To assess the severity of the anxiety, it is important to understand to what extent the symptoms of anxiety are interfering with the activities of daily living. For dosing information of antidepressants used for anxiety as described in this summary, see the PDQ summary on Depression. An anxiolytic medication is often needed alone or in combination with psychologic approaches. The choice of a benzodiazepine depends on the duration of action that is best suited to the patient, the desired rapidity of onset needed, the route of administration available, the presence or absence of active metabolites, and metabolic problems. Dosing schedules depend on patient tolerance and require individual titration.
Benzodiazepines decrease daytime anxiety and reduce insomnia.
The most common side effects of benzodiazepines are dose dependent and are controlled by titrating the dose to avoid drowsiness, confusion, motor incoordination, and sedation. Buspirone is also useful in the geriatric population as an augment to fluoxetine for the treatment of anxiety and depression. The beginning dose is 5 mg given three times a day and can be increased to 15 mg given three times a day. Buspirone can also be given two times a day. Low-dose neuroleptics can also be used when benzodiazepines are not helpful or when there is the possibility of delirium, dementia, or other complications.