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 18.104.22.168.
- 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
- 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