Anxiety - Treatment

Question 1

What are the therapy options for Generalised Anxiety Disorder?

Answer 1

Pharm: SSRIs, Venlafaxine XR, Pregabalin
Other non-optimal options – TCAs, BB, hydroxyzine, buspirone etc

Non-Pharm: CBT, psychotherapy
Relaxation, anxiety management

Question 2

What are the therapy options for Panic Disorder?

Answer 2

Pharm: SSRI, TCAs (possibly MAOIs, valproate?)

Non-Pharm: CBT

Question 3

What are the therapy options for Social Anxiety Disorder?

Answer 3

Pharm: SSRIs (Other non-optimal options – MAOIs ± BZD)

Non-Pharm: Behavioural therapy

Question 4

What are the therapy options for Obsessive Compulsive Disorder?

Answer 4

Pharm: SSRIs, clomipramine

Non-Pharm: CBT, Exposure and Response Prevention (ERP)

Question 5

What are the therapy options for PTSD?

Answer 5

Pharm: SSRIs (TCAs less optimal)

Non-Pharm: CBT (impt 1st line Tx)
Psychotherapy, counselling

Question 6

What are the therapy options for Acute Stress?

Answer 6

Pharm: Short-course PRN BZDs
Antihistamines e.g. hydroxyzine

Question 7

What are the therapy options for Agoraphobia?

Answer 7

Pharm: Short-course PRN BZDs

Non-Pharm: Behavioural therapy, group therapy, CBT

Question 8

How should adjunct benzodiazepines be used?

Answer 8

• Effective for physical symptoms of anxiety (e.g. muscle tension)
• Fast onset of action: can be within 30min (e.g. lorazepam)
• Aim for short-term (3-4/12) of Tx, PRN dosing – taper afterwards
  (Do give patients the heads up that this is meant for short term use, and will be discontinued soon)
• Avoid abrupt cessation after weeks of continued use (withdrawal), gradual taper required
• High potency agents usually preferred in anxiety disorders – Clonazepam, Lorazepam, Alprazolam
• Cautions: Paradoxical excitement esp in children and elderly; Dependence and withdrawal symptoms can occur esp in patients w drug dependence Hx