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  • image The long-term goal in treatment of generalized anxiety disorder is remission with minimal or no anxiety symptoms and no functional impairment.
  • image Antidepressants are the agents of choice for the management of generalized anxiety disorder.
  • image Antidepressants have a lag time of 2 to 4 weeks or longer before antianxiety effects occur in generalized anxiety disorder.
  • image When monitoring the effectiveness of antidepressants in panic disorder, it is important to allow an adequate amount of time (8 to 12 weeks) to achieve full therapeutic response.
  • imageClonazepam and alprazolam extended-release are alternatives to alprazolam immediate-release for patients with panic disorder having breakthrough panic symptoms at the end of a dosing interval.
  • image The optimal duration of panic therapy is unknown; 12 to 24 months of pharmacotherapy is recommended before gradual drug discontinuation over 4 to 6 months is attempted.
  • image Social anxiety disorder is a chronic long-term illness requiring extended therapy. After improvement, at least a 1-year medication maintenance period is recommended.
  • image The selective serotonin reuptake inhibitors or venlafaxine are considered first-line pharmacotherapy for social anxiety disorder.
  • image An adequate trial of antidepressants in generalized social anxiety disorder lasts at least 8 weeks, and maximal benefit may not be seen until 12 weeks.
  • image The three principal domains in which improvement should be observed in generalized social anxiety disorder are symptoms, functionality, and well-being.

On completion of the chapter, the reader will be able to:

  1. Describe the clinical presentation of generalized anxiety, panic, and social anxiety disorders.

  2. Explain the pathophysiologic processes underlying the anxiety disorders.

  3. Identify medications that may exacerbate or cause symptoms of anxiety.

  4. Recommend starting doses of first-line pharmacotherapy options in each anxiety disorder.

  5. Design a pharmacotherapy treatment regimen for each anxiety disorder.

  6. Recommend the expected duration of treatment for each anxiety disorder.

  7. Identify medications that can affect the pharmacokinetics and pharmacodynamics of benzodiazepines.

  8. Formulate a plan of how to discontinue pharmacotherapy with antidepressants for each of the anxiety disorders.

  9. Develop a plan for discontinuing benzodiazepines in panic disorder.

  10. Recommend alternate pharmacotherapy in the management of anxiety disorders resistant to first-line therapy.

  11. Create a monitoring plan for a patient treated for a given anxiety disorder based on the treatment regimen.

  12. Describe aspects of patient education necessary for successful management of anxiety disorders.

  13. Discuss treatment goals of pharmacotherapy for each of the anxiety disorders.

  14. Explain the role of nonpharmacologic therapy in the management of each anxiety disorder.

  15. Compare the adverse effects of the different classes of medications used to treat anxiety disorders.

Anxiety is an emotional state commonly caused by the perception of real or perceived danger that threatens the security of an individual. It allows a person to prepare for or react to environmental changes. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation. This is an adaptive response and is transient in nature.

Anxiety can produce uncomfortable and potentially debilitating psychological (e.g., worry or feeling of threat) and physiologic arousal (e.g., tachycardia or ...

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