Psychopharmacologic treatment of pediatric anxiety disorders

The pharmacologic treatment of pediatric anxiety disorders has historic roots, which coupled with recent advances over the last decade, has expanded evidence-based practice; however, much work still remains to be done. This article provides a practical overview of the current literature with an emphasis on the results of controlled and open trials, side effects, short- and long-term treatment strategies, and treatment-resistant illness. SSRIs seem to be the treatment of choice for most pervasive and impairing anxiety disorders in youth. Despite extensive experience with the TCAs, side effects and less overall efficacy data relegate the TCAs to second-line treatment. Although benzodiazepines have been evaluated extensively in adults, they are less commonly used in children because of better alternatives and the risk for dependency in this vulnerable population. As research on the treatment of pediatric anxiety disorders continues, our understanding of who responds best to what treatment, how to combine medication with psychosocial treatments, how long to treat to reduce the risk for relapse off medication, and the long-term safety of current medications will improve the outcome for children who suffer from these disorders.