What is the best medication for treating anxiety and loss of appetite?

Best Medication for Anxiety and Loss of Appetite

Mirtazapine is the most effective medication for treating both anxiety and loss of appetite, as it uniquely increases appetite while providing anxiolytic effects.

Medication Selection Rationale

Mirtazapine offers a distinct advantage for patients with both anxiety and decreased appetite because:

• It significantly increases appetite, with appetite increase reported in 17% of patients compared to 2% for placebo 1
• In clinical trials, 49% of mirtazapine-treated patients had weight gain of at least 7% 2
• It effectively treats anxiety disorders while simultaneously addressing appetite issues 3

Dosing and Administration

• Start with 15 mg once daily at bedtime
• Titrate according to response and tolerability
• Maximum effective dose is typically 45 mg daily 3
• Take in the evening due to sedative effects

Alternative Options

If mirtazapine is contraindicated or not tolerated, consider these alternatives:

SSRIs (Second Choice)

• Sertraline: Starting dose 25-50 mg daily, target dose up to 200 mg daily 3
• Effective for anxiety but may cause initial appetite suppression
• Generally weight-neutral with long-term use 1
• FDA-approved for multiple anxiety disorders 4

SNRIs (Third Choice)

• Duloxetine: Starting dose 30 mg daily for 1 week, then increase to target dose of 60 mg daily 3
• Associated with decreased appetite and weight loss 3
• FDA-approved for generalized anxiety disorder 3

Clinical Considerations

Advantages of Mirtazapine

• Rapid onset of anxiolytic effect due to sedative properties
• No sexual dysfunction (unlike SSRIs/SNRIs)
• Improves sleep quality
• Increases appetite through H1 receptor antagonism

Potential Side Effects

• Somnolence: Most common side effect, may improve with continued use
• Weight gain: Monitor regularly, especially beneficial in this case
• QTc prolongation: Exercise caution in patients with cardiovascular disease 2
• Rare but serious: Serotonin syndrome (with other serotonergic agents), angle-closure glaucoma 2

Monitoring Parameters

• Appetite and weight at each visit
• Mood and anxiety symptoms
• Sedation and cognitive function
• Metabolic parameters (lipids, glucose)

Special Considerations

Contraindications

• Concurrent use with MAOIs is contraindicated 2
• Use caution in patients with seizure disorders, as mirtazapine may lower seizure threshold 2
• Caution in patients with cardiovascular disease due to potential QTc prolongation 2

Drug Interactions

• Avoid combining with other sedative medications or alcohol
• Use caution with other serotonergic medications due to risk of serotonin syndrome

Treatment Duration

• Continue treatment for at least 12-24 months after achieving remission 3
• Assess response at 2,4,6, and 12 weeks using standardized rating scales
• If inadequate response after 4-6 weeks at therapeutic dose, consider alternative medication

Conclusion

For patients with both anxiety and loss of appetite, mirtazapine provides the unique benefit of treating anxiety while stimulating appetite. This dual action makes it particularly valuable for this specific clinical presentation, offering advantages over SSRIs and SNRIs which may initially worsen appetite problems.