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

2. 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

3. 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

4. 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