Medication Guidelines
• Antidepressant medications are effective and frequently used to treat Anxiety Disorders. For advice
and dosages, please refer to the Guidelines for the Treatment of Depression in Primary Care.
• Patients with anxiety disorders are particularly sensitive to side-effects from medication.
Therefore, commence medication at a lower initial dose, subsequently increasing to FULL
THERAPEUTIC DOSE. For example, start citalopram / paroxetine / etc.. 10mg OD, INCREASING
TO 20mg (or more) after 1-2 weeks. Initial response to treatment may take longer than for
depression (> 6 weeks).
• Some SSRIs have licences for specific anxiety disorders, e.g. paroxetine for social phobia
& PTSD. However, despite not having a specific licence, there is little difference between
most of the SSRIs.
• Patients with anxiety disorders are at high risk of developing benzodiazepine dependance.
If a patient has never taken benzodiazepines before, prescribe for less than 4 weeks and only one
course per year.
• Hypnotics & benzodiazepines should be used with great caution and for less than 4 weeks.
Avoid repeat prescriptions. Closely monitor patient progress. Benzodiazepines are rapidly
addictive, easily abusable and may be sold on as street drugs.
• Anxiety disorder sufferers commonly have depression co-morbidity. Therefore, it is vital to
assess RISK OF SELF-HARM (see Depression Guidelines).

* Please also refer to appendix guidelines on withdrawing anti-depressants.

Management Of Acute Distress
1. Advice, reassurance and councelling aimed at problem resolution.
2. Appropriate involvement of local services, e.g. CAB, grief counselling organisations, victim support,
rape crisis centre, etc...
3. Assess risk of self-harm or harm to others (see Depression Guidelines).
4. Short-term sedative medication may be helpful in a minority.
5. Medication: PROMAZINE 25MG PRN QDS, or sedative antidepressant e.g. TRAZODONE 50-
100mg nocte or BD. Sedative antihistamines e.g. HYDROXYZENE 10-100mg daily.
PROPRANOLOL 20-160mg daily may be useful for somatic symptoms of anxiety (beware asthma & vascular disease).
These are ‘off licence’ uses of these medications.

ASSESS OVERDOSE RISK
USE SMALL SUPPLIES OF MEDICATION
REVIEW PATIENT PROMPTLY

Other Useful Telephone Numbers

Information For Patients
Good general information available on:
www.psychiatry24x7.com
www.nhsdirect.nhs.uk

Support Organisations
Social Anxiety UK
P.O. Box 5283
Burton-On-Trent
Staffs
DE15 02D

No Panic
Helpline 0800 783 1531

National Phobics Society
Helpline 0870 7700 456

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