Is etizolam safe for treating anxiety in individuals under 18 years old?

Etizolam is Not Safe for Treating Anxiety in Individuals Under 18 Years Old

Etizolam should not be used for treating anxiety in individuals under 18 years of age due to lack of safety data and availability of better-established treatment options.

Evidence-Based Treatment Options for Anxiety in Children and Adolescents

First-Line Treatments

• Cognitive-behavioral therapy (CBT) is the recommended first-line treatment for children and adolescents aged 6-18 years with anxiety disorders including social anxiety, generalized anxiety, separation anxiety, specific phobia, and panic disorder 1
• For pharmacological treatment, SSRIs are the first-line medication option for anxiety disorders in children and adolescents, with substantial empirical support for effectiveness and safety 2, 3, 4
• Duloxetine (an SNRI) is the only medication in its class with FDA indication for generalized anxiety disorder in children 7 years and older 2

Evidence for Recommended Treatments

• CBT has been shown to improve primary anxiety symptoms (based on child, parent, and clinician reports), global function, and treatment response compared to waitlist/no treatment controls 1
• SSRIs have demonstrated moderate to high strength of evidence for improving primary anxiety symptoms, response to treatment, and remission of anxiety disorders in children and adolescents 3, 4
• A combined approach using both CBT and medication (when indicated) has been found to be most effective for optimal outcomes 2, 3, 4

Concerns Regarding Etizolam Use in Children and Adolescents

Lack of Safety Data

• There is no established safety profile for etizolam in individuals under 18 years of age 2, 5
• A case report documented paradoxical excitation and muscle weakness in a child who accidentally ingested a single adult therapeutic dose of etizolam 5
• The American Academy of Child and Adolescent Psychiatry does not include etizolam in its recommendations for anxiety treatment in children and adolescents 1, 2

Risk of Dependence

• Etizolam is a thienodiazepine with pharmacological properties similar to benzodiazepines, which carry risks of dependence 6, 7
• Case reports have documented etizolam dependence in adults, suggesting similar caution should be exercised as with other benzodiazepines 7
• The World Health Organization has listed etizolam as a new psychoactive substance since 2015 due to concerns about its abuse potential 8

Monitoring and Safety Considerations

For Recommended Treatments

• When using SSRIs in children and adolescents, close monitoring for adverse effects is essential, particularly during the first 4 weeks of treatment 2
• The pooled absolute rates for suicidal ideation across all antidepressant classes for youth treated for anxiety have been reported to be 1% compared to 0.2% for those treated with placebo 2
• SSRIs typically require 4-6 weeks for full therapeutic effect, with clinically significant improvement by week 6 and maximal improvement by week 12 3

Clinical Algorithm for Anxiety Treatment in Children and Adolescents

1. Begin with CBT as first-line treatment for children and adolescents aged 6-18 years with anxiety disorders 1
2. If response to CBT is inadequate or anxiety symptoms are severe:
   • Add an SSRI (fluoxetine, fluvoxamine, paroxetine, or sertraline) 2, 4
   • Start with a low dose and slowly titrate upward to minimize side effects 3
   • Monitor closely for adverse effects, particularly during the first 4 weeks 2
3. For treatment-resistant cases:
   • Consider switching between different SSRIs 3
   • Consider an SNRI (duloxetine) for children 7 years and older 2
4. Do NOT use etizolam or other benzodiazepine-like medications due to:
   • Lack of safety data in this age group 2, 5
   • Risk of dependence 6, 7
   • Potential for paradoxical reactions in children 5
   • Availability of safer, evidence-based alternatives 1, 2

Common Pitfalls to Avoid

• Using medications like etizolam that lack safety data in children and adolescents instead of evidence-based treatments 2, 5
• Failing to consider CBT as a first-line treatment option before initiating pharmacotherapy 1
• Inadequate monitoring for adverse effects when using SSRIs in children and adolescents 2
• Overlooking the potential for dependence with benzodiazepine-like medications such as etizolam 6, 7