Sertraline is probably the best medication available as first line drug treatment for severe anxiety in terms of the evidence from many different scientific trials - it has a lower rate of problematic side-effects and is usually very well tolerated. It also has better success rates than most other medications particularly if there is also associated low mood or OCD. But every child is unique and success is never guaranteed. It is usual to start at a low dose such as 25 or 50mg then for this to be increased after review. Some mild initial nausea is very common and usually short lasting - typically a few days. It may take about 2-3 weeks before any real benefit is seen. But as I say every person is different and I have sometimes seen dramatic improvements within a week. Only very rarely are side-effects unmanageable and there is no way of predicting in advance the few individuals who experience severe gastritis, or lethargy/fatigue , or deterioration of mood. But don't give up other effective medications can also be used.
Other treatable anxiety provoking issues may respond to OT involvement and management of sensory issues (sensitivities to noise, lights, smells, fabrics, personal space, seating arrangements etc).
DR Ciaran Kelly, Independent Child Psychiatrist, Romsey.
