Mrs. M reluctantly agrees to a trial of sertraline, 50 mg/d. She refuses a prescription for clonazepam because she is afraid of drug dependence but accepts a referral for CBT. Two days later, she calls the clinic and says she is more anxious and wants to stop the sertraline. The psychiatrist reassures her and reduces the dosage to 25 mg/d.
Mrs. M’s spike of anxiety resolves by her 2-week follow-up appointment and sertraline is titrated to 200 mg/d. Her irritability, anxiety, and mood improve within 2 months. The worry does not completely resolve, but she is much improved at 6 months, and the focus of her therapy shifts to her marriage.
Related Resources
Goldberg D, Kendler KS, Sirvatka PJ, et al, eds. Diagnostic issues in depression and generalized anxiety disorder—refining the research agenda for DSM-V. Arlington, VA: American Psychiatric Publishing; 2010.
Fricchione G. Generalized anxiety disorder. N Engl J Med. 2004;351(7):675-682.
Drug Brand Names
Buspirone • Buspar
Clonazepam •Klonopin
Diazepam • Valium
Duloxetine • Cymbalta
Escitalopram • Lexapro
Fluoxetine • Prozac
Gabapentin• Neurontin
Hydroxyzine • Vistaril, Atarax
Imipramine • Tofranil
Paroxetine • Paxil
Pregabalin • Lyrica
Quetiapine • Seroquel
Riluzole • Rilutek
Sertraline • Zoloft
Venlafaxine • Effexor
Disclosure
Dr. Barry reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
