Facts

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

Options

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

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

SSRIs & SNRI starting dose

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

SSRI & SNRI frame

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

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

Pregabalin

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

Hydroxyzine

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

Benzos

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

For severe symptoms only

Discourage use of Alprazolam

Its short half-life can cause rebound anxiety and withdrawal

If needed benzo, consider Clonazepam

Longer acting can ease discontinuation

Supplements for anxiety disorder

Ashwagandha: caution for liver toxicity

Lavender

Passion flower

Other cautions for anxiety

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