From the Guidelines
For anxiety neurosis, the first-line SSRI recommendation is sertraline (Zoloft), typically started at 25-50 mg daily and gradually increased to an effective dose of 50-200 mg daily. This recommendation is based on the most recent and highest quality study available, which suggests that sertraline is a effective and safe treatment option for anxiety disorders 1.
Key Considerations
- Sertraline is a selective serotonin reuptake inhibitor (SSRI) that works by increasing serotonin levels in the brain, which helps regulate mood, emotion, and anxiety responses.
- The medication should be taken consistently for 4-6 weeks before full therapeutic effects are realized, though some improvement may be noticed earlier.
- Side effects are usually mild and transient, including nausea, headache, insomnia, and sexual dysfunction.
- Patients should be advised not to discontinue treatment abruptly as this can cause withdrawal symptoms.
Alternative Options
- Escitalopram (Lexapro) is another excellent option, starting at 5-10 mg daily with a target dose of 10-20 mg daily 1.
- Other SSRIs, such as fluoxetine, paroxetine, and fluvoxamine, may also be effective, but sertraline is generally considered a first-line treatment due to its favorable side effect profile and once-daily dosing.
Important Notes
- Regular follow-up appointments are important to monitor response and adjust dosing as needed.
- The choice of a specific SSRI is governed by considerations such as pharmacokinetics, pharmacodynamics, and patient-specific factors 1.
- While the evidence for SSRIs in anxiety disorders is strong, it is essential to consider individual patient needs and circumstances when selecting a treatment option.
From the Research
Pharmacologic Agents for Anxiety Neurosis
The best pharmacologic agent for anxiety neurosis, specifically a selective serotonin reuptake inhibitor (SSRI), can be determined by examining the efficacy and acceptability of various drugs.
- Studies have shown that SSRIs are effective in treating anxiety disorders, with some showing better efficacy than others 2, 3.
- A network meta-analysis found that duloxetine and escitalopram showed better efficacy, while vortioxetine showed better acceptability 2.
- A systematic review and meta-analysis found that higher doses of SSRIs, but not SNRIs, were associated with significantly greater symptom improvement and likelihood of treatment response 3.
- Another study found that SSRIs and SNRIs are effective in treating anxiety disorders, with the greatest treatment benefits observed for social anxiety disorder 3.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are a commonly used class of drugs for treating anxiety disorders.
- Examples of SSRIs include fluoxetine, sertraline, and escitalopram 4, 2.
- Studies have shown that SSRIs are effective in reducing symptoms of anxiety, with some showing better efficacy than others 2, 3.
- The efficacy of SSRIs can be influenced by factors such as dose and individual patient characteristics 3.
Treatment Guidelines
Treatment guidelines for anxiety disorders recommend SSRIs as a first-line treatment option 5, 6.
- The guidelines suggest that the choice of SSRI should be based on individual patient characteristics, such as comorbid conditions and side effect profiles 5, 6.
- Studies have shown that SSRIs can be effective in treating anxiety disorders, with some showing better efficacy than others 2, 3.
- A review of pharmacotherapy for anxiety disorders found that evidence-based dosing for most specific agents is available, and that a pragmatic stepwise approach to treatment can be effective 6.