In pediatric anxiety, under what conditions may SSRIs be considered?

• A. For mild cases, SSRIs are always preferred.
• B. SSRIs are contraindicated in pediatric anxiety.
• C. SSRIs like fluoxetine may be considered for moderate to severe cases under supervision.
• D. SSRIs replace CBT as sole treatment.

Answer: (C)

In pediatric anxiety, medication with SSRIs is considered when the illness is moderate to severe and causing noticeable impairment, and it should be used under careful supervision—often alongside psychotherapy or after psychotherapy alone has not yielded adequate improvement. Fluoxetine is a commonly cited example of an SSRI that may be considered in these cases, with dosing and safety monitored by a clinician. The reason this approach fits is that SSRIs have demonstrated efficacy for pediatric anxiety disorders, but they come with risks such as potential suicidality and various side effects, so they require gradual titration and close monitoring.

Milder cases are usually managed with psychotherapy alone, particularly CBT, before resorting to medication. SSRIs are not contraindicated across the board, but they are not the default first-line choice for all pediatric anxiety. They also should not be used as a replacement for CBT as the sole treatment; a combined or sequential approach is often chosen based on symptom severity, impairment, and response to therapy.