Gastrointestinal symptoms are commonly reported as adverse effects of
selective serotonin reuptake inhibitors (
SSRIs), the first-line pharmacologic treatment for pediatric
anxiety disorders; however, the temporal course of these symptoms during treatment, although believed to be transient, has never been prospectively evaluated. Additionally, rates of gastrointestinal symptoms and functional gastrointestinal syndromes in anxious youth are poorly understood. We examined gastrointestinal symptoms in youth with
anxiety disorders during a double-blind, placebo-controlled trial of
escitalopram (n = 51). Then, in a separate sample of prospectively treated children and adolescents with generalized, social and/or
separation anxiety disorders (n = 56), we examined the frequency of gastrointestinal symptoms based on the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) and ROME III criteria and the association of these symptoms with clinical and demographic characteristics using logistic regression. The frequency/severity of
abdominal pain,
diarrhea, bloating
constipation or total gastrointestinal symptoms did not differ between patients receiving placebo (n = 25) or
escitalopram (n = 26). However,
escitalopram-treated youth had transient changes in
nausea/
vomiting and total upper gastrointestinal symptoms during the first two weeks of treatment. ROME III criteria for functional gastrointestinal syndromes were present in 12/56 patients (21.4%). QPGS-related functional gastrointestinal syndromes and symptoms were unrelated to treatment, treatment type, or clinical or demographic variables. Gastrointestinal symptoms are common in youth with anxiety and
SSRIs produce transient-rather than sustained-gastrointestinal symptoms. Assessing gastrointestinal symptoms prior to
pharmacotherapy and discussing factors that increase (or decrease) the likelihood of transient SSRI-related symptoms in youth may decrease patient uncertainty related to side effects and decrease medication-related anxiety.