Drug Treatments for Child Anxiety Problems
Anxiety problems are sometimes treated with medication, typically antidepressants or antipsychotics such as Lexapro, Klonopin or Zoloft. Occasionally the type of stimulants designed to treat ADHD are prescribed off-label and used to treat anxiety.
How effective are medications used to treat anxiety?
The effectiveness of such drugs is questionable, especially when used alone. One 12-week randomized controlled trial compared cognitive behavioral therapy (CBT) alone, the antidepressant sertraline (Zoloft), the combination of both cognitive therapy and Zoloft, and a placebo drug. The participants were almost 500 children ranging in age from 7 to 17 with different types of anxiety disorders. It was found that more than 80% of children receiving combined therapy experienced significant improvement, compared with 60% of the kids who received CBT and 55% of those receiving only sertraline. Both solo treatments were around twice as effective as a placebo. (Miller, 2009) This is about as robust an effect as you will find for any type of drug therapy, and on the surface, would appear to be reasonably effective.
However, kids receiving the actual antidepressant reported a higher number of side effects such as sedation, sleepiness, and fidgeting. Sleepy children who are drugged are naturally less anxious. This suggests these drugs are merely covering up the symptoms rather than effectively dealing with the underlying disorder. In essence, you're trading one set of symptoms for another, choosing a more lethargic child in place of an anxious one.
There are also other things to consider. Even studies that find medication to be helpful in treating anxiety still show it to be the LEAST EFFECTIVE type of stand-alone therapy, and generally less effective than psychological interventions. So any additional benefit the drugs might provide is negligible. (In the aforementioned study there was an additional 20% improvement over therapy alone.) But a large part of this 20% may come from (or at the expense of) a drugs side effects. Furthermore, many studies show that the positive effects of such drugs ware off over time.
For these reasons, we would suggest against using these drugs to treat a child's anxiety, and recommend medication only as a last-resort option. But each child and every situation is unique, and parents should do what they feel in their heart is best after consulting with a child psychiatrist.