Anxiety in Teens and Young Adults: When Is It Time to Get Help?

 

Part of the Jellybean Pediatrics Teen & Young Adult Health Library

 

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Short answer

 

Everyone feels anxious sometimes.

 

Anxiety before a test, a big game, a first date, a college interview, or an unfamiliar situation is part of being human. But sometimes anxiety becomes more than an occasional feeling. It can start taking up too much space—affecting sleep, school, relationships, physical health, or the things you want to be able to do.

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When that happens, you don't necessarily need to figure out on your own whether you have an "anxiety disorder."

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You can start by talking with a healthcare professional about what's going on.

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And if anxiety is significantly interfering with your life, effective treatments are available—including therapy, medication, or sometimes both.

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What can anxiety look like?

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Anxiety doesn't always look like someone saying, "I'm anxious."

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It can look like:

• worrying constantly about things that might happen

• replaying conversations or mistakes over and over

• needing frequent reassurance

• feeling overwhelmed by things that other people seem to handle easily

• avoiding school, activities, driving, social situations, presentations, or other things that make you nervous

• procrastinating because starting something feels overwhelming

• having trouble falling asleep because your brain won't quiet down

• irritability or feeling constantly on edge

• difficulty concentrating

• feeling like you can't relax

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Anxiety can also feel surprisingly physical.

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Some people experience:

• racing or pounding heart

• nausea or stomachaches

• headaches

• sweating

• shakiness

• dizziness

• chest tightness

• shortness of breath

• muscle tension

• feeling hot or flushed

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Sometimes people seek medical care for the physical symptoms before realizing anxiety may be contributing to them.

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Why does my teen have stomach aches every morning?

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This is one of the most common reasons anxious teens end up in my office—not because anyone said "I feel anxious," but because they feel sick.

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Morning nausea, stomach pain right before school, appetite changes, or symptoms that look a lot like irritable bowel syndrome are extremely common in anxious kids and teens. There's a real biological reason for this: the gut has its own extensive network of nerves, and it communicates constantly with the brain along what's sometimes called the gut-brain axis. Stress hormones and gut function are directly linked. This connection isn't unique to anxiety—but anxiety is one of the most common drivers of it in this age group.

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A few things I want families to know:

• These symptoms are real, not "made up" or exaggerated—even though a full GI workup often comes back completely normal.

• It's still worth ruling out other causes with your pediatrician, especially if there are red flags like weight loss, blood in the stool, fevers, or symptoms that wake someone from sleep.

• When the workup is normal and anxiety is the driver, treating the anxiety is often the most effective way to improve the stomach symptoms—sometimes more effective than anything aimed at the gut directly.

• This pattern is especially common right before school, on Sunday nights, or before anything socially stressful, which is often a helpful clue.

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If your teen has had normal bloodwork, normal imaging, or a normal GI evaluation and the stomach symptoms are still happening, it's worth asking whether anxiety could be part of the picture.

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Stress or anxiety disorder?

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There isn't a single line separating "normal stress" from anxiety that needs treatment.

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One of the most useful questions is:

Is anxiety getting in the way of your life?

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Maybe you're still getting good grades—but it takes hours of panic and perfectionism to get your work done.

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Maybe you have friends—but spend days worrying about something you said.

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Maybe you go to school—but feel sick every morning before you leave.

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Maybe you've started avoiding activities, classes, driving, eating around other people, or other things you actually want to be able to do.

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How much anxiety affects your life can matter just as much as how anxious you appear to everyone else.

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Anxiety rarely travels alone

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One thing I want families to understand: anxiety often shows up alongside other things, and recognizing those connections can change how we approach treatment.

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Eating patterns. Anxiety and disordered eating are closely linked, and one often sets the stage for the other. The same traits that fuel anxiety—perfectionism, a need for control, difficulty tolerating uncertainty—are common in teens who develop restrictive or disordered eating patterns. When I'm evaluating anxiety, I'm also paying attention to how someone's relationship with food and body image is doing, because catching a shift early makes a real difference. If this feels relevant to you or your teen, it's worth naming directly at a visit—we can talk through it and involve additional specialists if needed.

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Stomach and GI symptoms. (More on this above—it's common enough that I gave it its own section.)

