Medication Dosing in Anxiety Disorders: What the Evidence Shows

[David Baxter PhD]

Medication Dosing in Anxiety Disorders: What the Evidence Shows
by Dr. M.P. White
Primary Psychiatry. 2009;16(10):21-28

Dr White is clinical instructor of Psychiatry and Behavioral Science-Behavioral Medicine and postdoctoral medical fellow of Psychiatry and Behavioral Science at Stanford University in California.

• Despite their common use, benzodiazepine dosing in anxiety disorders remains poorly studied.
• Several selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, citalopram, and escitalopram, have limited data regarding use in anxiety disorders
• There may be diminishing returns for higher doses of SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs).
• SNRIs, particularly extended release venlafaxine, may be useful at lower doses.
• Buspirone, gabapentin, and pregabalin have limited supporting data in anxiety; of these, pregabalin is by far the best characterized.

Abstract
Social anxiety disorder, generalized anxiety disorder, and panic disorder are common and sometimes disabling conditions. While benzodiazepines, antidepressants, buspirone, and several anticonvulsants are frequently used to treat these conditions, an individual medication is often used as a member of "class" without specific attention to the data behind its use in a particular condition.

This article reviews the state of the literature regarding the most common medications used to treat these anxiety disorders with specific attention to optimal dosing. For most of these medications there is sufficient data to suggest a minimum and average effective dose. More problematic, however-and with instructive data for only a few medications-is the question as to whether dosages higher than these levels can provide increased likelihood or degree of response.

Source + Full Text

 

[NicNak]

• There may be diminishing returns for higher doses of SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs).
• SNRIs, particularly extended release venlafaxine, may be useful at lower doses.

I am on a lower dosage of Effexor for these reasons. When I developed major depressive illness, we tried to raise the dosage of the Effexor. Then my anxiety and panic got more difficult to treat and control.

It became about finding a balance where the depression is "tolorable" (I use that term very losely) and where the anxiety and panic isn't majorly severe.

 

[David Baxter PhD]

I'll add my observations from treating clients on SSRIs over the years:

• anxiety disorders tend to require lower doses than depression for the same medication
• for depression, if a medication isn't working at close to the maximum recommended drug, changing the medication is likely to be more beneficial than increasing the dose of the current medication (unless there's some reason that the patient cannot switch to a different medication)
• OCD may require higher doses of the same medication than either anxiety disorders or depression; for OCD, Luvox (fluvoxamine) appears to be the best of the SSRIs