Anxiety Signs and Treatments in Teens and Young Adults

by Dr. Wesley c. Sassaman, DNP, MPH, MSN-NE, MBA, FNP-C, CARN-AP

Understanding the Prevalence of Anxiety

The prevalence of anxiety among teens and young adults in the United States is a significant public health concern, with various studies highlighting its widespread impact. According to a study analyzing data from the National Survey of Children's Health (NSCH), approximately 20% of US children have a reported mental health condition, and an estimated 40% will be diagnosed with one by age 18, indicating a substantial prevalence of anxiety and other mental health issues in this demographic (Asos et al., 2024).

Recognizing the Signs of Anxiety

As a parent, there are several signs you might look for that could indicate your child has an emerging anxiety disorder. You may notice an increased frequency and intensity of anxiety symptoms such as excessive worry, fear, and avoidance behaviors. For example, children might show heightened stress responses to everyday situations, which can manifest as physical symptoms like headaches or stomachaches, as well as emotional symptoms like irritability or restlessness (Skaarnes et al., 2023)] Additionally, observe if your child is struggling with social interactions, leading to social isolation or withdrawal from activities they previously enjoyed. This was particularly noted during the COVID-19 pandemic when social functioning and quality of life were significantly impacted  (Mcloughlin et al., 2023).

Keep an eye on your child's academic performance; it may decline due to difficulties in concentrating and persistent worry, exacerbated by the stress of navigating school environments and peer relationships  (Haley et al., 2023). Furthermore, children exposed to negative parental behaviors, such as threatening or overly critical attitudes, may develop feelings of helplessness and low self-efficacy, contributing to the severity of their anxiety symptoms.

Effective Treatments for Anxiety

Various psychiatric medications are utilized in the treatment of anxiety disorders in adolescents and young adults, tailored to the specific condition at hand. For generalized anxiety disorder (GAD), common prescriptions include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), with agomelatine also proving effective in this demographic (Update on treatments for anxiety-related disorders, 2022; Lee & Stein, 2022). Social anxiety disorder (SAD), or social phobia, is similarly addressed with SSRIs and SNRIs, while recent research indicates that transcranial direct current stimulation (tDCS) holds promise as a viable treatment option (Update on treatments for anxiety-related disorders, 2022; Lee & Stein, 2022). Although less discussed, separation anxiety is commonly treated with SSRIs, which are widely used in various anxiety disorders due to their effectiveness and safety profile. Panic disorders are managed with SSRIs, SNRIs, and benzodiazepines, the latter being useful for immediate symptom relief, albeit with caution due to the risk of dependence (Update on treatments for anxiety-related disorders, 2022; Lee & Stein, 2022). Specific phobias often involve exposure therapy, but pharmacological solutions like SSRIs and benzodiazepines can be utilized to alleviate severe anxiety symptoms linked to phobic triggers (Update on treatments for anxiety-related disorders, 2022; Lee & Stein, 2022). Furthermore, emerging treatments such as ketamine, psilocybin, and cannabidiol are under investigation for their potential benefits in various anxiety disorders, including GAD and SAD, although further research is needed to establish their efficacy and safety in young adults (Update on treatments for anxiety-related disorders, 2022; Lee & Stein, 2022). The significant prevalence of anxiety disorders in young adults, as evidenced by a study reporting a 10.9% incidence rate, emphasizes the importance of early detection and intervention to minimize the long-term impact of these conditions (Guimarães et al., 2022). This holistic approach to pharmacotherapy, in conjunction with psychological interventions, aims to deliver effective management of anxiety disorders in adolescents and young adults.

Medications for Each Anxiety Disorder

Generalized Anxiety Disorder (GAD): Medications for GAD include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline, or serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine, which help balance brain chemicals to reduce anxiety symptoms .

Social Anxiety Disorder (SAD): SSRIs such as paroxetine and sertraline, and SNRIs like venlafaxine, are commonly prescribed for SAD to help manage symptoms by increasing serotonin and norepinephrine levels in the brain .

Specific Phobias: Medications are not typically the first line of treatment for specific phobias; instead, exposure therapy is often used to help individuals gradually face and overcome their fears .

Panic Disorder: SSRIs like fluoxetine and sertraline, and benzodiazepines such as alprazolam and clonazepam, are used to manage panic disorder by reducing the frequency and severity of panic attacks .

Agoraphobia: SSRIs and SNRIs are also used for agoraphobia, often in combination with cognitive-behavioral therapy (CBT) to help individuals manage their fear of open or crowded spaces .

Separation Anxiety Disorder: SSRIs are sometimes prescribed for separation anxiety disorder, especially when symptoms are severe and interfere with daily functioning .

Selective Mutism: SSRIs like fluoxetine may be used to help reduce anxiety in children with selective mutism, although behavioral therapies are often the primary treatment .

Obsessive-Compulsive Disorder (OCD): SSRIs such as fluoxetine, fluvoxamine, and sertraline are commonly used to treat OCD by reducing the intensity of obsessions and compulsions .

Post-Traumatic Stress Disorder (PTSD): SSRIs like sertraline and paroxetine are approved for treating PTSD, helping to manage symptoms such as re-experiencing the trauma and hyperarousal .

Acute Stress Disorder: Short-term use of benzodiazepines may be prescribed to help manage acute stress disorder symptoms, although the focus is often on psychological therapies .

Adjustment Disorders: Medications are not typically the first line of treatment for adjustment disorders; instead, supportive counseling and stress management techniques are often used .

Substance/Medication-Induced Anxiety Disorder: Treatment involves discontinuing the substance or medication causing the anxiety, and sometimes using medications like SSRIs to manage symptoms during withdrawal .

