Anxiety Disorder Treatment Guidelines

First-Line Treatments

The American College of Neuropsychopharmacology recommends SSRIs and SNRIs as first-line pharmacological treatments for anxiety disorders with substantial evidence supporting their efficacy 1, 2, 3
Cognitive behavioral therapy (CBT) is recommended as a first-line non-pharmacological treatment for anxiety disorders by the American College of Neuropsychopharmacology 2, 4

SSRIs (such as escitalopram, sertraline, paroxetine, fluvoxamine) have demonstrated efficacy with a number needed to treat (NNT) of 4.70 for anxiety disorders, according to the American College of Neuropsychopharmacology 2, 5
SNRIs (particularly venlafaxine) have similar efficacy (NNT = 4.94) for anxiety disorders, as reported by the American College of Neuropsychopharmacology 2, 5
Both medication classes have dropout rates similar to placebo, suggesting good tolerability for anxiety disorders, as noted by the American College of Neuropsychopharmacology 5

There is a risk of serotonin syndrome when combining vilazodone with other serotonergic medications, as warned by the American College of Neuropsychopharmacology 1
There is a potential for discontinuation symptoms if vilazodone is stopped abruptly, according to the American College of Neuropsychopharmacology 2
Monitoring for emergence of suicidal ideation is necessary, particularly in adolescents, as advised by the Journal of the American Academy of Child and Adolescent Psychiatry 6

The American College of Neuropsychopharmacology suggests considering both pharmacological and non-pharmacological approaches when treating anxiety disorders 2, 4
Patients should be monitored closely during the initial weeks of treatment with any serotonergic medication, as recommended by the American College of Neuropsychopharmacology 1
For patients with treatment-resistant anxiety or those who cannot tolerate first-line agents, consultation with a psychiatrist is recommended before trying medications with less evidence, according to the American College of Neuropsychopharmacology 2

The American Academy of Child and Adolescent Psychiatry recommends SSRIs, particularly sertraline, and SNRIs, such as duloxetine for ages 7+, as first-line treatments for children and adolescents with anxiety 7