What is the first-line medication for anxiety?

From the Guidelines

Selective serotonin reuptake inhibitors (SSRIs) or anxiolytics should be considered as the first-line medication for anxiety, with the choice informed by side-effect profiles, interactions, response, patient age, and preference. When selecting an SSRI, considerations such as starting dose, potential side effects, and patient-specific factors are crucial 1. Commonly prescribed SSRIs include sertraline, escitalopram, and fluoxetine, which typically take 4-6 weeks to reach full effectiveness. Key factors influencing the choice between SSRIs and anxiolytics include the patient's medical history, current medications, and personal preferences, as outlined in recent guidelines 1.

Some key points to consider when prescribing SSRIs or anxiolytics for anxiety include:

• Starting with a low dose and gradually increasing as needed and tolerated
• Monitoring for side effects and adverse events, particularly during the initial treatment phase
• Considering the potential for drug interactions and adjusting the treatment plan accordingly
• Educating patients on the importance of consistent dosing and the potential benefits and risks of treatment

In terms of specific medications, SSRIs are generally preferred due to their favorable safety profile and efficacy in treating multiple anxiety disorders, as well as comorbid depression 1. Anxiolytics, on the other hand, may be considered for short-term use, but their potential for dependence and tolerance limits their use as a first-line treatment. Ultimately, the choice of medication should be individualized to each patient's unique needs and circumstances, with regular monitoring and adjustments as needed to optimize treatment outcomes 1.

From the FDA Drug Label

Alprazolam tablets are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of social anxiety disorder, also known as social phobia in adults The first line medication for anxiety is not explicitly stated in the provided drug labels, however, both sertraline and alprazolam are indicated for the treatment of anxiety disorders.

• Alprazolam is indicated for the management of anxiety disorder or the short-term relief of symptoms of anxiety 2
• Sertraline is indicated for the treatment of social anxiety disorder, also known as social phobia in adults 3

From the Research

First-Line Medication for Anxiety

• The first-line medications for anxiety disorders include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) 4, 5, 6, 7.
• SSRIs, such as sertraline, have been shown to be effective in treating anxiety disorders, including generalized anxiety disorder, panic disorder, and social phobia 8.
• SNRIs, such as venlafaxine, have also been found to be efficacious in treating anxiety disorders, with comparable tolerability to SSRIs 4.
• A network meta-analysis found that duloxetine and escitalopram showed better efficacy, while vortioxetine showed better acceptability in the treatment of generalized anxiety disorder 6.
• The choice of medication depends on various factors, including age, co-morbidity, and prior treatment, and clinicians should consider these factors when selecting a pharmacotherapy for patients with anxiety disorders 7.
• Higher doses of SSRIs, but not SNRIs, have been associated with significantly greater symptom improvement and likelihood of treatment response, but also with an increased likelihood of dropout due to side effects 5.