From the Guidelines
Inpatient anxiety treatment should prioritize a comprehensive approach combining medication, therapy, and supportive care, with a focus on cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) as first-line treatments, as suggested by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology clinical practice guideline for social anxiety disorder 1.
Treatment Options
The treatment of anxiety in an inpatient setting involves a multifaceted approach, including:
- Medication: Benzodiazepines like lorazepam (0.5-2mg every 4-6 hours as needed) or diazepam (5-10mg every 6-8 hours) for immediate symptom relief, though limited to short-term use due to dependency risks 1.
- SSRIs such as sertraline (starting at 25-50mg daily, increasing to 50-200mg) or escitalopram (10-20mg daily) for longer-term management, taking 2-4 weeks to reach full effectiveness 1.
- Therapy: Daily individual and group therapy sessions using cognitive-behavioral techniques to develop coping strategies and address underlying issues 1.
Cognitive-Behavioral Therapy (CBT)
CBT should be structured with a total of approximately 14 sessions over 4 months, with each session lasting 60-90 minutes, following models like the Clark and Wells model or the Heimberg model 1. Group therapy can also be effective, consisting of 12 sessions over 3 months, with one 120- to 150-minute group session per week 1.
Inpatient Stay and Follow-Up
The typical inpatient stay lasts 5-14 days, focusing on stabilization rather than complete resolution of symptoms 1. Following discharge, a solid outpatient follow-up plan including continued medication management, therapy appointments, and sometimes partial hospitalization or intensive outpatient programs is essential for maintaining progress and preventing readmission 1.
From the FDA Drug Label
The provided drug labels do not directly address treatment options for anxiety in an inpatient setting. The FDA drug label does not answer the question.
From the Research
Treatment Options for Anxiety in an Inpatient Setting
- The treatment options for anxiety in an inpatient setting include pharmacotherapy and cognitive behavioral therapy (CBT) 2.
- Pharmacotherapy approaches for generalized anxiety disorder (GAD) include:
- Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, or escitalopram 3, 4, 5, 6.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine or duloxetine 4, 5.
- Benzodiazepines, azapirones, antihistamines, alpha(2)delta Ca++ channel modulators, and atypical antipsychotics 4, 5.
- CBT is also an effective treatment for social anxiety disorders (SADs) and can be used in combination with conventional treatment for patients with SSRI-resistant SAD 2.
Considerations for Treatment
- When individualizing treatment, drug dose ranges and side effect profiles need to be considered, as well as the patient's comorbid conditions 4.
- Doses may need to be reduced for elderly or medically ill patients or those taking other medications, and increased for refractory cases 4.
- Common comorbid conditions with GAD include depression, alcohol or drug abuse, social anxiety disorder, and panic disorder 4, 5.
- Remission is attainable but can take several months, and stopping medication increases the risk of relapse within the first year of initiating treatment 4, 5.