From the Guidelines
For a 17-year-old female with depression and anxiety, Lexapro (escitalopram) is the preferred first-line choice over Prozac (fluoxetine) due to its efficacy, safety profile, and FDA approval for adolescents with major depressive disorder. The choice between Lexapro and Prozac for a 17-year-old female with depression and anxiety should be based on the most recent and highest quality evidence available. According to the study published in the Annals of Internal Medicine 1, SSRIs, including escitalopram, have been shown to be effective in treating depression in adolescents. Key points to consider when prescribing Lexapro include:
- Starting dose: 10mg once daily, which can be increased to 20mg if needed after several weeks.
- Side effects: initial nausea, headache, sleep changes, or increased anxiety, which often improve within 1-2 weeks.
- Monitoring: close monitoring during the first few weeks of treatment is essential due to the black box warning for increased suicidal thoughts in young people.
- Treatment duration: at least 6-12 months after symptom improvement.
- Accompanying therapy: cognitive behavioral therapy should ideally accompany medication treatment for the best outcomes in adolescent depression and anxiety. As noted in another study 1, the American College of Physicians recommends assessing patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis, beginning within 1 to 2 weeks of initiation of therapy. It's also important to consider the potential differences in adverse event profiles among SSRIs, as reported in the study 1. Overall, the evidence supports the use of Lexapro as a first-line treatment for depression and anxiety in adolescents, with careful monitoring and consideration of individual patient factors.
From the FDA Drug Label
- 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 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 [see Clinical Studies (14. 1)] 1.2 Generalized Anxiety Disorder Escitalopram is indicated for the acute treatment of Generalized Anxiety Disorder (GAD) in adults [see Clinical Studies (14. 2)].
First line treatment for a 17-year-old female with depression and anxiety is Escitalopram (Lexapro), 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.
- Dose: 10-20 mg/day
- Note: There is no direct information about Prozac in the provided drug labels, therefore, Lexapro is the preferred choice based on the available information 2 2.
From the Research
Treatment Options for Depression and Anxiety in a 17-Year-Old Female
- The choice between Prozac (fluoxetine) and Lexapro (escitalopram) for a 17-year-old female with depression and anxiety can be informed by several studies 3, 4, 5, 6, 7.
- Efficacy and Tolerability: A study from 2025 found that selective serotonin reuptake inhibitors (SSRIs), including sertraline and paroxetine, have a good benefit-risk profile, making them suitable as first-line treatments for depression and anxiety 4.
- Comparative Effectiveness: Another study from 2013 compared fluoxetine with other antidepressants and found that it was as effective as tricyclics, but less effective than some other SSRIs, such as sertraline and venlafaxine 5.
- Treatment for Adolescents: A study from 2005 found that combination treatment with cognitive behavioral therapy and fluoxetine was superior to monotherapy for adolescents with moderate to severe depression 6.
- Multiple-Treatments Meta-Analysis: A 2014 meta-analysis found that combined fluoxetine and cognitive behavioral therapy exhibited the highest efficacy, while sertraline, escitalopram, venlafaxine, and paroxetine were the best tolerated 7.
- Specific Considerations: When choosing between Prozac and Lexapro, it's essential to consider the individual's specific needs and circumstances, as well as the potential side effects and interactions of each medication 3, 4, 5, 6, 7.