4.1.2.1 Acute anxiety state

Prescribing Notes

• The most appropriate first-line treatments for anxiety are self-help strategies, counselling and CBT. See resources e.g. ‘Good relaxation guide’ on the Patient Area and the Choice and Medication website
• Benzodiazepines are indicated for the short-term relief (2-4 weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress. The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable
• Before starting benzodiazepines refer to NICE NG215 for information that should be considered and discussed with the patient, including steps to reduce the risk of dependence
• Benzodiazepine anxiolytics should not be used as sole treatment for chronic anxiety, and they are not appropriate for treating depression or chronic psychosis
• Treatment should be limited to the lowest possible dose for the shortest possible time
• Diazepam has a medium duration of action and rapid onset. It is the recommended daytime anxiolytic (and issued as pre-medication before surgery and other procedures. See BNF)
• New patients should not be put on a repeat prescription system and existing patients receiving an anxiolytic should be reviewed and offered the chance to stop. See 4.10.3  and resources on the primary care intranet. NICE have produced a visual summary for reviewing medication associated with dependence
• The beta-blocker propranolol may be useful for somatic symptoms of anxiety such as tachycardia, sweating and tremor in performance related anxiety. Please refer to BNF for doses and contraindications, etc
• Buspirone has little efficacy as an acute anxiolytic as clinical effect typically takes 2-4 weeks to achieve. However, it is only licensed for short term use, making its place in therapy unclear

Cautions

See cautions here.