First-Line Medications for Anxiety

Medication Options

The American Academy of Child and Adolescent Psychiatry suggests Paroxetine as a treatment option for social anxiety disorder, which is covered by national health insurance in some countries 1
The Journal of the American Academy of Child and Adolescent Psychiatry recommends Fluvoxamine as an effective treatment for anxiety disorders, but notes its greater potential for drug-drug interactions 2
The American Academy of Child and Adolescent Psychiatry guidelines recommend Escitalopram as a first-line treatment for anxiety disorders, with potentially fewer drug interactions 1, 3
The Journal of the American Academy of Child and Adolescent Psychiatry suggests Citalopram as an effective treatment for anxiety disorders, but advises caution due to potential QT prolongation at doses exceeding 40 mg/day 2
The American Academy of Child and Adolescent Psychiatry recommends Venlafaxine (extended release) as a first-line medication for anxiety disorders 4

The Journal of the American Academy of Child and Adolescent Psychiatry notes that SSRIs with fewer drug interactions, such as citalopram and escitalopram, may have a lower propensity for drug-drug interactions 2
The Journal of the American Academy of Child and Adolescent Psychiatry warns that Paroxetine has been associated with an increased risk of suicidal thinking compared to other SSRIs 2
The Journal of the American Academy of Child and Adolescent Psychiatry advises that concomitant administration of any SSRIs with monoamine oxidase inhibitors (MAOIs) is contraindicated due to the risk of serotonin syndrome 2

The Journal of the American Academy of Child and Adolescent Psychiatry notes that some SSRIs, particularly paroxetine, fluvoxamine, and sertraline, have been associated with discontinuation syndrome 2
The Journal of the American Academy of Child and Adolescent Psychiatry lists symptoms of discontinuation syndrome, including dizziness, fatigue, headaches, nausea, insomnia, and anxiety 2

The Journal of the American Academy of Child and Adolescent Psychiatry recommends starting with lower doses and increasing gradually, with shorter half-life SSRIs (sertraline, citalopram) increased at 1-2 week intervals and longer half-life SSRIs (fluoxetine) increased at 3-4 week intervals 2
The Journal of the American Academy of Child and Adolescent Psychiatry suggests that faster titration may be indicated for more severe anxiety presentations 2

The Journal of the American Academy of Child and Adolescent Psychiatry recommends combination treatment (CBT and an SSRI) as a preferential option over monotherapy for optimal outcomes 2