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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

General Notes

  • 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
  • Before starting antidepressants refer to NICE NG215 for information that should be considered and discussed with the patient, including steps to reduce the risk of dependence or withdrawal symptoms
  • 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. See NICE NG215 for further information on withdrawing
  • Do not offer St John’s Wort or other over-the-counter medications and preparations for anxiety