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ADHD. Anxiety and ADHD overlap often enough that I always screen for both when either one is on the table. Anxiety can make ADHD symptoms look worse (a distracted, anxious brain has trouble focusing on anything), and undiagnosed ADHD can generate a lot of anxiety of its own—falling behind, forgetting things, feeling like you're constantly failing to keep up. Sorting out which symptoms belong to which condition—and in what order to treat them—is part of what an evaluation is for. It also matters for medication decisions: treating underlying ADHD can sometimes improve anxiety, while some people do notice increased anxiety with stimulant medication.

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None of this means anxiety automatically comes with these other conditions. It just means I'm listening for them, because treating anxiety in isolation when something else is also going on tends to leave people stuck.

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Does anxiety look different in girls and boys?

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In some ways, yes.

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Anxiety disorders are diagnosed roughly twice as often in girls and young women as in boys and young men, and that gap tends to open up specifically around puberty. Before adolescence, rates are closer to equal. Something about the hormonal, social, and developmental changes of the teen years seems to hit girls harder, on average, when it comes to anxiety.

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Girls more often present with the anxiety we typically picture—persistent worry, social anxiety, panic symptoms, and anxiety that clusters with eating and body image concerns.

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Boys can also be struggling with anxiety even when it doesn't look like the anxiety we typically picture. It can show up as irritability, anger, restlessness, or acting out, and it's more likely to travel with ADHD or other externalizing behavior. Because of that, anxiety in boys can be under-recognized—by parents, by schools, and sometimes by boys themselves, who may not identify what they're feeling as "anxious" at all.

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I mention this because anxiety doesn't always announce itself as worry. Irritability, anger, avoidance, restlessness, and physical complaints can all be part of the picture, in any teen.

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What happens during an anxiety evaluation?

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There isn't a blood test or brain scan that diagnoses anxiety.

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An evaluation starts with a conversation.

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I want to understand what you're experiencing, how long it has been happening, what makes it better or worse, and how much it is affecting your everyday life.

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We may talk about:

• worry and fears

• panic symptoms

• school or work

• friendships and relationships

• sleep

• mood

• concentration

• ADHD symptoms

• eating patterns and body image

• stomach or other physical symptoms

• medications and substances, including caffeine

• medical conditions that could contribute to what you're experiencing

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Screening questionnaires can also help us understand your symptoms and track whether they're improving over time.

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One thing worth calling out from that list: caffeine. Energy drinks, coffee, and highly caffeinated sodas are a bigger part of teen life than a lot of parents realize, and caffeine can mimic anxiety symptoms—racing heart, jitteriness, trouble sleeping—or make existing anxiety noticeably worse. It's not the whole picture for most people, but cutting back is a simple, free experiment worth trying alongside anything else we decide to do.

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For teens, part of the visit may happen privately without a parent in the room. That's a normal part of adolescent healthcare and gives teens an opportunity to talk openly about what's going on.

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A note for parents: the accommodation trap

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This is one of the most useful things I discuss with families, and almost nobody talks about it outside a therapist's office.

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When your teen is anxious, the loving instinct is to make the anxiety-provoking thing go away. You email the teacher so they don't have to give the presentation. You order for them at the restaurant. You let them skip the party. You do the phone call they're dreading. You check in on their symptoms constantly to make sure they're okay.

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This is called accommodation, and it's completely understandable—no parent wants to watch their kid suffer. But accommodation tends to make anxiety stronger over time, not weaker. Every time avoidance is made easier, the brain gets a clear message: that thing really was dangerous, and avoiding it was the right call. The anxiety gets reinforced instead of tested.

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This doesn't mean pushing an anxious teen into the deep end or refusing to help at all. It means being thoughtful about the difference between:

• Supporting — validating how hard something feels, helping them make a plan, going with them the first time, praising the attempt regardless of outcome

• Accommodating — doing the hard thing for them, letting them avoid it altogether, or restructuring the family's life around the anxiety long-term

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A useful shift for many families is moving from "let me fix this for you" to "let me help you get through this." Small, repeated practice facing manageable amounts of the anxiety-provoking thing—with support rather than avoidance—is a lot of what CBT is built around. Simply noticing where accommodation has crept in can be a helpful first step.

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If you're not sure whether something you're doing is support or accommodation, that's a very reasonable thing to bring up at a visit.

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Do I need therapy?

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Therapy—particularly cognitive behavioral therapy (CBT)—is one of the best-studied treatments for anxiety.

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A good therapist can help you understand patterns of anxious thinking and avoidance and gradually build skills for handling situations that anxiety has made difficult.

