PG11 Anxiety Spectrum and Related Disorders - Devon Partnership ...

Generalised Anxiety Disorder (GAD)InitiationWhen starting someone on an antidepressant for GAD they should be reviewed 2-4 weeks after startingtreatment and regularly thereafter depending on their response to treatment.Advise patients prescribed antidepressants for GAD, at the time that treatment is initiated, of:potential side effects (including transient increase in anxiety at the start of treatment)the risk of discontinuation/withdrawal symptoms if the treatment is stopped abruptly or in someinstances if a dose is missed or the dose of the drug is reducedthe delay in onset of effect, the time course of treatment and the need to take medication asprescribedTreatment choice and durationPharmacological therapy should be considered for individuals who have not responded to low-intensitypsychological interventions and who express a preference for medication instead of high-intensitypsychological interventions.Initial treatment choice is an SSRI:Sertraline initially 50mg dailyas per NICE CG113 (off-licence indication)If initial treatment is not tolerated or there is an inadequateresponse after a 12 week course, discontinue and consideran alternative SSRI or SNRI (NB If no improvement at all isobserved within the first 4 weeks, response to treatmentunlikely- consider increasing dose or switching to alternativemedication)Venlafaxine MR tablets initially 75mg dailyEscitalopram initially 10mg dailyIf the person cannot tolerate SSRIs or SNRIs consideroffering:Consider the use of a benzodiazepine(diazepam) for the immediatemanagement of;severe anxiety symptoms ifextremely distressing and/ ordisablinginitial worsening of anxietysymptoms when starting treatmentwith SSRIShort term treatment only: up to 4weeks treatment including tapering offperiodPregabalin initially 75mg twice dailyNotes1. Antidepressants (see above) should be the only pharmacological intervention used in the longertermmanagement of generalised anxiety disorder. Initially prescribed dose is above and the dosetitrated upwards as tolerated (to minimise initial worsening of anxiety symptoms which may beexperienced when treatment started).2. Before prescribing consider the individual’s age, previous treatment responses, risk of self-harm,possible interactions with pre-existing conditions and medicines, the individual’s preference and,where all else is equal, cost.3. Escitalopram is not currently available as a cheaper generic medicine.PG11 – Pharmacological Treatment of Anxiety Spectrum & Related DisordersApproved by Drug and Therapeutics Committee: June 2014Review date: June 2016 Page 4 of 13