Most Effective Talk Therapies for Teens and Young Adults

The most effective talk therapies for teens and young adults include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Metacognitive Interpersonal Therapy (MIT). CBT and DBT are widely recognized for their efficacy in treating various mental health issues in adolescents, including depression, anxiety, and borderline personality disorder (BPD). CBT focuses on changing negative thought patterns and behaviors, while DBT combines CBT techniques with mindfulness and emotional regulation strategies. Studies have shown that both individual and group-based DBT can significantly improve symptoms of emotion dysregulation, depression, and stress in young people, with no significant difference in effectiveness between shorter and more intensive programs (de Andrade et al., 2024). In high-intensity settings like inpatient and partial hospitalization programs, adaptations of CBT and DBT are necessary due to the high acuity and limited resources, yet they remain effective in managing severe cases (Thordarson et al., 2024). Additionally, internet-based CBT (ICBT) has proven beneficial for adolescents with social anxiety disorder (SAD), offering a self-help format that reduces symptoms of social anxiety, depression, and general anxiety, making it a viable option for those who prefer not to engage in face-to-face therapy (Matsumoto et al., 2023). Furthermore, MIT, which focuses on enhancing mentalization skills, has shown greater efficacy in symptom reduction compared to treatment-as-usual (TAU) therapies, indicating its potential in improving psychopathology in adolescents and young adults (Marconi et al., 2023). The therapeutic alliance, a critical component in all these therapies, is particularly challenging yet essential in adolescent psychotherapy. Addressing and repairing alliance ruptures can significantly enhance engagement and outcomes, underscoring the need for therapists to adapt their approaches to the unique developmental stages and challenges faced by adolescents (Cirasola et al., 2024) Collectively, these therapies offer robust frameworks for addressing the complex mental health needs of teens and young adults.

Comparison of Therapy and Medication for Anxiety and Depression

·       Effectiveness of Therapy: Therapy, particularly cognitive-behavioral therapy (CBT), has been shown to be highly effective in treating anxiety and depression by helping individuals understand and change their thought patterns and behaviors, which can lead to long-term improvement and coping strategies.

·       Effectiveness of Medication: Medications, such as antidepressants and anti-anxiety drugs, can be effective in reducing symptoms of anxiety and depression, often working faster than therapy to alleviate symptoms, but they may not address the underlying causes of these conditions.

·       Combination of Both: Research suggests that a combination of therapy and medication can be more effective than either treatment alone, as therapy can provide coping strategies and address underlying issues, while medication can help manage symptoms more quickly.

·       Long-term Benefits of Therapy: Therapy can offer long-term benefits by equipping individuals with tools and strategies to manage their symptoms and prevent relapse, whereas medication often requires ongoing use to maintain its effects.

·       Side Effects and Risks: Medications can have side effects and risks, such as dependency or withdrawal symptoms, which are not a concern with therapy. Therapy, on the other hand, is generally considered safe and free of physical side effects.

·       Personalized Treatment: The choice between therapy, medication, or a combination of both should be personalized based on the individual's specific needs, preferences, and the severity of their symptoms, as well as any other health considerations.

·       Adolescent Considerations: For adolescents, therapy can be particularly important due to the unique developmental challenges they face, such as resistance to treatment and confidentiality issues, which can strain the therapeutic relationship and require a tailored approach to effectively address their needs.

Summary

In summary, both therapy and medication have their own strengths and can be effective in treating anxiety and depression. The best approach often depends on the individual's specific situation, and a combination of both may provide the most comprehensive treatment.

Reference

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Skaarnes, H., Sorensen, N., Lomholt, J.J., Thastum, M.M., Mathiasen, K. (2023). [Title of the Article]. European Psychiatry, 66, S857-S857.

Mcloughlin, A., Mulholland, K. R., McMahon, E., Plunkett, R., Hennigan, K., McDonald, C., Hallahan, B. (2023). A 2-year longitudinal evaluation of the impact of the COVID-19 pandemic on individuals with pre-existing anxiety disorders. Irish Journal of Psychological Medicine, 1-8. Doi: 10.1017/ipm.2023.17,\.

Haley, C. R. B., Tibbo, P., Conrod, P. J., Yunus, F. M., Keough, M. T., Thompson, K., Krank, M. D., Hadwin, A. F., Stewart, S. H. (2023). Do anxiety symptoms mediate the association between cannabis use frequency and psychotic-like experiences in emerging adult undergraduates? The Canadian Journal of Psychiatry.

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Lee, H. J., & Stein, M. B. (2022). Update on treatments for anxiety-related disorders. Current Opinion in Psychiatry, 36, 140-145. doi: 10.1097/YCO.0000000000000841.

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de Andrade, D., Davidson, L., Robertson, C. M. T., Williams, P. L., Leung, J., Walter, Z., Allan, J., & Hides, L. (2024). Randomized effectiveness‐implementation trial of dialectical behavior therapy interventions for young people with borderline personality disorder symptoms. Journal of Clinical Psychology. Wiley-Blackwell.

Thordarson, M. A., Sullivan, P., Baweja, R., Zucker, J., Neelley, M., Xie, I., & Friedberg, R. D. (2024). Cognitive behavior and dialectical behavior therapy in high intensity settings. Journal of the American Academy of Child.

Matsumoto, K., Hamatani, S., Shiga, K., Iiboshi, K., Kasai, M., Kimura, Y., Yokota, S., Watanabe, K., Kubo, Y., & Nakamura, M. (2023). Effectiveness of unguided internet-based cognitive behavioral therapy for subthreshold social anxiety disorder in adolescents and young adults: Multicenter, randomized, controlled trial (Preprint). JMIR Pediatrics and Parenting.

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