From the Guidelines
Fluoxetine is prescribed for children with anxiety disorders typically starting at a lower dose than adults, usually 5-10 mg daily for children aged 7-18 years. The dose may be gradually increased if needed, with a typical target range of 10-20 mg daily, not exceeding 60 mg per day, as recommended by the American Academy of Child and Adolescent Psychiatry 1. Treatment should continue for at least 6 months after symptom improvement to prevent relapse. Parents should be aware that fluoxetine may take 2-4 weeks to show therapeutic effects, and common side effects include nausea, headache, sleep disturbances, and decreased appetite. Close monitoring is essential during the first few weeks of treatment due to a small increased risk of suicidal thoughts in pediatric patients, as noted by the USPSTF 1. Fluoxetine works by increasing serotonin levels in the brain, which helps regulate mood and anxiety. It should be part of a comprehensive treatment plan that includes psychotherapy, particularly cognitive-behavioral therapy, as suggested by the AACAP 1. Abrupt discontinuation should be avoided; instead, the medication should be tapered gradually under medical supervision to prevent withdrawal symptoms, as recommended by the American Academy of Pediatrics 1.
Some key considerations when prescribing fluoxetine for children with anxiety disorders include:
- Starting with a low dose and gradually increasing as needed
- Monitoring for common side effects such as nausea and headache
- Close monitoring for suicidal thoughts and behaviors, especially during the first few weeks of treatment
- Combining medication with psychotherapy, such as cognitive-behavioral therapy
- Tapering the medication gradually when discontinuing to prevent withdrawal symptoms
Overall, fluoxetine can be an effective treatment for anxiety disorders in children, but it should be used with caution and under close medical supervision, as recommended by recent studies 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fluoxetine Prescription for Children with Anxiety
- Fluoxetine is prescribed for children with anxiety disorders, including overanxious disorders, social phobia, and separation anxiety disorder 2.
- The medication is typically started at a low dose, such as 5 mg daily, and increased weekly by 5 or 10 mg daily until improvement occurs or to a maximum of 40 mg (children under 12) or 80 mg (adolescents) 3.
- Studies have shown that fluoxetine can be an effective and safe treatment for non-depressed children and adolescents with anxiety disorders, with 61% of patients showing much to very much improvement in anxiety symptoms 4.
- Common side effects of fluoxetine in children include drowsiness, sleep problems, decreased appetite, nausea, abdominal pain, and excitement, but these are typically transient and mild 3, 4.
Dosage and Administration
- The mean dose of fluoxetine for children is 24 mg (0.7 mg/kg) and for adolescents is 40 mg (0.71 mg/kg) 3.
- Youths with only one anxiety disorder may respond to lower doses of fluoxetine than patients with multiple anxiety disorders 3.
- Fluoxetine can be used in combination with cognitive-behavioral therapy (CBT) to produce greater improvement than either treatment alone 5.
Response to Treatment
- The response to fluoxetine treatment can vary across disorders, with social phobia and generalized anxiety disorder responding better to fluoxetine than placebo 4.
- Severity of anxiety at intake and positive family history for anxiety can predict poorer functioning at the end of the study 4.
- Combination treatment with SSRI and CBT can produce faster and greater relief, especially for patients who are younger, with milder baseline anxiety/depression symptoms, and depressive disorders 5.