What is the first-line treatment medication for anxiety?

From the Guidelines

Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication treatment for anxiety disorders. According to the most recent and highest quality study 1, both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents. Commonly prescribed SSRIs include sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), and paroxetine (Paxil). Treatment typically begins with a low dose that is gradually increased over several weeks to minimize side effects. For example, sertraline might start at 25-50mg daily and increase to 50-200mg daily as needed. A full therapeutic trial requires 8-12 weeks, though some improvement may be noticed within 2-4 weeks. SSRIs work by increasing serotonin levels in the brain, which helps regulate mood and anxiety.

Some key points to consider when treating anxiety disorders include:

• The effectiveness of treatments for anxiety has been evaluated by trials summarized in systematic reviews of psychological and pharmacologic therapies 1
• SNRIs, such as venlafaxine and duloxetine, may be considered as an alternative treatment option, particularly for more severe presentations or when quality CBT is unavailable 1
• Combination treatment (CBT and SSRI) may be a more effective short-term treatment for anxiety in children and adolescents than either treatment alone 1
• Common side effects of SSRIs include nausea, headache, sleep disturbances, and sexual dysfunction, which often improve with time 1
• It's essential to take these medications consistently and not stop abruptly, as this can cause withdrawal symptoms 1

In terms of medication options, the choice of medication for anxiety within the SNRI class may also be governed by other considerations such as pharmacokinetics, pharmacodynamics, tolerability, cost, insurance formularies, and unique risks leading to warnings or precautions 1. However, SSRIs remain the first-line medication treatment for anxiety disorders, and SNRIs may be considered as an alternative option.

From the FDA Drug Label

The recommended starting dose of Escitalopram tablets is 10 mg once daily. If the dose is increased to 20 mg, this should occur after a minimum of one week.

The first line treatment medication to treat anxiety is Escitalopram, with a recommended starting dose of 10 mg once daily 2.

From the Research

First-Line Treatment Medications for Anxiety

• Selective serotonin reuptake inhibitors (SSRIs) are considered first-line pharmacotherapy for anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder 3, 4, 5.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also emerging as first-line treatments for anxiety disorders alongside SSRIs 3, 5.
• Benzodiazepines are effective treatments for anxiety disorders, but their use is limited due to potential for abuse and lack of antidepressant properties 3, 4, 5.

Specific Medications

• Examples of SSRIs used to treat anxiety include paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram 4, 6.
• Venlafaxine, an SNRI, is also effective in treating anxiety disorders 4, 5.
• Buspirone, an azapirone, is considered a second-line pharmacotherapy for generalized anxiety disorder 5.

Considerations for Treatment Selection

• Treatment selection should consider factors such as age, co-morbidity, and prior treatment 5.
• In pediatric patients with generalized anxiety disorder, SSRIs should be considered the first-line pharmacotherapy, while in adults, SSRIs and SNRIs represent the first-line psychopharmacologic treatment 5.