4.3.2 Antidepressants for the treatment of anxiety disorders
Includes generalised anxiety disorder [GAD], panic disorder, social anxiety disorder, obsessive–compulsive disorder [OCD] and post- traumatic stress disorder [PTSD].
For treatment of acute anxiety state, see section 188.8.131.52.
- Diagnosis and treatment can be difficult and in some cases specialist advice or referral will be necessary.
- For mild anxiety disorders, consider a period of active monitoring and provide verbal and written information about the condition.
- Due to the risk of withdrawal reactions, patients taking paroxetine should not stop the drug suddenly. Cessation of treatment should involve a very gradual downward titration. If intolerable symptoms develop it may be necessary to reinstate the previously prescribed dose and withdraw more gradually.
- For doses of fluoxetine 60mg it is more cost-effective to prescribe this dose as 3 x 20mg capsules.
- Do not offer St John’s Wort or other over-the-counter medications and preparations for anxiety.