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Weigh Med Options for Generalized Anxiety Disorder

front 1

Facts

back 1

About 1 in 13 adults in the US will be diagnosed with generalized anxiety disorder in their life time

front 2

Options

back 2

Cognitive behavioral therapy or meds as initial treatment...efficacy seems similar

front 3

SSRIs & SNRI

back 3

  • First line med
  • also preferred for depression disorder
  • There's NO best SSRI/ SNRI.
  • Lean towards escitalopram or sertraline...or duloxetine or venlafaxine

front 4

SSRIs & SNRI starting dose

back 4

Low doses first then titrating to limit early side effects..worsening anxiety, insomnia, etc

front 5

SSRI & SNRI frame

back 5

  • takes about 2-4 weeks
  • or even to max 12 weeks (3 months)

front 6

Buspirone

back 6

  • 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

front 7

Pregabalin

back 7

  • Alternative or add-on
  • Can take as early as 1 week to work
  • Consider misuse, drownsiness, dizziness, weight gain

front 8

Hydroxyzine

back 8

  • Consider as quick-onset med or PRN med
  • Limited evidence
  • anticholinergic effect: dry mouth...occurs

front 9

Benzos

back 9

Add-on only for a few weeks when SNRI/ SSRI kicks in

For severe symptoms only

front 10

Discourage use of Alprazolam

back 10

Its short half-life can cause rebound anxiety and withdrawal

front 11

If needed benzo, consider Clonazepam

back 11

Longer acting can ease discontinuation

front 12

Supplements for anxiety disorder

back 12

Ashwagandha: caution for liver toxicity

Lavender

Passion flower

front 13

Other cautions for anxiety

back 13

  • stimulant meds for ADHD can worsen anxiety
  • Try conditions causing anxiety such as alcohol use disorder