Anxiety disorders
- Psychotherapy + SSRIs/SNRIs are core treatments
- Choose drug by anxiety subtype + comorbidity
- Buspirone is useful mainly for generalized anxiety
- Benzodiazepines work rapidly but add dependence risk
- Beta blockers target performance symptoms—not core GAD
- Adequate dose/duration matters before declaring failure
Use at a glance
- Psychotherapy + SSRIs/SNRIs are core treatments
Practical pearls
- Adequate dose/duration matters before declaring failure
Other practical pearls
- Buspirone is useful mainly for generalized anxiety
- Beta blockers target performance symptoms—not core GAD
Treatment options
- Choose drug by anxiety subtype + comorbidity
Other treatment options
- Benzodiazepines work rapidly but add dependence risk
Key points
- 1st-line: SSRI or SNRI; benefit may take up to 6 wk
- Benzodiazepines: immediate relief, early adjunct to SSRI/SNRI; dependence, seizures on abrupt stop
- Pregabalin ≈ SSRI/SNRI for GAD, faster onset; pregabalin/gabapentin: respiratory depression, abuse
- Buspirone: FDA-approved monotherapy, used mainly as adjunct
- TCAs effective for panic disorder, GAD; anticholinergic AEs limit use
- SGAs 2nd/3rd-line: weight gain, metabolic AEs, akathisia, TD
- Single-dose beta blocker ↓ performance anxiety; CBT ≥ drugs, more durable
Nonpharmacologic therapies
- CBT
- Exposure therapy
- Mindfulness-based interventions
- Psychodynamic therapy
- Exercise
- Acupuncture
- Yoga
- rTMS
Pearls
- SSRI/SNRI preferred with comorbid depression; fine long-term
- Start low, titrate slowly to limit early jitteriness
- Lorazepam, oxazepam: preferred BZDs while breastfeeding; no CYP3A4
- Kava: high doses or long use risk severe hepatotoxicity
- No cannabinoid approved; cannabis can worsen anxiety
Self-check
- What are core anxiety treatments?
Psychotherapy + SSRIs/SNRIs. - Which anxiety subtype is buspirone mainly useful for?
Generalized anxiety.
Drugs used for this (28)
All clinical uses · Open Anxiety disorders in the interactive console ↗