Best Anxiety Medication for a 17-Year-Old
For a 17-year-old with anxiety, escitalopram (Lexapro) is the recommended first-line medication due to its established safety profile, FDA approval for adolescents, and demonstrated efficacy in reducing anxiety symptoms with minimal side effects. 1
Medication Selection Algorithm
First-Line Options:
- Escitalopram (Lexapro)
- Starting dose: 10 mg daily
- FDA-approved for adolescents (12-17 years)
- Well-established safety profile in adolescents
- Lower risk of side effects compared to other SSRIs
Second-Line Options (if escitalopram is ineffective or not tolerated):
Sertraline (Zoloft)
- Starting dose: 25-50 mg daily
- Target dose: up to 200 mg daily
- Well-established safety profile
- Effective for both anxiety and comorbid depression 2
Fluoxetine (Prozac)
- Starting dose: lower than adult dose (10 mg daily)
- Demonstrated efficacy in adolescent anxiety disorders 3
- Longer half-life may help with adherence issues
Combination Treatment Approach
If medication alone provides insufficient response after an adequate trial (6-8 weeks):
- Consider adding Cognitive Behavioral Therapy (CBT)
- Combination of SSRI plus CBT has shown superior outcomes compared to either treatment alone 4, 5
- The American Academy of Child and Adolescent Psychiatry suggests combination treatment over monotherapy for anxiety disorders 4
Medication Administration and Monitoring
- Start with a lower dose than typically used in adults
- Gradually titrate up based on response and tolerability
- Monitor closely during the first 4 weeks for:
- Increased anxiety/agitation (common initial side effect)
- Suicidal ideation (particularly important in adolescents)
- Sleep disturbances
- Appetite changes
- Assess response at 2,4,6, and 12 weeks using standardized rating scales 2
Important Considerations and Precautions
- Black box warning: All antidepressants carry a warning about increased risk of suicidal thinking and behavior in children, adolescents, and young adults
- Regular monitoring: Weekly face-to-face contacts for the first 4 weeks of treatment
- Weight and growth: Monitor regularly as SSRIs may affect appetite 1
- Medication adherence: Involve parents/guardians in medication management 4
- Avoid benzodiazepines: While lorazepam and other benzodiazepines are mentioned for anxiety in adults 4, they are not recommended as first-line treatment for adolescents due to risk of dependence and potential for abuse
Treatment Duration
- Continue treatment for at least 12-24 months after achieving remission 2
- Taper gradually when discontinuing to avoid withdrawal symptoms
Non-Pharmacological Approaches
These should be implemented alongside medication:
- Cognitive Behavioral Therapy (CBT) - first-line psychological treatment
- Regular exercise
- Sleep hygiene practices
- Stress management techniques (deep breathing, progressive muscle relaxation)
By following this structured approach with escitalopram as the first-line medication choice, combined with appropriate monitoring and non-pharmacological interventions, anxiety symptoms in a 17-year-old can be effectively managed while minimizing risks.