Medication Adjustment for Persistent Anxiety

Rationale for Medication Adjustment

• The American Academy of Child and Adolescent Psychiatry identifies SSRIs as first-line pharmacotherapy for anxiety disorders with superior efficacy to buspirone, and buspirone is generally reserved for patients who cannot tolerate SSRIs or when avoiding sedation is paramount 1, 2, 3

Dosing Strategy

• Prioritize optimizing buspirone first, as it is currently underdosed, while vortioxetine is at a reasonable therapeutic level, according to Praxis Medical Insights 1

Critical Pitfalls to Avoid

• Do not abandon buspirone prematurely, as the medication requires 2-4 weeks to demonstrate full anxiolytic effect, and the current dose is subtherapeutic 1
• Do not add benzodiazepines for chronic management, as they carry dependence risk and are inappropriate for ongoing treatment 2