1
Facts
About 1 in 13 adults in the US will be diagnosed with generalized anxiety disorder in their life time
2
Options
Cognitive behavioral therapy or meds as initial treatment...efficacy seems similar
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SSRIs & SNRI
- First line med
- also preferred for depression disorder
- There's NO best SSRI/ SNRI.
- Lean towards escitalopram or sertraline...or duloxetine or venlafaxine
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SSRIs & SNRI starting dose
Low doses first then titrating to limit early side effects..worsening anxiety, insomnia, etc
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SSRI & SNRI frame
- takes about 2-4 weeks
- or even to max 12 weeks (3 months)
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Buspirone
- Consider this if SNRI/ SSRI not tolerated
- or as add-on therapy if they are not enough
- Should be given BID or TID...not PRN
- May take about 2 weeks to seeing some effects.
- Emphasize titrating up to 60 mg/ day if needed
7
Pregabalin
- Alternative or add-on
- Can take as early as 1 week to work
- Consider misuse, drownsiness, dizziness, weight gain
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Hydroxyzine
- Consider as quick-onset med or PRN med
- Limited evidence
- anticholinergic effect: dry mouth...occurs
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Benzos
Add-on only for a few weeks when SNRI/ SSRI kicks in
For severe symptoms only
10
Discourage use of Alprazolam
Its short half-life can cause rebound anxiety and withdrawal
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If needed benzo, consider Clonazepam
Longer acting can ease discontinuation
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Supplements for anxiety disorder
Ashwagandha: caution for liver toxicity
Lavender
Passion flower
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Other cautions for anxiety
- stimulant meds for ADHD can worsen anxiety
- Try conditions causing anxiety such as alcohol use disorder