Should I put my child on anxiety medication?

The Clinical Framework: When Each Treatment Works Best

Both cognitive behavioral therapy (CBT)—an approach that targets unhelpful thoughts and builds coping strategies—and medication can effectively treat children ages six to 18 with these anxiety disorders:

• Social anxiety disorder
• Generalized anxiety disorder
• Separation anxiety disorder
• Specific phobias
• Panic disorder

Both CBT and medication are considered safe and effective short-term treatments for children and adolescents.

When Therapy First (CBT) Is Recommended

CBT alone is as effective as medication for mild to moderate childhood anxiety. It’s typically the first-line treatment when:

• Symptoms are mild to moderate and don’t severely impact daily functioning
• Child is willing to participate in the therapy structure (may be talk-, play-, or art-based)
• Family can commit to the timeline. Therapy is time-limited, typically lasting 12 to 20 weeks
• Family supports the approach, understanding that CBT may include exposure techniques where the child gradually faces anxiety-provoking situations (this can feel uncomfortable for everyone involved)

When Medication May Be Needed

For many kids, therapy is enough. But medication can be a valuable addition when symptoms are more severe.

Selective serotonin reuptake inhibitors (SSRIs) are the first-line medications for anxiety disorders, including fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). Children seven and older may also take duloxetine (Cymbalta), a selective serotonin and norepinephrine reuptake inhibitor (SSNRI).

Medication may be considered when:

• Symptoms are moderate to severe and impact daily functioning, like having panic attacks or refusing to go to school
• The child is unwilling or unable to participate in therapy
• CBT has been tried but isn’t working well enough
• Child can stick to their medication routine (with parental monitoring)

Combination therapy is considered the gold standard for anxiety treatment. Research shows that medication and therapy together often reduce symptoms more effectively than either approach alone. However this decision should always be made on an individual basis.

Some providers may also recommend a medication trial for mild to moderate anxiety to assess how your child responds and evaluate potential benefits versus risks.

When a Combination Approach Works Best

Medication and therapy together can be especially effective when:

• CBT alone isn’t reducing symptoms enough
• Anxiety symptoms are so strong they prevent your child from using the coping tools they’re learning in therapy

Here’s how I often explain it to families: Medication can lower the anxiety “volume” enough that children can actually practice and benefit from their therapy skills. As these skills become more automatic and natural, many children can eventually discontinue medication under their doctor’s guidance.

How Your Child's Age Affects Treatment Decisions

While both CBT and medications work for children and teens, your child’s developmental stage significantly influences which approach works best and how treatment is delivered.

Younger Children (Ages 6-11): Therapy-First Approach

For younger children dealing with anxiety, therapy is typically the best first-line treatment. Anxiety in kids often stems from their inability to put words to overwhelming feelings. Therapy allows them to process emotions in developmentally appropriate ways—through play, art, games, and age-appropriate conversations.

Here’s how this looks in practice: Let’s say a child doesn’t want to get on the school bus because another student is bullying them. A therapist might say, “It sounds like you’re really scared to go to school.” Suddenly, the child has learned a new word for what they’re experiencing.

Over time, therapy helps children build an emotional vocabulary so they can express themselves in the moment rather than sitting in their seat shaking without understanding why. This emotional literacy also helps the adults in their life provide better support outside of that one therapy hour each week.

Medication may be considered if therapy alone isn’t sufficient, though age does limit which medications are available and appropriate for younger children.

Adolescents (Ages 12-18): Including Them in the Decision

With preteens and teens, you can—and should—include them in treatment decisions. Ask for their input: What are they willing to try? How do they feel about therapy versus medication?

While you’re still the parent responsible for their safety and well-being, their perspective matters significantly. Getting their buy-in makes treatment far more effective.

I recommend having an open discussion with your child, their therapist, psychiatrist, or pediatrician about treatment options. Prepare your teen ahead of time with questions they might want to ask, so they feel empowered to participate in their own care.

