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At this step of treating an anxiety disorder, which treatment is next?
More, if you want it
What does the patient fear?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: an antidepressant that blocks serotonin reuptake, such as sertraline.
You can: Name an SSRI as the first drug when a patient with panic disorder or social phobia declines talking therapy.
Definition: an older antidepressant class, such as imipramine or clomipramine.
You can: Tell a tricyclic from moclobemide by the disorder: a tricyclic follows a failed SSRI in panic disorder.
Definition: an antidepressant that blocks serotonin reuptake, such as sertraline.
You can: Name an SSRI as the first drug when a patient with panic disorder or social phobia declines talking therapy.
Definition: a late-line drug for social phobia after SSRIs fail.
You can: Tell moclobemide from a tricyclic by the disorder: moclobemide follows failed SSRIs in social phobia.
Definition: a gabapentinoid used in generalised anxiety disorder after SSRIs and SNRIs.
You can: Name pregabalin when SSRIs and SNRIs fail or are not tolerated in generalised anxiety disorder.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
An SSRI such as sertraline is the first-line drug for panic disorder in someone who declines talking therapy.
An such as sertraline is the first-line drug for panic disorder in someone who declines talking therapy. Sertraline is also the drug most likely to help social phobia when the person cannot engage in psychological treatment.
For many anxiety disorders, psychological therapy is the preferred first step, and NICE supports this approach. A drug becomes the route when the patient declines talking therapy. In panic disorder, SSRIs and the SNRI venlafaxine are both first-line drugs. Tricyclics and MAOIs work but cause more side effects. In social phobia, medication is kept for patients who decline therapy, or whose therapy fails or only partly works. Escitalopram and sertraline are the named SSRIs. Venlafaxine also works in social phobia. An SSRI is a selective serotonin reuptake inhibitor, an antidepressant.
Ngozi Adeyemi sees the community mental health team in Lewisham. Ngozi has panic disorder and says, "I do not want talking therapy. I want a tablet."
Panic disorder and social phobia share the same first drug. An SSRI such as sertraline comes first in both panic disorder and social phobia.
5 more sections on Drug treatment of panic disorder, social phobia and generalised anxiety disorder: SSRI, tricyclic, moclobemide, pregabalin
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