25
Table 10. Medications for Anxiety-Related Symptoms
a
Medication
Class/
mechanism Considerations for use
Other
population
considerations
Chronic anxiety (GAD, panic, PTSD, social anxiety)
Buspirone
d
5HT1A
receptor agonist
Not effective as a prn agent
Only effective for GAD
Selective
serotonin
reuptake
inhibitors
(SSRIs)
e
Antidepressant
f
May be anxiogenic upon
initiation and dose increase;
start at a low dose and titrate
slowly
Variable interactions with other
medications
Serotonin-
norepinephrine
reuptake
inhibitor
(
SNRIs
)
e
Antidepressant
f
May be anxiogenic upon
initiation and dose increase;
start at a low dose and titrate
slowly
May increase blood pressure
Caution in uncontrolled
hypertension
Mirtazapine
c
Serotonin and
norepinephrine
modulator
Not FDA approved for
treatment of anxiety disorders
May be anxiolytic upon
initiation
More sedating than SSRIs and
SNRIs upon initiation
Prazosin
b
Central alpha-1
antagonist
Approved for hypertension; may
be used off-label for PTSD-
related nightmares but not other
symptoms of anxiety
Monitor blood pressure; avoid
in hypotension
a
Use in individual patients should always include review of medical and medication history
and individual prescribing information to assess for any relative/absolute contraindications.
b
Not FDA approved for anxiety disorders. e CGC noted that gabapentin has potential
for misuse and, therefore, while it may be useful in certain circumstances, should not be
considered prior to other potential adjunctive medications.
c
FDA approved.
d
FDA approved for GAD only.
e
Variably approved for GAD, panic disorder, PTSD, and social anxiety disorder.
f
Antidepressants have boxed warnings regarding suicidality, especially in adolescents and
emerging adults.
(cont'd)
