SSRI choice — start low, go slow
- Start at roughly half the usual depression starting dose — anxiety can transiently worsen in weeks 1–2.
- Escitalopram or sertraline — commonly well-tolerated first choices for GAD, panic and social anxiety.
- Fluoxetine — an option for OCD, which typically needs a higher dose toward the top of the SSRI range.
- Confirm exact starting/target doses in the AMH or eTG.
Comorbidity & screening
- Screen for depression (PHQ-9) and substance use (AUDIT-C) at every assessment — high overlap with anxiety.
- Anxiety can mimic cardiac, thyroid, or GI conditions — exclude organic causes first.
- Consider OSA screening if hypersomnia/snoring — untreated OSA can worsen anxiety.
Benzodiazepine stewardship. Not first-line — CBT and SSRIs treat the disorder; benzodiazepines don't. Reserve for short-term use (commonly ≤2–4 weeks) in acute crisis or while an SSRI takes effect, at the lowest effective dose. Tolerance can develop within 4–6 weeks. If tapering after longer use, individualise the pace — current guidance favours slow, patient-centred reductions, which can take many months for long-term use.
