-1st line treatment (SSRIs, SNRIs, and Azapirones [like Buspirone]).
-2nd-line agents: Hydroxyzine, TCAs (Amitriptyline, Nortryptyline, Imipramine), antiepileptics (like Pregabalin), and antipsychotics (Quetiapine).
-3rd-line agents: MAO inhibitors (like Isocarboxazid, Phenelzine, and Tranylcypromine)
Benzodiazepines: May be used for augmentation in the short-term. “When used in combination with antidepressants, benzodiazepines may speed recovery from anxiety-related symptoms but do not improve longer-term outcomes. Because benzodiazepines are associated with tolerance, they should be used only short term during crises.” AAFP 2015
Benzodiazepines: Alprazolam (Xanax), Clonazepam (Klonopin), Diazepam (Valium), Lorazepam (Ativan)
—-///—
May combine SSRIs with
-Hydroxyzine 25-100 mg PO q6h prn. Start low and go slow with older patients.
or
-Buspirone 20-30 mg/day po divided bid-tid. Start 7.5mg po BID, then increase by 5mg/day q2-3 days.
or
-Benzodiazepines (short term)