From the Guidelines
When prescribing for anxiety disorders, selective serotonin reuptake inhibitors (SSRIs) are generally recommended as first-line treatment due to their favorable efficacy, tolerability, and cost-effectiveness, as supported by the most recent guideline from the Journal of the American Academy of Child and Adolescent Psychiatry 1.
Medication Options
The following medications are considered effective for anxiety disorders:
- Selective Serotonin Reuptake Inhibitors (SSRIs): sertraline (starting at 25-50mg daily, increasing to 50-200mg daily) or escitalopram (starting at 5-10mg daily, increasing to 10-20mg daily) offer the best balance of efficacy and tolerability 1.
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): venlafaxine (75-225mg daily) or duloxetine (30-120mg daily) are reasonable alternatives for patients who cannot tolerate SSRIs 1.
- Benzodiazepines: short-term use of lorazepam (0.5-2mg as needed) may be considered for acute anxiety symptoms, but should be limited to 2-4 weeks due to dependence risks 1.
- Non-benzodiazepine alternatives: buspirone (15-30mg daily in divided doses) or hydroxyzine (25-100mg daily in divided doses) may be used for short-term relief 1.
Cost-Benefit Analysis
From a cost perspective, generic SSRIs like sertraline ($4-10 monthly) are significantly more affordable than newer branded medications like vortioxetine ($300+ monthly) 1.
Table of Medications
| Medication | Dosage Range | Cost |
|---|---|---|
| Sertraline | 25-200mg daily | $4-10 monthly |
| Escitalopram | 5-20mg daily | $10 monthly |
| Venlafaxine | 75-225mg daily | $14-30 monthly |
| Duloxetine | 30-120mg daily | $65 monthly |
| Lorazepam | 0.5-2mg as needed | variable |
| Buspirone | 15-30mg daily | variable |
| Hydroxyzine | 25-100mg daily | variable |
The cost-benefit analysis strongly favors starting with generic SSRIs, which provide effective symptom control for most patients at minimal cost, reserving more expensive options for treatment-resistant cases, as recommended by the American Society of Clinical Oncology guideline adaptation 1.
From the Research
Medication Options for Anxiety Disorders
The treatment of anxiety disorders involves a variety of medications, including:
- Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline and paroxetine 2, 3, 4
- Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) such as venlafaxine, milnacipran, and duloxetine 2, 5, 6
- Benzodiazepines, such as diazepam, which are often used for acute anxiety but are less suitable for long-term treatment due to their potential for dependence and withdrawal 2
- Tricyclic antidepressants, such as imipramine, and monoamine oxidase inhibitors, which have been shown to be effective but have limited use due to side effects and safety concerns 2
Cost-Benefit Analysis
The cost-benefit analysis of these medications is complex and depends on various factors, including the specific medication, dosage, and duration of treatment. However, studies suggest that SSRIs and SNRIs are generally effective and well-tolerated treatments for anxiety disorders, with some potential clinical advantages over other medications 3, 4, 5.
Table of Medications
| Medication | Class | Efficacy | Tolerability |
|---|---|---|---|
| Sertraline | SSRI | Effective in treating generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder [3,4] | Generally well-tolerated, with common side effects including nausea, headache, and insomnia [4] |
| Paroxetine | SSRI | Effective in treating generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder [3,4] | Generally well-tolerated, with common side effects including nausea, headache, and insomnia [4] |
| Venlafaxine | SNRI | Effective in treating anxiety disorders, with some potential clinical advantages over SSRIs [5,6] | Generally well-tolerated, with common side effects including nausea, headache, and insomnia [5] |
| Diazepam | Benzodiazepine | Effective in treating acute anxiety, but less suitable for long-term treatment due to potential for dependence and withdrawal [2] | Common side effects include drowsiness, dizziness, and dependence [2] |
Comparison of Medications
Studies have compared the efficacy and tolerability of different medications, including SSRIs and SNRIs. For example, a study comparing paroxetine and sertraline found that both medications were effective and well-tolerated in treating generalized anxiety disorder, with no significant differences between the two medications 4. Another study found that venlafaxine was as efficacious as SSRIs in treating anxiety, with comparable tolerability 6.