The effective dose of antidepressant for anxiety is generally higher than that for antidepressant effect and takes longer for improvements to be seen (at least 4-8 weeks compared to 2-3 weeks for depression). The patient should be maintained on as high a dose as can be tolerated for at least 8 weeks before changing a medication. Educating the patient is crucial to obtaining cooperation.
The duration of treatment is often a controversial issue. Anxiety disorders (apart from the self-limiting acute stress reaction) are chronic conditions and may require treatment for as long as that used in depression. In a first episode, patients may need medication for at least 6 months, withdrawing over a further 4-8 weeks if they are well. Those with recurrent illness may need treatment for 1-2 years to enable them to learn and put into place psychological approaches to their problems. In many cases the illnesses are lifelong and chronic maintenance treatment is justified if it has significantly improved their wellbeing and function. A combination of medication with psychological techniques is likely to be most beneficial, especially for resistant cases.
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