Critical coordination point: If your child takes medication, ensure their therapist and prescribing doctor communicate regularly. This is often overlooked but essential. For example, if a therapist notices their teen client has become more emotionally disconnected in sessions, the doctor may need to adjust their medication dose. This kind of collaborative care is only possible when professionals stay in contact.

Warning Signs Medication May Be Needed

Anxiety symptoms can evolve and intensify over time. Even if your child is already in therapy, there may come a point when adding medication becomes important. Here are the red flags I urge parents to watch for that suggest it may be time to consider medication:

Immediate concerns that warrant medication evaluation:

• Panic attacks: especially if they’re happening frequently or in “safe” environments like home or during routine activities
• Severe mood episodes: periods of intense sadness, hopelessness, or emotional numbness that last for days
• Explosive behavioral outbursts: reactions that seem disproportionate to the trigger and are becoming more frequent or intense
• Anxiety that disrupts basic functioning: refusing to attend school, avoiding previously enjoyed activities, or inability to complete daily tasks

The key distinction I help parents understand: It’s completely normal to feel anxious before a big test or social event. But if your child is having panic attacks during regular class time or when safe at home, that’s beyond typical anxiety and needs attention.

If your child expresses any thoughts of self-harm or suicide, seek immediate professional help. This is always an emergency.

Timeline: How Long to Try Therapy Before Considering Medication

There’s no one-size-fits-all answer, but typical therapy timelines range from two to six months, depending on your child’s specific situation and symptoms.

If after one to two months your child isn’t showing any improvement from therapy—they’re not feeling different at all or symptoms aren’t decreasing—it’s worth having a medication evaluation. Remember, an evaluation is just a conversation. You’re gathering information and exploring options. No one has to leave that appointment with a prescription if it doesn’t feel right for your family.

Understanding Medication as a Tool, Not a Permanent Solution

It’s crucial to understand that medication isn’t a long-term fix or replacement for coping skills. Instead, medication serves as a tool to bring anxiety down to a manageable level so your child can actually learn and practice the emotional regulation skills taught in therapy.

Here’s how I explain the process to families: Think of severe anxiety like trying to learn to swim while the waves are crashing over your head. Medication helps calm the waters enough so your child can focus on learning the strokes. As these skills become more natural and automatic, your child’s psychiatrist or pediatrician will gradually reduce the medication under careful supervision.

This is when you’ll see them independently using the coping strategies they learned in therapy—and you’ll get to celebrate those victories together.

Critical safety note: Never stop psychiatric medication abruptly without medical supervision. Always work with your child’s doctor to create a safe tapering plan.

Questions to Ask Your Child's Doctor or Therapist

When everyone is on the same page about treatment, outcomes improve significantly. Since this is such an important decision for your family, here are essential questions to ask your child’s provider:

About treatment planning:

• What are our specific treatment goals?
• What timeline should I expect for therapy and/or medication to show results?
• What does success look like for my child’s particular situation?

About medication (if recommended):

• What side effects should I watch for, and how do we manage them?
• Which side effects are concerning enough to warrant an immediate call to you or emergency care?
• How will we know if the medication is working?

About the treatment process:

• What’s the plan for eventually stopping medication and/or therapy?
• What does aftercare look like? Do you recommend periodic check-ins?
• How do I access ongoing support if needed?

For coordination between providers:

• How will you and my child’s other providers communicate about their progress?
• Who should I contact first if I have concerns about medication or therapy progress?

The Bottom Line: Making the Right Decision for Your Family

The most important thing you can do is work with knowledgeable mental health professionals who understand childhood anxiety treatment. While some pediatricians and primary care providers are well-versed in mental health care, others may have limited experience.

Don’t hesitate to ask for a referral to a child psychiatrist if you need someone who specializes in psychiatric medication for children and adolescents. They can discuss realistic expectations, timelines, potential side effects, and guide you on how to best support your child throughout treatment.

Remember: You’re not alone in this decision, and seeking help—whether therapy, medication, or both—is a sign of good parenting, not failure.