are ineffective or not tolerated.
Common and Rare Side Effects: What to Expect
All medicines can cause side effects. Knowing what is normal helps you manage them calmly and report them accurately to the doctor.
Common Side Effects (Usually Temporary)
When starting the medication, side effects are typical but generally mild. They usually go away within the first 2 to 4 weeks. Doctors minimize these issues by starting with a very small dose and gradually increasing it.
The Rare Safety Concern: Increased Suicidal Thoughts
We must discuss the rare, serious risk known as the Black Box Warning. Clinical studies showed a small rise in suicidal thinking or agitation in children and teens, mainly when they first start the medicine or change the dose.
It is critical to remember:
Clinician Insight:“When we start an SSRI, we make sure parents are alert. If they notice any rapid, serious mood changes—like sudden agitation, panic, they need to inform us immediately. The most important tool we have for safety is communication, especially in those first few weeks.” – Dr. Meena Gnanasekharan Child Psychiatrist
The Very Rare Emergency: Serotonin Syndrome
This is a very rare but dangerous reaction caused by too much serotonin (often from drug interactions). If you see these signs, get immediate medical help:
Monitoring, Timeline, and Interactions
Starting a medication requires teamwork. You must commit to regular check-ins with the doctor.
Anxiety relief is not immediate. It usually takes 4 to 8 weeks for the medicine to fully build up in the system and for you to see clear benefits. Be patient.
Monitoring appointments are frequent at first (sometimes weekly or every two weeks for the first month) to check for side effects and how well the medicine is working. Once things are stable, appointments become less frequent.
Before your child starts taking the medication, you must give the prescriber a complete list of everything they take: all prescriptions, all over-the-counter drugs, and all herbal supplements.
While guidelines offer a framework, the final decision is always specific to your child. Here are examples of how others have navigated this process:
Case Vignette 1: Starting Medication
Case Example: Sarah, Age 14 (Social Anxiety)Surya had tried CBT, but her severe social anxiety still kept her out of the classroom. Her anxiety was controlling her life. She and her parents agreed to try Sertraline. She felt nauseous for about 10 days, but that passed. After two months, she said she still worried sometimes, but the feeling no longer "stopped her." She was able to return to school and continue her therapy.
Case Vignette 2: Managing Side Effects
Case Example: Ethan, Age 10 (Generalized Anxiety) Ishan started Fluoxetine for constant worry that was ruining his sleep. After two weeks, his parents reported he became more agitated and had new, severe insomnia. His doctor quickly decided to switch medications. They slowly stopped the Fluoxetine and started Fluvoxamine. The new medicine worked well, and the side effects disappeared. Switching medicine is a safe, normal process when the first one doesn't fit.
Deciding on medication for anxiety is a careful choice that weighs the risks against the significant benefits for your child. CBT is the main treatment; SSRIs are the safest and most common; aggressive monitoring is necessary, especially at the start; and open, honest talks with your doctor are the most important safety tool you have.
Your Next Logical Step
Book a consultation with a pediatric mental health expert and take this simple checklist with you.
Question to Ask the Prescriber
1. Will my child be on this forever?
No. The common goal is to keep the child on the medicine for 9 to 12 months after their anxiety has stabilized. The medicine is then slowly stopped, under the doctor's supervision, while the child continues to use their coping skills.
2. Are these medications addictive?
No. SSRIs are not addictive in the way drugs like narcotics are. They don’t cause a euphoric feeling. However, they cannot be stopped suddenly. They need to be slowly reduced to prevent temporary symptoms like dizziness or flu-like feelings.
3. Will it change my child’s personality?
This is a very common fear. A properly managed anxiety medication should not change who your child is. Its goal is to take away the crushing burden of anxiety, allowing their true self—their personality, humour, and curiosity—to fully return.