According to the DSM-IV, "Diagnostic and Statistical Manual of Mental Disorders," a child diagnosed with Separation Anxiety Disorder must experience anxiety causing "clinically significant distress or impairment in social, academic or other important areas of functioning," when separated from attachment figures or home. Symptoms last at least four weeks and include excessive worry and fear about being alone, recurrent fear of losing loved ones, reluctance or refusal to go to school or to sleep, nightmares about separation and complaints of physical symptoms when separation is anticipated. Treatment may include psychotherapy, desensitization, behavioral therapy and medications.
Anti-Anxiety Medications
About 4 percent of children and young adolescents suffer from separation anxiety disorder and the condition is slightly more common in girls, according to the DSM-IV. Psychotherapy may successfully treat some children with separation anxiety disorder, but if symptoms do not improve with psychotherapy alone, anti-anxiety medications may be prescribed to help an anxious child feel less nervous. Anti-anxiety medications should be used in conjunction with therapy.
A short prescription of benzodiazepine may be helpful in relieving anxiety symptoms, but according to the National Center for Health and Wellness, "side effects of benzodiazepines in children have yet to be properly established," and these drugs are not generally recommended for individuals younger than 18. Long-term use of benzodiazepine drugs may result in dependence, and stopping them abruptly often causes severe withdrawal symptoms.
Buspirone is another medication prescribed in the short-term to relieve anxiety, but "Psychiatric News" reports that a pediatric trial by Bristol-Myers Squibb found that buspirone was not particularly helpful in treating certain types of anxiety in children.
Antidepressants: Selective Serotonin Reuptake Inhibitors
Separation anxiety is often associated with symptoms of depression, such as sadness, withdrawal or difficulty concentrating. Antidepressants may be prescribed for certain anxiety disorders, especially when the anxiety is accompanied by depression. Medication commonly prescribed to treat symptoms of separation anxiety disorder include Luvox, Paxil, Celexa, Lexapro, Prozac and Zoloft, medicines that belong to a class of drugs called Selective Serotonin Reuptake Inhibitors, or SSRIs.
These medicines usually begin to relieve symptoms after the child or adolescent has taken them for two to four weeks, but it may take three months to know if the antidepressant will be effective for a particular child. According to Massachusetts General Hospital's School Psychiatry Program, "there is no 'best' medicine to treat separation anxiety disorder, and it is important to remember that medicines usually reduce rather than eliminate symptoms."
(reference 3:
http://www2.massgeneral.org/schoolpsychiatry/info_separationanxiety.asp)
Tricyclic Antidepressants
Medication is needed only for a small number of children who have persistent anxiety and do not respond to behavior modification and psychotherapy alone. In her article, "Separation Anxiety in Young Children," psychiatrist Carol E. Watkins, M.D., discusses tricyclic antidepressants and explains that "a number of studies have shown that imipramine can help separation anxiety disorder," but she warns, "one needs to follow EKGs--heart tests--and blood tests for safety reasons...and at this point, an SSRI would be the medication of choice instead of Imipramine."
Controlled pediatric studies have been done with drugs such as imipramine, clomipramine and alprazolam. A study examining drug treatment for separation anxiety, conducted by G.A. Bernstein, M.D., and other researchers at University of Minnesota's Division of Child and Adolescent Psychiatry, compared the tricyclic antidepressant, imipramine, the anti-anxiety medication, alprazolaman, and a placebo. Although they found "no significant differences among the three treatment groups, greater numbers of children improved with imipramine and alprazolam than with placebo," according to the article, "Childhood Anxiety Disorders," by Susan Jo Perlmutter, M.D. Unfortunately, because of the brevity of treatment and small sample size, no absolute conclusions were able to be drawn about the efficacy of psychotropic medications for Separation Anxiety Disorder.
(reference 5:
http://www.acnp.org/g4/GN401000163/CH159.html)
References
- BehaveNet: DSM-IV & DSM-IV-TR: Separation Anxiety Disorder
- National Center for Health and Wellness: Benzodiazepine Information Sheet
- Massachusetts General Hospital: Separation Anxiety Disorder
- Northern County Psychiatric Associates: Separation Anxiety in Young Children by Carol E. Watkins, MD
- American College of Neuropsychopharmacology: Childhood Anxiety Disorders
