There are two schools of thought on treating phobias. The medical model treats mental disorders as physical diseases, prescribing medication to treat the underlying chemical imbalances in the brain. Proponents of this model point to research that shows successful treatment of phobias through the use of SSRIs, MAOIs or other medications.
However, many professionals contend that medication is unnecessary in the treatment of phobias. Therapy has been repeatedly shown to be effective in treating phobias, often in just a few sessions. Proponents of this model argue that medications carry a risk of side effects and interactions and should not be prescribed for conditions that can be effectively treated without them.
FDA Warnings on Antidepressants
Since 2005, the Food and Drug Administration has required all antidepressants to carry a black box warning that clearly indicates an increased risk of suicidal behavior in children and teens. In 2007, that warning was expanded to include young adults under the age of 25.
Among the most commonly prescribed medications for phobias are antidepressants such as Prozac (fluoxetine) and Zoloft (sertraline). These medications, along with all other antidepressants, carry the warning labels.
Medication Alternatives to Antidepressants
Some medications that are prescribed for phobias are not antidepressants and do not appear to increase the risk of suicidal behavior in children and teens. These include:
- Beta Blockers: These medications suppress norepinephrine, also known as adrenaline.
- Benzodiazepenes: Mild sedatives such as Valium (diazepam) and Ativan (lorazepam).
Of course, these medications also have a risk of side effects and interactions with other substances. While the risks are low, parents should remember that there is no such thing as a completely risk-free medication.
Medication Monitoring
If medications are prescribed, then the child must be monitored for possible reactions. Although there is room for clinical discretion, depending on the situation, monitoring often follows some variation of the following schedule: Weekly doctor visits for the first month of treatment, tapering off to once every two weeks in the second month. A follow-up visit will likely occur after approximately 12 weeks. At that point, the doctor will determine how frequently visits should be scheduled.
Behavior Monitoring
Parents should also monitor their children for suicidal behavior or other adverse reactions. Behavioral changes that may indicate a problem include:
- Losing Interest in Activities and Friendships
- Increased Time Alone
- Agitation or Restlessness
- Increased Panic Attacks
- Anger or Hostility
- Increased Anxiety
- Trouble Sleeping
- Unusual Sadness
- Thoughts or Talk of Suicide
- Self-Injuring Behavior
These and any other behavior changes should immediately be brought to attention of the child’s doctor.
Should Medications Be Used?
Ultimately, this is a question that can only be answered by consulting the child’s health care provider. In many cases, phobias can be treated through therapy rather than medication. However, each child is different and each phobia is different.
Parents who are concerned about their children’s medication should request an appointment with the prescribing doctor to discuss the situation. Psychiatric medications should never be suddenly stopped without medical approval, as this can cause a dangerous reaction.
Source:“Antidepressants for children: Explore the pros and cons”. Mayo Clinic. May 23, 2007. March 12, 2008. http://www.mayoclinic.com/health/antidepressants/MH00059
