Teens and Anxiety Medication: What to Avoid and When

Twenty-five percent of 13- to 18-year-old teens suffer from anxiety, according to the National Institute of Mental Health. Almost 6 percent have severe anxiety. Without treatment, teens are at higher risk of poor academic performance, social isolation, and substance abuse. Many respond well to cognitive behavior therapy, which helps them recognize feelings of anxiety and develop coping skills. Some adolescents' anxiety is severe enough to warrant taking medication. Used in conjunction with therapy, medication can help reduce feelings of stress and anxiety. However, the benefits of medication must be weighed against the possible side effects.

Types of Medication

Selective Serotonin Reuptake Inhibitors (SSRIs) block receptors in the brain that absorb serotonin, which influences mood. As a result, it is used to treat depression, which often occurs alongside anxiety.

Possible side effects from SSRIs include:

  • Insomnia
  • Rashes
  • Headaches
  • Joint and muscle soreness
  • Upset stomach or nausea
  • Diarrhea
  • Reduced blood clotting, which significantly increases with use of aspirin, ibuprofen, naproxen or COX-2 inhibitors
  • Suicidal thinking

SSRI medications include:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Venlafaxine (Effexor)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

Tricyclic Antidepressants (TCAs) were an early form of anti-anxiety medication. While still effective and prescribed, they aren't used as much because they tend to have more side effects. Similar to the SSRIs, tricyclic medication blocks absorption of serotonin and norepinephrine, which helps brain cells send and receive messages and improve mood.

Side effects of tricyclic medication include:

  • Drowsiness
  • Fatigue
  • Headache
  • Nausea
  • Dizziness or light-headedness
  • Dry mouth
  • Constipation and urinary retention
  • Increased heart rate
  • Disorientation or confusion
  • Low blood pressure
  • Increased appetite (which can lead to weight gain)
  • Sensitivity to sunlight
  • Seizures

Tricyclic medications include:

  • Amitriptyline (Elavil)
  • Clomipramine (Anafranil)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)

Monoamine Oxidase Inhibitors (MAOIs) were another early form of anti-anxiety and antidepressant medication. Today, they are prescribed only if other treatment options fail because the side-effects are more serious. Similar to other anti-anxiety medications, MAOIs work on brain chemistry to block reuptake of norepinephrine, serotonin, and dopamine. This allows more of the neurotransmitters to be received by the brain, which results in an improved mood.

Side effects of MAOIs include:

  • Difficulty getting to sleep.
  • Dizziness, light-headedness, and fainting.
  • Dry mouth, blurred vision, and appetite changes.
  • High blood pressure and changes in heart rate and rhythm.
  • Muscle twitching and feelings of restlessness.
  • Loss of sexual desire or ability.
  • Weight gain.
  • Negative interactions with other medicines and some foods such as cheeses, beans, pickled foods, and red wine.

MAOIs include:

  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate).

Issues to Consider

Parents should take their teen to a psychiatrist that specializes in adolescent psychiatry before giving their child anxiety medication. The psychiatrist will know about psychological and biological issues related to teenagers and avoid medications that can negatively impact a teen's health.

Parents need to let the doctor know about any other health issues such as liver or heart problems, as well as any other medication their teen is taking including any herbal remedies or vitamins. Since many teens may also be on antidepressant or ADHD medication, the doctor needs to know about these to avoid prescribing a medication that can negatively impact the teen's health. Many anti-anxiety medications, particularly the MAOIs, can have severe interactions with food and medicine. In fact, depending on other existing health issues and the medication taken for it, anti-anxiety medication may not be advisable.

The FDA also warns that some anti-anxiety medication may increase suicidal thoughts in children and adolescents, although none of the studies reported suicide among its participants. A teen's health and behavior need to be monitored carefully by parents and doctors to ensure the biological and mental health are not compromised. However, parents should never stop giving their adolescent his medication without first consulting the psychiatrist.

Side effects of medication may require the teen to alter regular activity such as driving and some sports. Further, parents need to monitor diet and contact a doctor before giving their child any medication, including pain medication such as ibuprofen, as these can negatively interact with anti-anxiety medication.

Questions Parents Need to Ask

To ensure that parents and teens understand the risks and proper use of any medication, parents should have a discussion with the doctor prescribing the medication. Questions to ask include:

1. What is the medication and what are all of its names (i.e. generic name)?
2. What does the medication do?
3. How long does it take to see improvement?
4. What are the most common side effects and what can be done, if anything to offset them?
5. What are more serious side effects and how does one watch for them?
6. What is the recommended dosage?
7. Are there ongoing tests such as blood test that need to be conducted while on the medication?
8. Are there any medications or foods that should be avoided while on the medication?
9. Are there any activity precautions that need to be taken?
10. How long does the teen need to take the medication?
11. Is the medication addictive?

Medication should be seen only as a short-term solution. Combined with therapy, teens have good prognosis for recovery and leading a healthy, medication-free life.

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