Anxiety disorders remain a widely prevalent and underrecognized mental health disorder among the pediatric population, with a lifetime prevalence of 25–32%. A national survey reported an individual prevalence of anxiety disorders among youth (ages 13–17.4 years) as panic disorder (2.3%), agoraphobia (2.4%), specific phobia (19.3%), generalized anxiety disorder (2.2%), separation anxiety disorder (7.6%), and social anxiety disorder (9.1%). Early diagnosis and treatment improve the treatment results and prognosis for children and adolescents. 

The present study reviewed pharmacologic treatment options for children and adolescents. It searched two electronic databases (Scopus and PubMed) and found 274 studies. However, screening for only pharmacological treatments of social anxiety disorder, generalized anxiety disorder, panic disorder, social phobia, and separation anxiety disorder revealed only 35 relevant publications. 

The analysis found SSRIs to be the first-line medications for pediatric anxiety disorders and, when used along with psychotherapy, show enhanced effects. This combination treatment strategy also demands lower medication doses in comparison to pharmacologic treatment alone. The evidence favors using fluoxetine, sertraline, duloxetine, paroxetine, escitalopram, citalopram, atomoxetine, venlafaxine extended-release, and guanfacine extended-release. It also found N-Acetylcysteine effective in a case report when used in conjunction with sertraline. 

Pediatric anxiety disorders have a long course and, when untreated, can lead to the effects of other comorbid mental health issues, including mood instability, substance use, and suicidal ideation and attempt. For effectively treating any anxiety disorder, it is crucial to consider all aspects and trajectories of the biopsychosocial model for maximum advantage. Thus, the knowledge of evidence-based pharmacological interventions for specific anxiety disorders is critical for patient care.

Memon RI, Khan M, Khalid K, Quadri GJ, Zeshan M, and Naveed S. 5.17 Pediatric Anxiety Disorders (PAD) and pharmacologic intervention: which medication to pick? J Am Acad Child Adolesc Psychiatry 2019; 58(10): S250.