A substantial majority of primary care pediatricians in the United States believe it is their responsibility to prescribe medication, such as selective serotonin reuptake inhibitors (SSRI), to treat anxiety and depression in their patients, according to a research poster presented at the Pediatric Academic Societies (PAS) 2026 Meeting.

Most also felt well prepared to prescribe and manage SSRI in patients, more so than other ways to manage mood disorders, the researchers found. 

“The last 10 years have witnessed a youth mental health crisis, during which SSRI prescribing in primary care has increased sevenfold,” William Burr, PhD, of the American Academy of Pediatrics (AAP), and colleagues reported. 

However, primary care pediatricians’ comfort level with prescribing medications for these conditions declined with younger patients and with worsening symptoms in patients of any age.

Current clinical practice guidelines from the AAP recommend that pediatricians use an individualized multimodal approach to managing anxiety and depression in patients, with SSRI considered a first-line medication within a comprehensive treatment plan. 

To understand pediatricians’ comfort level with parts of these guidelines, the researchers analyzed data from the 2025 AAP Periodic Survey, a nationally representative survey of AAP members based in the United States who are actively practicing primary care, excluding residents. Of 1998 surveys, the response rate was 46% (n = 909). Questions related to the management of mental health included the respondents’ perception of their responsibility to prescribe SSRI, their preparedness to prescribe and manage SSRI, their comfort discussing different treatment options with families, and their interest in additional training related to prescribing SSRI.

Overall, 81% of pediatricians agreed or strongly agreed that it’s their responsibility to prescribe medication to treat anxiety and depression.

That number was surprising to co-author Mary Beth Miotto, MD, MPH, a pediatrician at Mattapan Community Health Center in Boston and an assistant professor of pediatrics at the UMass Chan Medical School in Worcester, Massachusetts.

“My previous impression was that a significant number of pediatricians historically felt psychiatrists were responsible for managing the mental health medication for adolescents,” Miotto told Medscape Medical News. “It’s reassuring that more pediatricians realize it’s our responsibility to our young patients to provide them access to care when they need it and do what it takes to master the prescribing skills.”

While 74% of respondents felt prepared or very prepared to prescribe and manage medication for these conditions in children aged 14 or older, 64% felt prepared for those aged 12-13, and 44% felt prepared for children under age 12.

“More training may be needed to improve pediatrician competence and confidence providing the full spectrum of anxiety and depression care for children, including care for children under 12,” the researchers concluded.

A majority of pediatricians (66%) also reported feeling prepared to manage SSRI medication when a patient’s anxiety or depression improves, but only 44% felt prepared to do so when their condition worsens. Nearly 1 in 4 pediatricians (23%) felt “not at all prepared” to manage SSRI with worsening symptoms.

Most pediatricians (76%) felt comfortable or very comfortable discussing SSRI with patients and their families. However, just half (52%) felt comfortable discussing emotional regulation skills, such as deep breathing, with families. Even fewer felt comfortable discussing cognitive behavioral therapy (CBT) techniques (33%) or second- and third-line medications, such as serotonin and norepinephrine reuptake inhibitors (25%; P < .001 for all comparisons).

“Non-medication management of depression and anxiety using brief office-based interventions is definitely a growth opportunity for primary care pediatricians like me,” Miotto said.

Nicole Nghiem, MD, a developmental-behavioral pediatrician at Cedars-Sinai Guerin Children’s in Los Angeles, also noted the high percentage of pediatricians who said prescribing medications was their responsibility. But at the same time that pediatricians start medication, they should also put in referrals for psychotherapy instead of waiting for the medication to “kick in” first, Nghiem said.

“For moderate-to-severe depression and anxiety, the most effective approach is concurrent initiation of an SSRI and evidence-based psychotherapy, particularly CBT,” she said. “Medication helps reduce symptom intensity, while psychotherapy, especially CBT, teaches skills for managing symptoms that provide more durable, long-term protection against relapse. For patients with mild symptoms, psychotherapy alone may be sufficient without medication.”

Miotto said she encourages pediatricians to expand their training for what they can offer families. “Those who have held off prescribing may realize it is feasible in the primary care office,” Miotto said. “Those already prescribing may want to consider taking the next step by seeking out further training in delivering cognitive behavior and emotional regulation therapies or teaming up with a state child psychiatry access program to close the gaps in primary care-based teen depression and anxiety treatment.”

The study was funded by the AAP. The authors reported having no disclosures. Nghiem also had no disclosures.

Tara Haelle is a science/health journalist based in Dallas.