What is the first line of treatment for a 17-year-old female with depression and anxiety?

From the Guidelines

For a 17-year-old female with depression and anxiety, the first-line treatment should be cognitive behavioral therapy (CBT) and other forms of psychotherapy, with medications such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) considered as secondary options. This approach is based on the recommendations from the Women's Preventive Services Initiative 1, which emphasizes the importance of screening for anxiety and depression in adolescent and adult women, and the use of CBT and other forms of psychotherapy as initial treatments.

The evidence suggests that CBT and other forms of psychotherapy are effective in treating anxiety and depression in adolescents, with a lower risk of side effects compared to medications 1. Additionally, the American College of Physicians recommends nonpharmacologic treatments, such as psychotherapy, as the first-line treatment for major depressive disorder in adults 1.

Some key points to consider when treating a 17-year-old female with depression and anxiety include:

• Screening for anxiety and depression using brief screening tools, such as those used on a touchscreen or in writing 1
• Using CBT and other forms of psychotherapy as initial treatments, with medications considered as secondary options 1
• Monitoring for side effects and response to treatment, with regular follow-up appointments every 1-2 weeks initially 1
• Informing parents about the potential risks and benefits of treatment, including the FDA black box warning regarding increased suicidal thoughts in adolescents starting SSRIs 1

Overall, the goal of treatment should be to improve health, function, and well-being, while minimizing the risk of side effects and other adverse outcomes. By prioritizing CBT and other forms of psychotherapy, and using medications judiciously, clinicians can provide effective and safe treatment for 17-year-old females with depression and anxiety.

From the FDA Drug Label

1.1 Major Depressive Disorder Escitalopram is indicated for the acute and maintenance treatment of major depressive disorder in adults and in adolescents 12 to 17 years of age 1.2 Generalized Anxiety Disorder Escitalopram is indicated for the acute treatment of Generalized Anxiety Disorder (GAD) in adults 14. 1 Major Depressive Disorder Adolescents The efficacy of Escitalopram as an acute treatment for major depressive disorder in adolescent patients was established in an 8-week, flexible-dose, placebo-controlled study that compared Escitalopram 10-20 mg/day to placebo in outpatients 12 to 17 years of age inclusive who met DSM-IV criteria for major depressive disorder

First line treatment for a 17-year-old female with depression and anxiety is escitalopram (PO), as it is indicated for the acute and maintenance treatment of major depressive disorder in adolescents 12 to 17 years of age and for the acute treatment of Generalized Anxiety Disorder (GAD) in adults, although the label does not explicitly state its use for GAD in adolescents.

• The recommended dose is 10-20 mg/day.
• Efficacy was established in an 8-week, flexible-dose, placebo-controlled study in adolescents 12 to 17 years of age 2 2.

From the Research

First-Line Treatment for Depression and Anxiety in a 17-Year-Old Female

• The combination of fluoxetine (a selective serotonin reuptake inhibitor) and cognitive-behavioral therapy (CBT) has been shown to be an effective treatment for adolescents with major depressive disorder 3.
• This combination therapy has been found to offer the most favorable tradeoff between benefit and risk for adolescents with major depressive disorder, with a response rate of 71.0% 3.
• Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line pharmacotherapies for depression, and fluoxetine is one of the most well-studied SSRIs in adolescents 4.
• The combination of an SSRI and CBT has been found to be more effective than either treatment alone in reducing symptoms of depression and anxiety in youth 5.
• Concomitant psychotherapy, such as CBT, has been shown to improve the prophylactic efficacy of SSRIs in preventing recurrence of major depressive disorder 6.

Factors to Consider

• The patient's age, severity of symptoms, and presence of comorbid disorders (such as anxiety) may influence the response to treatment 5.
• The combination of an SSRI and CBT may be more effective for patients with milder baseline symptoms and depressive disorders, while patients with severe symptoms and externalizing disorders may respond more slowly to treatment 5.
• The added value of CBT (with an SSRI) may occur late in treatment, highlighting the importance of ongoing assessment and adjustment of treatment plans as needed 5.