Anxiety Treatment Guidelines Maine Medical Center Anxiety Treatment Guidelines Additional notes for lecturer are provided below:

Step 4: Complex treatment refractory anxiety and/or marked functional impairment Such as risk of self-neglect or self-harm Refer to specialty clinic McGeachey Hall: multidisciplinary treatment of anxiety for 3-12 month period with subsequent treatment resumed by primary care clinic Step 3: Anxiety Disorder with inadequate response to Step 2 interventions or marked functional impairment Choice of a high-intensity psychological intervention (CBT/Applied Relaxation) And/Or Drug Treatment Embedded behavioral specialist Or Community Counseling Center Step 2: Diagnosed anxiety disorder that has not improved after Education And active monitoring low-intensity psychological interventions; individual non-facilitated self-help, individual guided self-help and psycho-educational groups Step 1: All known and suspected cases of anxiety disorder Identification and assessment; education about anxiety and Treatment options; active monitoring

Medication algorithm (anxiety disorders) 1st trial: Try an SSRI 2nd trial: Try another SSRI or an SNRI Consider psychiatric consult or referral (at any point--but particularly before considering a benzodiazepine or atypical antipsychotic) Panic Disorder: Consider Imipramine or Clomipramine or Pregabalin GAD/Social Anxiety: Consider Gabapentin or Pregabalin PTSD: Consider (augmentation for sleep disturbance) Prazosin 3rd trial Partial response for any disorder: Consider addition 2nd agent (e.g., mirtazapine + SSRI, TCA + SSRI, if also depressed, bupropion +SSRI/SNRI) ?4th trial

Medication algorithm (OCD) 1st trial: Try an SSRI 2nd trial: Try another SSRI Consider psychiatric consult or referral (at any point--but particularly before considering a benzodiazepine) Try Clomipramine monotherapy 3rd trial Consider augmentation with atypical antipsychotic (Risperidone or Aripiprazole) or with CBT 4th trial