How to approach an 18-year-old patient with depression and anxiety, who has a narcissistic mother and reports emotional numbness?

From the Guidelines

The most effective approach for an 18-year-old patient with depression and anxiety, who has a narcissistic mother and reports emotional numbness, is to recommend scientifically tested and proven treatments, such as psychotherapies (e.g., CBT or IPT-A) and/or antidepressant treatment (e.g., SSRIs), while also considering the patient's preferences and the availability of treatment services 1. To address the patient's emotional numbness, it is essential to build a trusting therapeutic relationship through validation and emotional education. This can be achieved by acknowledging her experience without challenging her belief directly, using statements like "I hear that you don't feel emotions the way others describe them." Some key considerations in developing a treatment plan include:

• Customizing the treatment according to the severity of disease, risk of suicide, and the existence of comorbid conditions 1
• Implementing a "common factors" approach, which focuses on evidence-based practices common across therapies, such as better communication skills, being supportive, and engaging in shared decision-making 1
• Considering the prescription of physical exercise, sleep hygiene, and adequate nutrition as part of the management plan 1
• Validating the impact of the patient's relationship with her narcissistic mother on her emotional development, as children of narcissistic parents often learn to suppress feelings for self-protection
• Using techniques like dialectical behavior therapy (DBT) to help the patient identify and label physical sensations that accompany emotions, and mindfulness exercises to notice these bodily sensations without judgment
• Maintaining a consistent, non-judgmental approach, as building emotional awareness takes time, especially with trauma history
• Documenting any suicidal ideation or self-harm thoughts, as emotional numbness can sometimes mask severe depression requiring immediate intervention.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Approach to an 18-year-old patient with depression and anxiety

• The patient's symptoms of depression and anxiety can be addressed through various therapeutic approaches, including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) 2, 3, 4, 5.
• CBT has been shown to be effective in reducing symptoms of depression and anxiety in patients with depressive disorders 3, 5.
• DBT has been found to be more effective in improving executive function, which may be beneficial for patients with emotional numbness 2.
• The use of behavioral activation (BA) strategies has been shown to predict depressive symptom improvement, while DBT skills and psychological flexibility predict anxiety symptom change 4.

Considerations for patients with narcissistic mothers

• There is limited research on the specific approach to patients with narcissistic mothers, but it is essential to consider the patient's unique circumstances and relationships when developing a treatment plan.
• A therapeutic approach that focuses on building a strong therapeutic relationship and improving emotional regulation skills may be beneficial for patients with a history of emotional trauma or neglect 3.

Treatment outcomes and recommendations

• Studies have shown that CBT can be effective in reducing symptoms of depression and anxiety in patients with depressive disorders, even in primary care settings 5.
• Combined therapy, including medication and CBT, may be more effective than monotherapy in achieving remission and reducing suicidal ideation in adolescent patients with depression 6.
• A comprehensive treatment plan should consider the patient's individual needs, symptoms, and circumstances, and may involve a combination of therapeutic approaches and interventions 2, 3, 4, 5, 6.