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8, 12, 13, 16– 18 However, since October 2004, antidepressants, including SSRIs, carry a black-box warning for an increased risk of suicidality in children 19 and, while select SSRIs are approved by the US Food and Drug Administration (FDA) to treat obsessive-compulsive disorder (OCD), SSRIs are not approved for pediatric non-OCD anxiety. 14, 15 SSRIs are generally well tolerated and have a mild side effect profile compared to other drugs, and there is minimal empirical evidence to support use of other medications to treat pediatric anxiety. 8, 12, 13 Randomized controlled trials (RCTs) showed efficacy of SSRIs over placebo in children with anxiety.

8, 12, 13 While there are a variety of pharmacological approaches to treat anxiety, selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacotherapy for pediatric anxiety. 8, 12, 13 AACAP recommends pharmacological treatment when moderate to severe symptoms or comorbid psychiatric disorders are present, or when children are unable/unwilling to participate in or have a partial response to psychotherapy. The American Academy of Child and Adolescent Psychiatry (AACAP) practice parameters recommend psychotherapy as the first-line treatment for anxiety of mild severity.

Early diagnosis and effective treatment of anxiety disorders are essential to manage symptoms and improve quality of life and can reduce the persistence of anxiety into young adulthood and beyond. 9 In 2010, anxiety disorders were the fifth leading contributor to years lived with disability in the US, 10 demonstrating the sustained impact of unmanaged anxiety. 3– 8 Pediatric anxiety disorders are likely to occur in association with somatic symptoms, including headaches, nausea, and trouble sleeping. 2 Children with anxiety disorders have an increased risk for future additional anxiety disorders, depression, and substance use and experience academic impairments. Anxiety disorders are one of the most common mental illnesses in children in the United States (US), 1 with lifetime prevalence of pediatric anxiety around 15–20%.