School phobia (also called school refusal) is a complex condition often rooted in underlying anxiety disorders, depression, or separation anxiety, particularly in children and adolescents. Pharmacological treatment is not always the first line (behavioral and family-based therapies usually come first), but certain medications may help, especially in severe or persistent cases.
1. SSRIs (Selective Serotonin Reuptake Inhibitors)
Often considered first-line when medication is needed, particularly if school refusal is linked to:
- Separation anxiety disorder
- Generalized anxiety disorder (GAD)
- Social anxiety disorder
- Depression
Effective SSRIs:
- Fluoxetine (Prozac): FDA-approved for depression in children >8 years
- Sertraline (Zoloft): Often used off-label for anxiety in children >6
- Escitalopram (Lexapro): Approved for adolescent depression >12
- Fluvoxamine: Useful for anxiety/OCD-like school refusal
2. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
Used if SSRIs are not tolerated or ineffective:
- Venlafaxine (Effexor XR): Some efficacy in pediatric anxiety, but may have more side effects (e.g., blood pressure, irritability)
- Duloxetine (Cymbalta): Approved for GAD in children ≥7 years
3. Anxiolytics (Short-term Use Only)
- Benzodiazepines (e.g., lorazepam, clonazepam): Not recommended long-term due to dependency risk, but occasionally used short-term for extreme distress.
- Hydroxyzine: Non-addictive antihistamine with anxiolytic effects; useful in acute episodes.
4. Atypical Antipsychotics (Augmentation in Severe Cases)
- Risperidone or Aripiprazole: Sometimes added if anxiety is severe, comorbid with autism spectrum disorder or behavioral dysregulation.
Important Notes:
- Multimodal treatment is key: Always combine with CBT, family therapy, and school reintegration plans.
- Early intervention and individualized plans are essential.
- Monitor for increased anxiety, suicidal thoughts, or behavioral activation, especially in the first weeks of SSRI treatment.
Would you like a treatment flowchart or a brief review of evidence-based non-drug interventions for school refusal?
