Treatment of Anxiety in Adults

First-Line Treatment Options

The American Psychiatric Association recommends initiating treatment with either an SSRI (sertraline or escitalopram preferred) or cognitive behavioral therapy (CBT) based on patient preference, with individual CBT being the gold standard psychotherapy approach 1, 2
SSRIs are the recommended first-line pharmacological treatment for anxiety disorders in adults, according to the American Psychiatric Association 1, 2

The National Institute for Health and Care Excellence suggests that SSRIs can cause transient anxiety or agitation in the first 1-2 weeks of treatment, which typically resolves 3
Full therapeutic benefit of SSRIs requires 4-8 weeks of treatment, as stated by the American Psychiatric Association 3
Treatment with SSRIs should continue for at least 4-12 months after symptom remission for first episode, according to the American Psychiatric Association 3, 4

Cognitive Behavioral Therapy (CBT) specifically developed for anxiety disorders is the psychotherapy with the highest level of evidence, recommended by the American Psychological Association 1, 5
Individual therapy is preferred over group therapy due to superior clinical and cost-effectiveness, as suggested by the American Psychological Association 1, 5

Combination treatment (CBT plus SSRI) may be more effective than either alone in certain populations and can be considered if monotherapy fails, according to the American Psychiatric Association 4

The American Psychiatric Association recommends determining specific anxiety disorder subtype and screening for comorbid psychiatric conditions before initiating treatment 6
Treatment decisions should involve shared decision-making between clinician and patient, considering scientific evidence alongside patient values and preferences, as stated by the American Medical Association 1

Beta-blockers (atenolol, propranolol) are not recommended based on negative evidence, according to the American Heart Association 5