Roughly one-quarter of all American teenagers will develop symptoms of an anxiety disorder at some point during adolescence.
Roughly one-quarter of all American teenagers will develop symptoms of an anxiety disorder[i] at some point during adolescence. Most of those affected do not receive proper treatment, however; many teens do receive a course of treatment that includes anti-anxiety medications. While these medications can produce tremendous benefits, they also come with some potentially serious risks for a few teenagers.
At its root, anxiety is a completely natural feeling of intense worry and apprehension. Human beings have long relied on this feeling as a motivating reaction to highly stressful situations that could cause harm or endanger their lives. Most people are very familiar with the temporary anxiety that arises in response to specific circumstances. While unpleasant, this sensation causes no lasting problems.
A person affected by an anxiety disorder experiences unusually strong or misplaced feelings of anxiety when encountering circumstances that don’t create a lot of stress for most other people. The American Psychiatric Association has set official guidelines for the diagnosis of eight main anxiety-related conditions[ii], as well as four, less precisely defined secondary conditions. Each disorder in this category comes with its own identifiable symptoms, which doctors look for when making their examinations.
Anxiety[iii] is common among teenagers, who typically go through tremendous changes in their biology, outward physical appearance and social world. Even in the absence of clinically severe mental health symptoms, the strain of these stresses can lead to such things as:
Teens can potentially develop any of the anxiety disorders that affect adults. However, they may have particularly heightened chances of developing diagnosable symptoms of panic attacks, panic disorder (marked by repeated panic attacks), social phobia (also known as social anxiety disorder) and other phobia-related conditions.
Along with several forms of cognitive-behavioral therapy, medications are an accepted part of treatment for teenagers dealing with the effects of anxiety disorders. The most commonly used medications include three types of antidepressants[iv]: SSRIs (selective serotonin reuptake inhibitors), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants.
SSRIs work by increasing the brain’s supply of the naturally occurring, mood-stabilizing chemical serotonin. Well-known examples of these medications include fluoxetine, citalopram, paroxetine and citalopram. SNRIs (e.g., venlafaxine and duloxetine) work by increasing the brain’s supply of serotonin and mood-regulating norepinephrine. Tricyclic antidepressants (e.g., imipramine and amitriptyline) work by altering the brain levels of several chemicals.
Antidepressants are used to treat anxiety disorders for two reasons. First, these medications can have a direct positive impact on the severity of anxiety-related symptoms. In addition, a significant number of people affected by anxiety disorders also have symptoms of major depression or some other depressive disorder. SSRIs are used for anxiety treatment more often than SNRIs or tricyclic antidepressants.
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SSRIs and other medications have consistently been shown to provide a clear treatment benefit for many teenagers affected by panic disorder, social anxiety disorder or other anxiety-related conditions. These medications can produce positive results when used on their own. However, the Anxiety and Depression Association of America reports that they work best when used in combination with some form of behavioral therapy.[v] Some teenagers only need to take anti-anxiety medication for a short amount of time while others continue to take them on a longer-term basis.
The medications used to treat teen (and adult) anxiety can produce a range of unwanted side effects. For example, use of SSRIs can lead to symptoms such as:
Use of tricyclic antidepressants can lead to the appearance of symptoms that include:
However, there is another, potentially much more serious concern for teenagers who take SSRIs or other antidepressants. Since 2004, the U.S. Food and Drug Administration (FDA) has reported that teens, younger children and young adults who use these medications run a small, but still significant, risk for increased suicidal thoughts.
This appears to be true, in part, because antidepressants can make teens with anxiety disorder more anxious, not less anxious. As a result of the potential risk, the FDA requires all antidepressants available in the U.S. to carry a specific warning detailing this possibility. The warning falls into the “black box” category, the highest alert status used by the FDA.
The FDA warnings about the potential link between antidepressants and suicidal thinking should be taken with the utmost seriousness. However, in all the studies conducted to address this topic, no teenager has committed suicide.[vi] In addition, some studies show that, despite the small increase in the odds for suicidal thinking, teens and children who take antidepressants reduce their chances of killing themselves.
Not everyone responds to antidepressants or other medications in the same way. SSRIs and other options may truly be ill-advised for some teenagers. However, for a large percentage of teens coping with serious anxiety, the advantages of antidepressant use outweigh the disadvantages. Mental health experts recommend carefully considering the pros and cons before make treatment decisions for any adolescent child.
