Australian-first clinical guidelines for treating anxiety in children recommend starting with an SSRI over other medications if drug therapy is warranted but warn against pharmacotherapy as a first-line treatment.

The new guidance also suggests a ‘start low and go slow’ approach and to titrate up stepwise “to reach an effective dose that is well tolerated”. 

The starting dose for recommended SSRIs includes fluoxetine 5-10mg, sertraline 12.5-25mg, escitalopram 5mg or fluvoxamine 12.5-25 mg; if these are poorly tolerated or ineffective for symptom management, an SNRI could be considered.

However, the guideline authors — from the University of Melbourne, Murdoch Children’s Research Institute and the Royal Children’s Hospital Melbourne — stress that psychological therapy should be offered first when initiating treatment for anxiety in under-18s.