From the Guidelines
The recommended treatment for individuals with depression and anxiety is to prioritize the treatment of depressive symptoms, or use a unified protocol combining cognitive behavior therapy (CBT) treatments for depression and anxiety. This approach is based on the most recent and highest quality evidence, as outlined in the 2023 ASCO guideline update 1.
Key Considerations
When selecting a treatment approach, clinicians should consider the following factors:
- Symptom severity
- Psychiatric history
- History of substance use
- Prior mental health treatment response
- Functional abilities and limitations
- Presence of other chronic diseases
- Membership in socially and economically marginalized groups 1
Treatment Options
Treatment may involve a combination of psychotherapy and medication. Cognitive Behavioral Therapy (CBT) is considered a first-line psychotherapy approach, usually conducted in weekly sessions over 12-16 weeks. For medication, selective serotonin reuptake inhibitors (SSRIs) such as sertraline, escitalopram, or fluoxetine are commonly prescribed first due to their effectiveness and relatively mild side effect profile 1.
Lifestyle Modifications
Lifestyle modifications are also important, including:
- Regular physical exercise (30 minutes of moderate activity most days)
- Adequate sleep hygiene
- Stress management techniques like mindfulness meditation
- Reducing alcohol and caffeine consumption
Adjusting Treatment
If there is little improvement in symptoms after 8 weeks of treatment, the treating clinician should adjust the regimen, such as adding a psychological or pharmacologic intervention, changing the medication, or referring to individual therapy 1.
Personalized Treatment
Treatment should be personalized based on symptom severity, previous treatment response, and individual preferences. The choice of intervention should be based on shared decision making, taking into account availability, accessibility, patient preference, likelihood of adherence, and cost.
From the Research
Treatment Options for Depression and Anxiety
- The recommended treatment for individuals with depression and anxiety includes specific psychotherapies and antidepressant medications 2.
- First-line treatments such as cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy have been shown to have at least medium-sized effects in symptom improvement over usual care without psychotherapy 2.
- Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), have also been found to be effective in treating depression and anxiety 2, 3, 4, 5, 6.
Psychotherapy and Medication Combination
- Combining psychotherapy with antidepressant medication may be preferred, especially for more severe or chronic depression, as it has been shown to result in greater symptom improvement than either treatment alone 2.
- Collaborative care programs, which include systematic follow-up and outcome assessment, can also improve treatment effectiveness 2.
Selective Serotonin Reuptake Inhibitors (SSRIs)
- SSRIs are a commonly used treatment for depression and anxiety, and have been shown to be effective in reducing symptoms of anxiety disorders 3, 4, 6.
- However, SSRIs can also have adverse effects, such as an increased risk of suicidality in children and young adults, and a risk-benefit analysis must be considered when prescribing them 3.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
- SNRIs are another class of antidepressant medications that have been found to be effective in treating depression and anxiety, particularly in patients with accompanying symptoms such as pain 5, 6.
- SNRIs have been shown to be helpful in relieving chronic pain associated with and independent of depression, and may be a good option for patients who do not respond to SSRIs 5.