see also:

• stress
• psychiatry and mental health

• all people have periods of anxiety
• it may become troublesome and regarded as a disorder if it becomes persistent, or is out of proportion to what would be expected and interferes with functioning.
• personality style may be a critical cause of anxiety and in these cases, patients are unlikely to respond to drug Rx alone.
• most people can be managed with self-help programs although some may warrant referral to a clinical psychologist, and some may require pharmacologic assistance after pre-treatment counselling.
• substance abuse including alcohol use tends to increase anxiety disorders
• do not forget to exclude agitated depression and suicidality as a differential diagnosis

• Anxiety Online - an Aust. Govt funded website developed by Swinburne Uni
• This Way Up - an initiative of the Sydney St Vincent's Hospital Clinical Research Unit
• eCentre Clinic - developed by Macquarie University

• most agents will have initial mild adverse effects such as nausea, headache and dizziness, and anxious patients may interpret these as indicating they may have a serious medical problem
• it is thus important to spend time beforehand to discuss these issues and the fact, it will take some 4-6 weeks before benefit starts, and to start on a low dose for a few days to a week
• allow at least 4-6 weeks for the minimum recommended dose to work before increasing to higher doses
• most patients should be considered for Rx duration of around 1 year
• if inadequate response after good duration of Rx, consider changing to another SSRI
• consider adding cognitive behavioural Rx after some symptomatic improvement has occurred

• historically benzodiazepines were used as 1st line anxiolytics have their use has some disadvantages such as cognitive impairment, dependence and anxiety-producing withdrawal period which preclude their utility as 1st line agents
• current 1st line agents now should be SSRI/SNRI antidepressants
  • Rx dose may vary according to disorder, for example:
    • fluoxetine:
      • usual dose 20-40mg/d
      • panic disorder may require up to 60mg/d
      • OCD may require up to 80mg/d
• a very short course of benzodiazepines for only a few days to a week may be indicated to get patients through a particularly stressful period

• venlafaxine - most anxiety disorders except OCD
• duloxetine - generalised anxiety disorder
• tricyclic antidepressants
• monoamine oxidase inhibitors (MAOIs)
• anti-psychotic medications such as quetiapine