From the Research
For this 27-year-old female patient already on Lexapro 20mg who is experiencing increased anxiety and stress, mindfulness-based stress reduction (MBSR) is a recommended adjunctive treatment, as it has been shown to be noninferior to escitalopram in reducing anxiety symptoms 1. This approach can provide a non-pharmacological alternative to additional medication, and can be used in conjunction with her current SSRI therapy. Some key points to consider when recommending MBSR include:
- MBSR has been shown to decrease anxiety symptoms in patients with anxiety disorders 1
- MBSR can be used as an adjunctive treatment to pharmacotherapy, and has been shown to be noninferior to escitalopram in reducing anxiety symptoms 1
- MBSR can provide a non-habit-forming alternative to benzodiazepines, which can be beneficial for patients who are concerned about dependence or side effects In addition to MBSR, other stress management techniques such as deep breathing exercises, regular physical activity, and cognitive behavioral therapy (CBT) can also be recommended to help the patient manage her anxiety and stress. The patient should be scheduled for follow-up within 2-4 weeks to assess response and determine if continued support is needed. It's also important to note that while benzodiazepines such as lorazepam (Ativan) can provide immediate relief, they should be used with caution and only for a short period of time due to the risk of dependence and side effects 2, 3. Hydroxyzine 25-50mg as needed could be considered as a non-habit-forming option, but its use should be carefully monitored and limited to a small quantity with no refills to minimize dependence risk. Overall, a comprehensive treatment plan that includes MBSR, stress management techniques, and careful monitoring of medication use can help the patient manage her anxiety and stress while minimizing the risk of dependence and side effects.