Anxiety in Primary Care

Anxiety is a nonspecific term and often presents with combinations of the following:

 

  • Excessive worries, doubts, or fears
  • Immediately thinking about the worst case scenario in any situation 
  • Nervousness
  • Restlessness
  • Feeling “On Edge”
  • Feeling “overly aware” or hyper vigilant
  • Feeling like something bad is going to happen
  • Racing thoughts and Ruminations
  • Insomnia/sleep disturbances

 

Physical Symptoms (physical symptoms are the most common presenting symptoms in primary care settings):

 

  • Pain
  • Tingling
  • Numbness
  • Weakness
  • Vision changes
  • Shortness of breath
  • Palpitations/Racing heart beat
  • Chest pain
  • stomach pain/Indigestion
  • Muscle tension and tightness 
  • Headaches

 

SCREENING (GAD-7)

DIAGNOSIS ALGORITHM

 

  • Anxiety Disorders are classified by the presence or absence of triggers or precipitating events that cause anxious symptoms

 

 

NOTES:

  1. MORE THAN ONE DIAGNOSIS IS COMMON!
  2. IF NONE OF THE ABOVE CAN BE IDENTIFIED, CONSIDER REFERRAL TO PSYCHIATRY
  3. MEDICAL CONDITIONS, DEPRESSION, PANIC DISORDER, AND OTHER ANXIETY DISORDERS OFTEN CO-OCCUR AND SHOULD BE TREATED
  4. ANXIETY SYMPTOMS SHOULD BE ADDRESSED AND TREATED EVEN IF THEY ARE DUE TO A MEDICAL CONDITION

TREATMENT CHOICES

 

 

Additional Information:

 

  • When initiating SSRIs, start at half the dose for depression and increase dose more slowly
  • When initiating SSRIs in Generalized Anxiety Disorder and Panic Disorder, prescribe a benzodiazepine to mitigate initial anxiety/nausea common with initiation of SSRIs and to provide immediate relief as SSRIs typically take 2-6 weeks to work
  • SNRIs are also used (and effective) for Anxiety Disorders
  • There is little evidence supporting the use of Benzodiazepines in Social Anxiety Disorder, Obsessive Compulsive Disorder, and Post-Traumatic disorder
  • Benzodiazepines can be used as monotherapy for Panic Disorder and Generalized Anxiety Disorder (but SSRIs/SNRIs should be tried first)
  • Higher doses of SSRIs are usually required to relieve symptoms of Obsessive Compulsive Disorder
  • Click “SSRIs” , “SNRIs” , or “Benzodiazepines” for more detailed information about each medication. 

 

 

Additional Information:

 

  • When initiating SSRIs, start at half the dose for depression and increase dose more slowly
  • When initiating SSRIs in Generalized Anxiety Disorder and Panic Disorder, prescribe a benzodiazepine to mitigate initial anxiety/nausea common with initiation of SSRIs and to provide immediate relief as SSRIs typically take 2-6 weeks to work
  • SNRIs are also used (and effective) for Anxiety Disorders
  • There is little evidence supporting the use of Benzodiazepines in Social Anxiety Disorder, Obsessive Compulsive Disorder, and Post-Traumatic disorder
  • Benzodiazepines can be used as monotherapy for Panic Disorder and Generalized Anxiety Disorder (but SSRIs/SNRIs should be tried first)
  • Higher doses of SSRIs are usually required to relieve symptoms of Obsessive Compulsive Disorder
  • Click SSRIs , SNRIs , or Benzodiazepines for more detailed information about each medication. 

 

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