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For many people, therapy may be enough.

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For others, medication can also be an important part of treatment.

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And sometimes the best approach is both. In one of the largest studies of pediatric anxiety treatment, kids who did CBT together with an SSRI responded at a notably higher rate than kids who did either one alone—around 81% for the combination, compared with roughly 55–60% for CBT or medication by itself. That's part of why, when it fits someone's situation, I'll often suggest therapy and medication together rather than treating them as competing options.

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When is medication used for anxiety?

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Medication may be worth considering when anxiety is significantly interfering with daily life, symptoms are moderate to severe, therapy alone hasn't been enough, access to therapy is limited, or anxiety is making it difficult to participate fully in therapy or everyday activities.

The decision isn't based on whether your anxiety is "bad enough" compared with someone else's.

It's based on your symptoms, how they're affecting you, your medical history, what you've already tried, and what you and your family are comfortable with.

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What medications are used?

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For ongoing anxiety disorders in teens and young adults, medications called selective serotonin reuptake inhibitors (SSRIs) are commonly used.

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You may recognize names such as:

• fluoxetine (Prozac)

• sertraline (Zoloft)

• escitalopram (Lexapro)

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Despite being called antidepressants, SSRIs aren't only used for depression. They are also used to treat anxiety disorders. No specific SSRI carries an official FDA approval for anxiety in youth, but their use is backed by extensive clinical trial data and is recommended by the major pediatric guidelines—it's simply how this class of medication has been studied and used in practice for years.

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They don't work like a sedative, and the goal isn't to make you feel numb or change your personality.

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The goal is to turn down the intensity of anxiety enough that it stops controlling so much of your life.

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Interestingly, duloxetine (Cymbalta), an SNRI, does carry FDA approval for generalized anxiety disorder in children ages 7 and older. SSRIs are still commonly used first because they have extensive evidence supporting their use in pediatric anxiety, but duloxetine is sometimes a good option when an SSRI hasn't worked well—or when anxiety is showing up alongside chronic pain, frequent headaches, or ongoing stomach pain, since it can address both at once.

 

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Will medication make me feel different?

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Ideally, not in the way people often worry about.

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Successful anxiety treatment shouldn't make you stop caring about things or turn you into a different person.

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You may notice that something that previously produced an enormous anxiety response feels more manageable. You may find it easier to stop spiraling, tolerate uncertainty, fall asleep, participate in school, talk to people, or do things you've been avoiding.

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In other words, the goal isn't no anxiety.

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Some anxiety is useful.

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The goal is for anxiety to become proportional to what's actually happening—and manageable enough that you can live your life.

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How quickly do SSRIs work?

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Not immediately.

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Unlike medications that produce an effect within hours, SSRIs generally need time to work. Some people begin noticing improvement within the first few weeks, but the fuller effect often takes 6 to 12 weeks—and sometimes a dose adjustment—to become clear.

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Knowing this timeline ahead of time matters more than it might seem—one of the most common reasons SSRIs "don't work" is that someone stops too early, at week 2 or 3, right around when the medication is only just starting to build effect.

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That's why follow-up matters.

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Starting medication isn't just writing a prescription and hoping for the best. We check how you're doing, look for side effects, assess whether symptoms are improving, and adjust the plan when needed.

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What about side effects?

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SSRIs are generally well tolerated, but side effects can happen.

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Depending on the medication and the person, early side effects can include things like nausea, headache, changes in sleep, restlessness, or changes in appetite.

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Some people notice temporary increased jitteriness or anxiety when first starting medication—this is sometimes called "activation," and it's actually more common in teens than in adults. It's one reason I often start at a lower dose and increase gradually. Activation is often manageable, but it's something I want families to tell me about rather than simply pushing through on their own. Depending on what's happening, we may watch it, adjust the dose, or change the plan.

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SSRIs also carry an FDA boxed warning about an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults taking antidepressants. I think it's worth being specific about what this actually means, because the warning tends to sound scarier than the data behind it: in the studies that led to the warning, about 4% of young people on antidepressants reported new or worsening suicidal thoughts, compared with about 2% on placebo—and there were no completed suicides in any of those trials. That's a real difference worth taking seriously, not a reason to dismiss the warning, but it's also a much smaller absolute risk than many families picture when they first hear "boxed warning."

