Should My College Student Take Anxiety Medication?

Terri calls her mother and is crying. “Every day I wake up in the morning with my heart race racing and I’m too stressed to eat. I feel anxious all day and it’s hard to fall asleep. I'm worried that if I catch COVID, I’ll miss lab for my class and fail. Do you think I should take anxiety medication?”

Terri’s mother responds, “I think everyone’s anxious about COVID. When the rates come down, you’ll feel better. I don’t think you should take medication.”

Terri’s mother is correct that anxiety rates are up. Anxiety was already on the rise before COVID but is now sky-high in the COVID era. The Healthy Minds Study screens thousands of college students annually with a questionnaire for generalized anxiety disorder (GAD) and found that pre-COVID (2018-2019), the rate of GAD was 31%, while during COVID (winter and spring of 2021), the rate was 34%. GAD consists of at least six months of excessive anxiety accompanied by at least three other symptoms like poor concentration, muscle tension, fatigue, feeling on edge, irritability, and poor sleep. These symptoms interfere with a student’s ability to function or cause significant distress. In the age of COVID, students experience multiple triggers of their anxiety that include fear of loved ones getting COVID, uncertainty about whether classes will be online or in person, and social isolation from pandemic restrictions.

Should Terri take medication for anxiety? More college students are using medication for anxiety than they have in the past. Research shows that 1 in 4 college students used a psychiatric medication in the last year. In a study conducted by myself and colleagues, we found the use of medication specifically for anxiety (benzodiazepines, buspirone) has doubled from 2007-2019, increasing from 3.0% to 7.6% of students. The use of antidepressant medications like sertraline and escitalopram, which are FDA-approved to treat depression and GAD, has also doubled, from 8.0% to 15.3%.

Terri responds to her mother, “Well, I need to do something. I’ve been anxious for over six months and my grades are going down."

Terri’s mother says, “Why don’t you talk with a therapist at the campus counseling center to see what they recommend?”

It’s always a good idea for a person experiencing distressing anxiety to speak with a therapist. Not everyone with anxiety will need medication. The decision to start medication depends on the severity of symptoms, how functioning is impacted, and patient preference. British and Canadian universities use a stepped care model of treatment, matching level of treatment to the severity of anxiety. In American universities, there is also a similar assessment that will lead to recommendations for the appropriate level of mental health care.

If anxiety symptoms are mild, students might be offered suggestions like exercise, meditation apps, group therapy, or peer counseling. Peer counseling is increasingly popular among college students. A recently published report shows one-fifth of university students have used peer counseling, while nearly 2 of 3 of those who have not had peer counseling are interested in pursuing this, with stress and anxiety as top concerns.

Students with moderate symptoms could be offered individual therapy and/or a meeting with a primary care doctor or psychiatrist regarding medication options. The student might benefit from a physical exam to evaluate for medical causes of anxiety. Students with severe symptoms could consider treatment by a therapist and a psychiatrist.

Terri meets with her campus therapist who diagnoses GAD with moderate symptoms. The therapist refers her to the primary care doctor on campus, as she has not had a physical exam in a few years and describes daytime fatigue. The primary care doctor learns that Terri has been taking a daily energy drink containing a high level of caffeine to address her fatigue, but it might also increase her anxiety and insomnia. Her primary care doctor guides her on tapering the caffeine and recommends exercise to reduce anxiety and increase energy. Terri exercises and does cognitive behavioral therapy. Her anxiety decreases but continues to keep her up at night; her grades are slipping.

“Mom,” she says. “I want to try medication at this point. I’ll keep doing therapy, but it doesn’t seem to be enough.”

“I think taking medication is a good idea. Just make sure you don’t take anything you can get addicted to.”

Terri’s mother may be referring to the benzodiazepines, which include medications like alprazolam and lorazepam. Many college psychiatrists choose medications other than benzodiazepines due to their risk of abuse, dependency, and overdose. An alternative to benzodiazepines for the short-term relief of anxiety is an antihistamine called hydroxyzine. The best daily medications to treat GAD are antidepressants from the selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) categories. The SSRIs sertraline and escitalopram and the SNRIs venlafaxine and duloxetine are effective treatments for GAD.

Here are a few things to know about these SSRIs and SNRIs:

1. It’s best to start medication at a low dose and increase slowly to reduce side effects.
2. Patients should notice improvement in two to four weeks.
3. It’s recommended patients stay on medications for at least six to 12 months.
4. If it is decided to stop medication, it should be tapered slowly to reduce discontinuation effects.
5. Antidepressants have a black box warning that they can increase suicidal thinking and behaviors in those 24 or younger. This does not happen often, but if it does, the student should notify their provider.

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After taking escitalopram prescribed by a psychiatrist, Terri is able to sleep better and her grades improve. She continues to work in therapy on how to stay socially connected with friends while being safe, and how to cope with the uncertainty of academic life in the face of COVID. She practices Tai Chi, which is extremely effective for her anxiety, and after nine months of use, she tapers and stops her medication.

If your college student is experiencing anxiety, encourage them to get evaluated in their campus mental health service and explore different tools for treating their anxiety, that may or may not include medication. If your student does take medication, they will still benefit from working with a therapist who can teach behaviors to reduce anxiety and change catastrophizing thought patterns. While COVID has brought about a new age of anxiety, we can defeat symptoms with a stepped care approach to treatment.

To find a therapist, please visit the Psychology Today Therapy Directory.