What other medication can be added to sertraline (Selective Serotonin Reuptake Inhibitor - SSRI) to help manage symptoms of anxiety?

From the Guidelines

Buspirone is the most recommended medication to add to sertraline for managing anxiety symptoms, starting at 5-10mg twice daily and gradually increasing to 20-30mg daily, due to its minimal side effects and different mechanism of action on serotonin receptors 1. When considering adding a medication to sertraline for anxiety, it's essential to evaluate the patient's specific symptoms, medical history, and potential drug interactions.

• Buspirone is a common augmentation option, with a starting dose of 5-10mg twice daily, which can be gradually increased to 20-30mg daily.
• Low-dose benzodiazepines, such as lorazepam (0.5-1mg as needed) or clonazepam (0.25-0.5mg once or twice daily), can provide short-term relief but should be used cautiously due to the risk of dependence.
• Other options include hydroxyzine (25-50mg as needed), an antihistamine with anxiolytic properties, or low-dose antipsychotics like quetiapine (25-50mg at bedtime).
• Beta-blockers, such as propranolol (10-20mg as needed), can help with physical symptoms of anxiety.
• Pregabalin (75-150mg twice daily) is effective for generalized anxiety disorder. It's crucial to discuss any medication addition with a doctor to ensure safe and effective treatment, as they can assess the patient's unique needs and potential interactions 1. The medications work through different mechanisms, such as enhancing GABA (calming neurotransmitter), modifying serotonin pathways, or blocking physical symptoms of anxiety, and the choice of medication should be based on the patient's specific symptoms and medical history 1.

From the FDA Drug Label

If concomitant use of sertraline with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases

The FDA drug label does not answer the question of what other medication can be added to sertraline to help manage symptoms of anxiety. It does mention that buspirone, a serotonergic drug, can be used concomitantly with sertraline, but it also warns of a potential increased risk for serotonin syndrome 2, 2.

From the Research

Medication Options for Anxiety

To manage symptoms of anxiety in addition to sertraline, several medication options can be considered:

• SSRIs and SNRIs are first-line treatments for generalized anxiety disorder (GAD) in adults 3
• Buspirone, benzodiazepines, second-generation antipsychotics (SGAs), and pregabalin can be used as second-line treatments for GAD in adults 3
• In pediatric patients with GAD, SSRIs are recommended as the first-line pharmacotherapy, and psychotherapy can enhance antidepressant response 3
• Quetiapine has been shown to be effective in reducing anxiety symptoms in patients with mood disorders, including bipolar disorder and major depressive disorder 4

Considerations for Combination Therapy

When adding medication to sertraline for anxiety, consider the following:

• The efficacy and tolerability of the added medication 5
• The potential for drug interactions and side effects 6
• The patient's age, co-morbidity, and prior treatment history 3
• The importance of achieving a stable daily dose and minimizing pill burden to improve adherence and persistence 7