Maine Medical Center Anxiety Treatment Guidelines

Maine Medical Center
Anxiety Treatment Guidelines
Step 4: Complex treatment refractory anxiety
and/or marked functional impairment
Such as risk of self-neglect or self-harm
Refer to specialty clinic
Step 3: Anxiety Disorder with inadequate response
to Step 2 interventions
or marked
functional impairment
Choice of a high-intensity psychological intervention
(CBT/Applied Relaxation)
And/Or Drug Treatment
Step 2: Diagnosed anxiety disorder that has not improved after Education
And active monitoring low-intensity psychological interventions;
individual non-facilitated self-help,
individual guided self-help and psycho-educational groups
Step 1: All known and suspected cases of anxiety disorder
Identification and assessment; education about anxiety and
Treatment options; active monitoring
McGeachey Hall: multidisciplinary
treatment of anxiety for 3-12 month
period with subsequent treatment
resumed by primary care clinic
Embedded behavioral specialist
Or
Community Counseling Center
Medication algorithm (anxiety disorders)
1st trial:
Try an SSRI
2nd trial: Try another SSRI or an SNRI
3rd trial
?4th trial
Panic Disorder:
Consider
Imipramine
or Clomipramine
or Pregabalin
GAD/Social
Anxiety:
Consider
Gabapentin
or Pregabalin
PTSD:
Consider
(augmentation
for sleep
disturbance)
Prazosin
Partial response for any disorder:
Consider addition 2nd agent
(e.g., mirtazapine + SSRI, TCA + SSRI,
if also depressed, bupropion +SSRI/SNRI)
Consider psychiatric
consult or referral
(at any point--but
particularly before
considering a
benzodiazepine or
atypical
antipsychotic)
Medication algorithm (OCD)
1st trial:
Try an SSRI
2nd trial:
Try another SSRI
3rd trial
4th
trial
Try Clomipramine monotherapy
Consider augmentation with
atypical antipsychotic
(Risperidone or Aripiprazole)
or
with CBT
Consider psychiatric
consult or referral
(at any point--but
particularly before
considering a
benzodiazepine)

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