What are the treatment options for anxiety and depression?

From the Guidelines

For patients with symptoms of both depression and anxiety, treatment of depressive symptoms should be prioritized, or a unified protocol combining cognitive behavior therapy (CBT) treatments for depression and anxiety may be used. This approach is based on the most recent and highest quality evidence, as outlined in the 2023 ASCO guideline update 1.

Key Considerations

When selecting treatment for anxiety and/or depression, clinicians should use a stepped-care model, considering symptom severity, psychiatric history, substance use, prior mental health treatment response, functional abilities, and presence of other chronic diseases 2.

Treatment Options

• Cognitive-behavioral therapy (CBT) is highly effective in reducing depressive and anxiety symptoms, with significant reductions reported in 11 meta-analyses 3.
• Exercise, both during and after cancer treatment, provides a moderate to large reduction in depression and may offer a reduction in anxiety 3.
• Mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR), demonstrate statistically significant improvements in both depression and anxiety compared to usual care 3.

Medication

While medication options are not explicitly outlined in the provided evidence, SSRIs and SNRIs are commonly used to treat depression and anxiety. However, the most recent and highest quality evidence prioritizes the treatment of depressive symptoms and the use of unified protocols combining CBT treatments for depression and anxiety 1.

Lifestyle Changes

Regular exercise, adequate sleep, stress management techniques like meditation, and social connection are also important in reducing symptoms of anxiety and depression. These lifestyle changes, combined with evidence-based treatments, can help address negative thought patterns and correct neurotransmitter imbalances in the brain, particularly serotonin and norepinephrine, which regulate mood, anxiety, and stress responses.

From the FDA Drug Label

Sertraline is a prescription medicine used to treat depression It is also used to treat: Major Depressive Disorder (MDD) Obsessive Compulsive Disorder (OCD) Panic Disorder Posttraumatic Stress Disorder (PTSD) Social Anxiety Disorder Premenstrual Dysphoric Disorder (PMDD)

Anxiety and Depression Treatment: Sertraline is used to treat anxiety and depression, including Major Depressive Disorder (MDD), Social Anxiety Disorder, Panic Disorder, and Posttraumatic Stress Disorder (PTSD).

• The drug label indicates that sertraline is effective in treating these conditions, but it is essential to follow the prescribed dosage and consult with a healthcare provider to determine the best course of treatment.
• It is crucial to note that sertraline may have potential interactions with other medications, and patients should inform their healthcare provider about all the medicines they are taking. 4 5

From the Research

Treatment Options for Anxiety and Depression

• Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are effective in treating anxiety disorders, with higher doses of SSRIs associated with greater symptom improvement and likelihood of treatment response 6.
• SSRIs and SNRIs are also used to treat depression, with studies suggesting that combination treatment with cognitive behavioral therapy (CBT) can produce greater improvement than either treatment alone 7.
• A network meta-analysis found that most drugs, including SSRIs and SNRIs, are more effective than placebo in treating generalized anxiety disorder, with duloxetine and escitalopram showing better efficacy 8.

Efficacy and Acceptability of Treatment Options

• The efficacy of SSRIs and SNRIs in treating anxiety disorders can be attributed to their ability to improve overall symptom improvement, likelihood of treatment response, and time course of treatment response 6.
• In terms of acceptability, most drugs, including SSRIs and SNRIs, do not show significant differences from placebo, except for vilazodone, which was found to be worse than placebo 8.
• Combination treatment with SSRIs and CBT can produce greater improvement than either treatment alone, with the fastest response seen in patients who are younger, with milder baseline anxiety/depression symptoms, and depressive disorders 7.

Limitations and Future Directions

• SSRIs have limitations, including induction of anxiety on treatment initiation, delayed onset of significant therapeutic effect, sexual dysfunction, and sleep disturbance, which may have placed a ceiling on the expectations of first-line pharmacological treatment 9.
• Future advances may come from the development of SNRIs that more closely mimic the actions of effective tricyclic antidepressants, or from combining SSRIs with 5-HT4 receptor agonists and 5-HT7 receptor antagonists 9.