Our review confirms the usefulness of long-term pharmacological treatments for PD and GAD and suggests that they can provide further improvement over that obtained during short-term therapy .
Paroxetine , escitalopram , and clonazepam can be effective for long-term treatment of PD .
Pregabalin and quetiapine can be effective for long-term treatment of GAD , while preliminary suggestions emerged for agomelatine and vortioxetine .
We did not find any evidence for determining the optimal length and /or dosage of medications to minimize the relapse risk .
Many aspects of long-term pharmacological treatments for  anxiety disorders ( AnxDs ) are still debated .
We undertook an up date d systematic review of long-term pharmacological studies on panic disorder ( PD ) , generalized anxiety disorder ( GAD ) , and social anxiety disorder ( SAD ) .
Tapering Clonazepam in Patients With Panic Disorder After at Least 3 Years of Treatment
High-potency benzodiazepines , such as clonazepam , are frequently used in the treatment of panic disorder ( PD ) because of their rapid onset of action and good tolerability . However , there is concern about their potential to cause withdrawal symptoms . We aim ed to develop a protocol for safely tapering off clonazepam in patients with PD who had been receiving treatment for at least 3 years . A specific scale for judging withdrawal was also developed , the Composite Benzodiazepine Discontinuation Symptom Scale . We selected 73 patients with PD who had been asymptomatic for at least 1 year and who wished to discontinue the medication . The trial consisted of a 4-month period of tapering and an 8-month follow-up period . The dosage of clonazepam was decreased by 0.5 mg per 2-week period until 1 mg per day was reached , followed by a decrease of 0.25 mg per week . The mean dosage at the start of tapering was 2.7 ± 1.2 mg/d . In total , 51 ( 68.9 % ) of the patients were free of the medication after the 4 months of tapering according to the protocol , and 19 ( 26.0 % ) of the patients needed another 3 months to be free of  medication . Clonazepam discontinuation symptoms were mostly mild and included mainly : anxiety , shaking/trembling/tremor , nausea/vomiting , insomnia/nightmares , excessive sweating , tachycardia/palpitations , headache , weakness , and muscle aches . The improvement in PD and general well-being was maintained during both the taper and follow-up phases . Clonazepam can be successfully discontinued without any major withdrawal symptoms if the dose is reduced gradually . We recommend reducing the dosage of clonazepam after intermediate-term use by 0.25 mg/wk
Our review confirms the usefulness of long-term pharmacological treatments for PD and GAD and suggests that they can provide further improvement over that obtained during short-term therapy .
Paroxetine , escitalopram , and clonazepam can be effective for long-term treatment of PD .
Pregabalin and quetiapine can be effective for long-term treatment of GAD , while preliminary suggestions emerged for agomelatine and vortioxetine .
We did not find any evidence for determining the optimal length and /or dosage of medications to minimize the relapse risk .
Many aspects of long-term pharmacological treatments for  anxiety disorders ( AnxDs ) are still debated .
We undertook an up date d systematic review of long-term pharmacological studies on panic disorder ( PD ) , generalized anxiety disorder ( GAD ) , and social anxiety disorder ( SAD ) .