For a more than a decade there has been evidence in the literature that Selective Serotonin Reuptake inhibiters (SSRI) can help teenagers with anxiety disorder feel and function better (Ipser et al., 2009). While these medications are not FDA approved for anxiety in adolescents, it appears clear that medications, in particular in combination with therapy are an effective adjunct treatment for anxiety. The most commonly used SSRIs for anxiety treatment for children and adolescents include sertraline, fluoxetine and escitalopram. Each carries FDA approval for alternate mental health indications (fluoxetine for depression and OCD, escitalopram for depression and sertraline for OCD), which provides the foundation for safety data.
A recent randomized control trial highlighted the role for Escitalopram in helping teenagers with generalized anxiety (Strawn et al, 2020). Interestingly, the study also found that certain genetic factors may impact effectiveness of the medication. This highlights the clear role for SSRIs in anxiety management, as well as possible future directions for tailoring psychiatric treatment. Other reviews of anxiety treatment highlight that SSRIs can be effective for multiple anxiety disorders (Generalized anxiety, social anxiety, panic disorder and others), and in general can take up to 8 weeks to take full effect (Kodish et al., 2011).
A proposed dosing strategy for adolescents with anxiety
Sertraline – start at 25 mg and increase by 25 mg every 1-4 weeks, targeting symptom remission. Typically response occurs between 100 – 150 mg, but can occur at lower doses. Sometimes doses up to 200mg may be used, provided the medication is tolerated.
Fluoxetine – start at 10 and increase by 10 mg – every 1-4 weeks, targeting symptom remission. Typically response occurs between 20 – 40 mg, but can occur at lower doses. Rarely doses up to 60 mg may be used, provided the medication is tolerated.
Escitalopram – start at 5 – 10 and increase by 5 – 10 mg – every 1-4 weeks, targeting symptom remission. Maximum dose is 20 mg, higher doses are not recommended due to QTC prolonging risks.
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- https://www.optumsandiego.com/content/dam/san-diego/documents/socdirectory/SBC_DBH-SUDRS_Provider_Directory_English.pdfIpser JC, Stein DJ, Hawkridge S, Hoppe L. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD005170. DOI: 10.1002/14651858.CD005170.pub2.Strawn JR, Mills JA, Schroeder H, Mossman SA, Varney ST, Ramsey LB, Poweleit EA, Desta Z, Cecil K, DelBello MP. Escitalopram in Adolescents With Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled Study. J Clin Psychiatry. 2020 Aug 25;81(5):20m13396. doi: 10.4088/JCP.20m13396. PMID: 32857933; PMCID: PMC7504974.
- Kodish, I., Rockhill, C., & Varley, C. (2011). Pharmacotherapy for anxiety disorders in children and adolescents. Dialogues in clinical neuroscience, 13(4), 439–452.