Be Familiar With Meds for Anxiety

Meds for generalized anxiety disorder are common on home med lists...since about 1 in 13 US adults will be diagnosed in their lifetime.

It’s more than occasional anxiety. It’s hard-to-control worry with related symptoms (insomnia, etc) that persist most days for months.

Be prepared to manage home anxiety meds during a hospital admission.

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SSRIs or SNRIs. Expect one of these to be used first-line, based on overall evidence for generalized anxiety disorder. Plus they’re preferred for common comorbidities, such as depression.

Clarify the indication when these are on a home med list.

For anxiety, expect to see escitalopram or sertraline...or duloxetine or venlafaxine...used most commonly. Limited data suggest these provide a better balance of efficacy and tolerability.

Continue SSRIs or SNRIs during an admission if able. Abruptly stopping can lead to withdrawal...flu-like symptoms, hyperarousal, etc.

Buspirone. Think of this as second-line if an SSRI or SNRI isn’t tolerated...or as an add-on if they aren’t enough.

You can hold buspirone on admission if needed...stopping it doesn’t cause withdrawal. But if it’s continued, ensure doses are bid or tid...and not prn.

Benzos. Anticipate these to be saved for select cases, such as severe anxiety disorders.

Expect to see longer-acting benzos, such as clonazepam, scheduled for generalized anxiety disorder. Shorter-acting benzos, such as alprazolam, can cause rebound anxiety or withdrawal.

In patients taking benzos, try to use non-opioid analgesics...since combining opioids and benzos increases risk for opioid-induced respiratory depression.

Get our updated chart, Pharmacotherapy of Anxiety, for more on other med options, such as pregabalin and hydroxyzine.

Key References

  • Szuhany KL, Simon NM. Anxiety Disorders: A Review. JAMA. 2022 Dec 27;328(24):2431-2445.
  • Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother. 2023 Jun;23(6):535-548.
  • DeGeorge KC, Grover M, Streeter GS. Generalized Anxiety Disorder and Panic Disorder in Adults. Am Fam Physician. 2022 Aug;106(2):157-164.
Hospital Pharmacist's Letter. October 2024, No. 401014



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