Medication Treatment for Pediatric Anxiety and OCD
PLEASE NOTE: The International OCD Foundation has no conflicts of interest or financial relationships related to the content of this web page.
If you have a student with anxiety/OCD in your school, it’s possible that they may be taking psychiatric medication as part of their treatment. It is important for school nurses to understand medication treatment not only because they may be the person administering the dose, depending on the student’s schedule, but also to be aware of any side effects or symptoms the student may need to manage because of their medication.
In general, psychiatric medication may be considered if the student’s symptoms are moderately severe and/or not helped by CBT/ERP alone. A specific kind of antidepressants known as serotonin reuptake inhibitors (SRIs) have been found to be the most helpful in reducing anxiety/OCD symptoms in youth, making it easier for them to actively engage in their CBT/ERP treatment. This is consistent with the recommendations from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.
Medications should only be prescribed by a licensed medical professional (such as a pediatrician or psychiatrist) who has experience working with kids and teens. This medical professional would ideally work together with the rest of the student’s treatment team to develop a plan.
Overview of Medication Prescribed for Anxiety/OCD in Kids
SSRI's and SNRIs are typically prescribed to treat anxiety/OCD in kids. As a school nurse, you may be presented with questions about how these medications work, and what the side effects may be.
What kind of medication is prescribed to treat anxiety and/or OCD in children?
In this video, Evelyn Stewart, MD, talks about the medications that are typically prescribed to help manage these conditions in children.
Read below for additional information about medication and dosage.
Common medications used in the treatment of pediatric anxiety include…
Medication | Starting Pediatric Dosage | Usual Effective Dosage |
|---|---|---|
| Citalopram (Celexa®) | 5 - 10 mg/day | 20 - 40 mg/day |
| Escitalopram (Lexapro®) | 2.5 - 5 mg/day | 5 - 20 mg/day |
| Fluvoxamine (Luvox®) | 25 - 50 mg/day | 50 - 200 mg/day |
| Fluoxetine (Prozac®) | 5 - 10 mg/day | 10 - 40 mg/day |
| Paroxetine (Paxil®) | 5 - 10 mg/day | 10 - 40 mg/day |
| Sertraline (Zoloft®) | 12.5 - 25 mg/day | 25 - 100 mg/day |
| Duloxetine (Cymbalta®) | 30 mg/day | 30 - 60 mg/day |
Common SRI medications used in the treatment of pediatric OCD include:
Medication | Pediatric Dosage |
|---|---|
| Citalopram (Celexa®) | 10 - 40 mg/day |
| Escitalopram (Lexapro®) | 10 - 20 mg/day |
| Fluvoxamine (Luvox®) | 50 - 300 mg/day |
| Fluoxetine (Prozac®) | 10 - 80 mg/day |
| Paroxetine (Paxil®) | 10 - 60 mg/day |
| Sertraline (Zoloft®) | 50 - 200 mg/day |
A non-SRI medication that may be used to treat pediatric OCD is Clomipramine (Anafranil®), which is a tricyclic antidepressant (TCA), for 50 – 200 mg/day.
NOTE: For pediatric OCD specifically, longer trials and higher dosages are often required for OCD treatment compared to depression and anxiety treatment. While other mental health conditions may only require 4-6 weeks to see results, youth with OCD often need 10-12 weeks to see the full effect of a medication. Doses of psychiatric medications may also be higher for youth with OCD than for youth with anxiety or other mental health conditions – the student’s prescribing physician will determine the best dose for them, and will alter it as indicated as the treatment course progresses.
How Long Should Medication be Taken?
How long should children with anxiety and/or OCD expect to be on medication?
In this video, Evelyn Stewart, MD, talks about the length of time that medication may be prescribed for and what to consider when taking medication.
What to Tell Students and their Families
Families may be wary of their student taking medication to help manage their anxiety/OCD. It can be helpful to remind them that there is ample research support for the use of psychiatric medication in youth with anxiety/OCD, and that two leading professional organizations – the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry – recommend them as gold standard treatment options when used together with CBT/ERP.
Addressing Common Medication Concerns
A big concern for students, families, and school personnel may be side effects. Every type of drug has the potential for side effects, not just psychiatric medication, and these side effects are usually weighed against its benefits by the prescribing physician before the student begins treatment.
What are common concerns that caregivers may have about their child taking medication to treat anxiety and/or OCD?
In this video, Evelyn Stewart, MD, talks about common concerns that caregivers might have, and how you can go about addressing these concerns.
To learn more about common medication side-effects, read below.
Common Medication Side Effects
For the psychiatric medications used to treat anxiety/OCD in youth, common side effects can include:
- Nausea or upset stomach.
- Difficulty with sitting still or concentrating.
- Sleepiness or insomnia.
- A heightened sense of energy.
- Weight gain.
- Dry mouth.
- Racing heartbeat.
- Problems with urination.
One very important side effect to be aware of is the potential for suicidal thoughts and urges. The FDA issues a “black box warning” regarding the use of antidepressants in pediatric populations because of this. The highest risk period for suicidal thoughts and urges are when starting or increasing the dose of the medication.
In spite of the potential side effects, these medications appear very safe with long-term use. The side effects typically reverse when the medications are stopped, and there are no long-term impacts on the student. There is no current evidence that taking psychiatric medication does permanent damage to the youth, neurodevelopmentally or otherwise.
It is important to note that psychiatric medications help to control and decrease symptoms, but that they do not “cure” mental health conditions. Both anxiety and OCD are usually able to be well-controlled and managed when proper treatment is in place.
How school nurses can help students with Anxiety/OCD
- Screen and assess students.
- Educate parents on anxiety/OCD.
- Help in administering medications when given explicit written permission.
- Educate parents on side effects of medication. Provide info to take to
- Provide resources for parents and keep them engaged.
- Monitor/evaluate students to determine progress.
Resources for school nurses
- School Nurse State Association: State associations often offer conferences, education material on various medical topics, and opportunities for continuing education classes. State school nurse associations are also a great resource to find out what topics are especially important in the community you live and work.
- The National Center for School Mental Health (NCSMH): This organization strengthens policies and programs in school mental health to improve learning and promote success for America's youth.
- The Mental Health Training Intervention for Health Providers in Schools (MH-TIPS): An innovative in-service training and implementation support system for school health providers aimed at enhancing their competence in managing the needs of students with or at risk for emotional and behavioral difficulties that interfere with learning.
- The Importance of School Nurses in Student’s Mental Health: This article by EduHealth does a great job of going over the importance of a school nurse in identifying mental health needs in a student.
- Northeastern University School Health Academy (NEUSHA): This organization has numerous CE available for school nurses. Numerous topics all relevant to school nursing.
