Evidence-based treatment of anxiety

In this post I’ll take a look at some of the available treatment guidelines for anxiety disorders. While psychotherapies are extremely important in the management of anxiety disorders, this post will focus only on anti-anxiety medications. The treatment guidelines I refer to come from the British Association for Psychopharmacology and the World Federation of Societies of Biological Psychiatry.

Benzodiazepines, while effective, are generally only recommended for short term use or where other treatments have failed, and there should be a careful consideration of the risks vs benefits for the specific individual.

Generalized Anxiety Disorder

It may take up to 12 weeks to achieve full response to antidepressant medication, but if there is no response at all after 4 weeks it is unlikely that particular medication will start to work with a longer duration of treatment.

1st line: SSRI (selective serotonin reuptake inhibitor): citalopram, escitalopram, paroxetine, sertraline

Alternatives to SSRI: SNRI (serotonin and norepinephrine reuptake inhibitor: venlafaxine, duloxetine), pregabalin (high dose may be more effective); quetiapine may be effective as monotherapy at doses of 50–300mg/day

2nd line: agomelatine, quetiapine, some benzodiazepines (alprazolam, diazepam, lorazepam), imipramine (a tricyclic antidepressant or TCA), buspirone, hydroxyzine (a sedating antihistamine), trazodone

Panic disorder

It may take up to 12 weeks for medication to fully take effect. When discontinuing medication after long-term treatment a lengthy gradual taper is recommended (over at least a 3 month period).

1st line: SSRI

Alternatives: some TCAs (clomipramine, desipramine, imipramine, lofepramine) venlafaxine, reboxetine, some benzodiazepines (alprazolam, clonazepam, diazepam, lorazepam), some anticonvulsants (gabapentin, sodium valproate)

Avoid: propranolol, buspirone and bupropion

Social Anxiety Disorder

It may take up to 12 weeks for medication to fully take effect.

1st line: SSRIs

Alternatives: venlafaxine, phenelzine, moclobemide, some benzodiazepines (bromazepam, clonazepam) and anticonvulsants (gabapentin, pregabalin), and olanzapine

Avoid: atenolol or buspirone in generalized social anxiety disorder; beta blockers can be effective for performance anxiety but not social anxiety disorder in general

Obsessive Compulsive Disorder

1st line: SSRI (may need a high dose)

Alternative: clomipramine

Add-on treatment: atypical antipsychotic, haloperidol, mirtazapine (may speed up response to citalopram)

What has your experience been like with anti-anxiety medication?

Image credit: 3dman_eu on Pixabay

Originally published at mentalhealthathome.wordpress.com on July 3, 2018.

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle | mentalhealthathome.org

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle | mentalhealthathome.org