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That doesn't mean these medications shouldn't be used. It does mean that the benefits and risks should be discussed and that young people should be monitored, particularly when starting treatment or changing the dose.

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If you develop new or worsening thoughts of hurting yourself while taking medication, tell a trusted adult or healthcare professional right away and seek urgent help if you may be in immediate danger.

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Will I have to take medication forever?

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Usually, that's not the assumption.

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If medication works, we generally don't stop it the moment you feel better. Staying on treatment for a period of time after symptoms improve can reduce the chance that anxiety quickly returns. As a general framework, pediatric guidelines suggest continuing treatment for roughly 6 to 12 months after symptoms have improved before even considering a taper—though this is a starting point for the conversation, not a fixed rule for every person.

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Eventually, you and your clinician can talk about whether and when it makes sense to gradually decrease the medication, ideally during a lower-stress stretch rather than, say, the week before finals.

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SSRIs should generally be tapered rather than abruptly stopped.

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The timeline is individualized. There isn't a prize for getting off medication as quickly as possible, and needing medication longer doesn't mean you've failed.

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What about Xanax or other fast-acting anxiety medications?

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When people hear "anxiety medication," they sometimes think first of benzodiazepines such as Xanax (alprazolam), Ativan (lorazepam), or Klonopin (clonazepam).

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These are very different from SSRIs.

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Benzodiazepines can work quickly, but they can cause sedation and impair thinking and coordination, and they carry risks including tolerance and dependence. Just as importantly, clinical trials haven't shown that benzodiazepines are actually effective for treating anxiety disorders in children and teens—so beyond the risks, there isn't good evidence they do the job we'd want them to do. They generally aren't the medication we reach for to manage ongoing anxiety in teens and young adults.

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There are situations in medicine where short-term or situational medications may be appropriate, but treating an anxiety disorder usually means addressing the anxiety itself rather than repeatedly sedating the anxious feeling when it appears.

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What if I'm not sure I want medication?

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That's completely reasonable.

An evaluation doesn't commit you to taking anything.

You can talk through what you're experiencing, what treatment options exist, what the evidence shows, and the potential benefits and risks before deciding what you want to do.

For teens, parents are often an important part of that conversation. But I also want the teen taking the medication to understand why we're considering it, what to expect, and what questions or concerns they have.

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Treatment works best when the person taking the medication is part of the decision.

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Common myths about anxiety treatment

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"Medication will change who I am." A well-chosen medication at the right dose shouldn't flatten your personality or make you stop caring about things. If it does, that's a sign the medication or dose isn't right—not something you have to live with.

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"Once I start medication, I'll be on it forever." Not necessarily. Many people take medication for a defined period, respond well, and eventually taper off under guidance. Some people do need it longer-term, and that's not a failure—but "forever" isn't the default assumption going in.

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"This will go on my permanent record and follow me." A visit for anxiety becomes part of your confidential medical record, just like other medical care. It isn't automatically reported to your school or placed on your transcript, college application, or ordinary background check.

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"I should be able to handle this on my own / just try harder." Anxiety disorders are a medical condition, not a character flaw or a lack of effort. Plenty of people with anxiety are also hardworking, high-achieving, and "handling it" on the surface while struggling privately underneath.

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"Therapy is only for people who are really struggling." Therapy is useful across a wide range of severity, including for people whose anxiety hasn't reached a crisis point but is still getting in the way of life they want to be living.

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When should I get help?

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Consider talking with a healthcare professional if anxiety:

• is interfering with school, work, sleep, relationships, or activities

• causes significant physical symptoms

• leads you to avoid things you want or need to do

• feels difficult to control

• is causing frequent panic attacks

• has been persistent rather than tied to one temporary stressful situation

• is accompanied by depression, changes in eating, or other mental health concerns

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You don't have to wait until things are unbearable.

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How Jellybean Pediatrics can help

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Jellybean Pediatrics offers extended Teen & Young Adult Health visits for ages 12–24.

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An anxiety visit can include a detailed review of your symptoms and medical history, screening for anxiety and related conditions, discussion of treatment options, and—when appropriate—starting and managing medication.

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I don't provide psychotherapy, but I can work alongside your therapist or help you understand where therapy may fit into your treatment plan.

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If medication is appropriate, follow-up is an important part of care. We'll monitor how you're doing, address side effects or concerns, and adjust treatment when needed.

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You don't need to know whether you need medication before scheduling.

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Figuring that out is part of the visit.