What is the best medication for anxiety and depression in youth?

From the Guidelines

The best medication for anxiety and depression in youth is typically a selective serotonin reuptake inhibitor (SSRI), with fluoxetine (Prozac) often being the first-line choice, as supported by the most recent and highest quality study 1.

Key Considerations

• Fluoxetine is usually started at 10mg daily for one week, then increased to 20mg daily, with dosages potentially ranging from 10-60mg depending on response and tolerability 1.
• Treatment should continue for at least 6-12 months after symptom improvement to prevent relapse.
• Other SSRIs that may be considered include sertraline (Zoloft) and escitalopram (Lexapro) 1.
• These medications work by increasing serotonin levels in the brain, which helps regulate mood and anxiety.
• It's essential to note that medication should be part of a comprehensive treatment approach that includes psychotherapy, particularly cognitive-behavioral therapy (CBT) 1.

Monitoring and Side Effects

• Youth taking these medications require close monitoring, especially during the first few weeks, as there is a small increased risk of suicidal thoughts initially 1.
• Side effects may include nausea, headache, sleep changes, and restlessness, which often improve after a few weeks.
• Response to medication varies among individuals, so adjustments may be necessary, and treatment should always be supervised by a healthcare provider specializing in youth mental health.

Comprehensive Treatment Approach

• Combination treatment (CBT and SSRI) may be a more effective short-term treatment for anxiety in children and adolescents than either treatment alone 1.
• Comprehensive, evidence-based assessment may enhance evidence-based treatment, and CBT may be considered the first-line treatment for anxiety in children and adolescents, particularly for mild to moderate presentations.

From the FDA Drug Label

The efficacy of fluoxetine 20 mg/day in children and adolescents (N = 315 randomized; 170 children ages 8 to < 13,145 adolescents ages 13 to ≤ 18) was studied in two 8- to 9-week placebo-controlled clinical trials in depressed outpatients whose diagnoses corresponded most closely to the DSM-III-R or DSM-IV category of Major Depressive Disorder In both studies independently, fluoxetine produced a statistically significantly greater mean change on the Childhood Depression Rating Scale-Revised (CDRS-R) total score from baseline to endpoint than did placebo.

The best medication for anxiety and depression in youth is fluoxetine (PO), as it has been shown to be effective in treating Major Depressive Disorder in children and adolescents.

• Key points:
  • Fluoxetine 20 mg/day was studied in two 8- to 9-week placebo-controlled clinical trials.
  • The medication produced a statistically significantly greater mean change on the CDRS-R total score from baseline to endpoint than did placebo.
  • Subgroup analyses on the CDRS-R total score did not suggest any differential responsiveness on the basis of age or gender. 2

From the Research

Medication Options for Anxiety and Depression in Youth

• Selective serotonin reuptake inhibitors (SSRIs) have been used to treat anxiety disorders and depression in children and adolescents, with fluoxetine being the most effective for depressive disorders 3.
• The combination of fluoxetine with cognitive-behavioral therapy (CBT) has been shown to be the most effective treatment for adolescents with major depressive disorder, offering a favorable tradeoff between benefit and risk 4.
• SSRIs, particularly sertraline and fluoxetine, are considered the most efficacious treatment for anxiety and depressive disorders in young persons, with combination therapies consisting of a psychotherapy plus an SSRI producing greater therapeutic effects than either treatment alone 5.

Efficacy of Specific Medications

• Fluoxetine has been proven to be effective for the treatment of depressive disorders in children and adolescents, although its effect is relatively modest 3.
• Sertraline has been authorized in France for the treatment of obsessive-compulsive disorders in children and adolescents, and has been shown to be effective in combination with CBT for the treatment of anxiety disorders 3, 5.
• The combination of CBT with fluoxetine has been identified as the most effective treatment for depression in youth, while CBT plus sertraline is most effective for anxiety 5.

Combination Therapies

• Combination therapies consisting of a psychotherapy plus an SSRI have been shown to produce greater therapeutic effects than either treatment alone, with the combination of fluoxetine with CBT being the most effective treatment for adolescents with major depressive disorder 4, 5.
• The added value of CBT with an SSRI occurs late in treatment, with the fastest response to SSRI+CBT being for patients who are younger, with milder baseline anxiety/depression symptoms and depressive disorders 6.

Patient Characteristics and Response to Treatment

• The response to combined treatment varies across disorders (anxiety versus depression), and by specific patient characteristics, such as age, severity of symptoms, and presence of externalizing disorders 6.
• The superiority of SSRI+CBT for youth with depression and anxiety is further supported, with combination treatment being the superior approach across anxiety and depression, and being robust to a range of participant characteristics 6.