What is the recommended pharmacotherapy for anxiety?

From the Guidelines

The recommended pharmacotherapy for anxiety typically begins with selective serotonin reuptake inhibitors (SSRIs) such as sertraline (50-200 mg daily), escitalopram (10-20 mg daily), or fluoxetine (20-80 mg daily), as suggested by the most recent guidelines 1. These medications are considered first-line due to their favorable safety profile, efficacy, and tolerability.

• Treatment should continue for at least 6-12 months after symptom improvement to prevent relapse.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (75-225 mg daily) or duloxetine (30-120 mg daily) are effective alternatives, as recommended by recent studies 1.
• For acute anxiety symptoms, benzodiazepines such as lorazepam (0.5-2 mg) or clonazepam (0.25-2 mg) may be used short-term (2-4 weeks maximum) due to risks of dependence and tolerance.
• Buspirone (15-30 mg daily in divided doses) offers a non-addictive option for generalized anxiety.
• Beta-blockers like propranolol (10-40 mg as needed) can help manage physical symptoms of performance anxiety. These medications work by modulating neurotransmitters like serotonin, norepinephrine, and GABA that regulate anxiety responses in the brain.
• Patients should be aware that SSRIs/SNRIs typically take 2-4 weeks to show therapeutic effects and may cause initial side effects like nausea, headache, or increased anxiety that generally subside within weeks, as noted in recent guidelines 1.

From the FDA Drug Label

The efficacy of sertraline in the treatment of PTSD was established in two 12-week placebo-controlled trials of adult outpatients whose diagnosis met criteria for the DSM-III-R category of PTSD Social anxiety disorder, as defined by DSM-IV, is characterized by marked and persistent fear of social or performance situations involving exposure to unfamiliar people or possible scrutiny by others and by fears of acting in a humiliating or embarrassing way The efficacy of sertraline in maintaining a response in adult patients with social anxiety disorder for up to 24 weeks following 20 weeks of sertraline treatment was demonstrated in a placebo-controlled trial

The recommended pharmacotherapy for anxiety is sertraline, as it has been established to be effective in the treatment of various anxiety disorders, including:

• Posttraumatic Stress Disorder (PTSD): sertraline has been shown to be effective in reducing symptoms of PTSD in adult outpatients 2
• Social Anxiety Disorder: sertraline has been demonstrated to be effective in maintaining a response in adult patients with social anxiety disorder for up to 24 weeks following 20 weeks of treatment 2 The dosage of sertraline for anxiety disorders is typically in the range of 50-200 mg/day, and patients should be periodically reassessed to determine the need for maintenance treatment 2 2

From the Research

Recommended Pharmacotherapy for Anxiety

The recommended pharmacotherapy for anxiety includes several classes of medications, such as:

• Selective serotonin reuptake inhibitors (SSRIs) like paroxetine and sertraline, which have been shown to be effective in the treatment of generalized anxiety disorder (GAD) 3
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, which have been found to be effective anxiolytics and can resolve symptoms of depression in patients with GAD 4
• Other SSRIs like citalopram, which may be an effective treatment for GAD, especially in patients who have failed previous treatment with other SSRIs 5

Treatment of Specific Anxiety Disorders

For panic disorder, the following medications may be recommended:

• SSRIs like fluoxetine, fluvoxamine, paroxetine, and sertraline, which have been found to be useful antipanic medications 6
• Venlafaxine, which may be effective in treating panic disorder, especially when combined with cognitive-behavioral therapy 6
• Combination treatments, such as the combination of an SSRI and a benzodiazepine, may be used in patients with treatment-resistant panic disorder 7

Considerations for Treatment-Resistant Anxiety

In patients with treatment-resistant anxiety, the following approaches may be considered:

• Changing the medication to other standard treatments 7
• Using combination treatments, such as the combination of an SSRI and a benzodiazepine 7
• Adding psychological treatments, such as cognitive-behavioral therapy, to the treatment plan 7