Anxiety and Panic Disorders Nursing Care Plans

An anxious or panicking patient pulls your own anxiety up with them. Your job is to read their level, stay calm enough to bring it down, and hand them concrete tools to interrupt the spiral before it climbs to panic. Stay with the severely anxious patient, keep the environment quiet, and never leave someone in panic alone.

Anxiety is a vague dread or uneasiness, the autonomic nervous system firing in response to a stimulus, with behavioral, emotional, cognitive, and physical symptoms. Fear is apprehension over a specific, identifiable threat.

Anxiety disorders are the most common psychiatric disorders. Under the DSM-5 they share features of excessive fear, anxiety, and related behavioral disturbance, and include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance- or medication-induced anxiety disorder, and anxiety disorder due to another medical condition. Panic attacks are abrupt surges of intense fear that peak within minutes with physical and cognitive symptoms. You diagnose a disorder when anxiety stops working as a signal of danger and instead becomes chronic, permeating major parts of life and driving maladaptive behavior and emotional disability.

These disorders come from an interaction of genetic vulnerability with stress and trauma. They carry high comorbidity with major depression and alcohol and drug abuse, severe cases can be complicated by suicide, and they occur in females versus males at roughly a 2:1 ratio.

Nursing Care Plans and Management

You will meet anxious patients and families everywhere, not just on psych. Assess the patient's anxiety level first, because the level dictates which interventions will work. Treatment usually combines medication and therapy, and the combination beats either one alone. Watch your own anxiety throughout. It is contagious, and staying calm and in control is the prerequisite for working with the patient at all.

Care centers on reducing anxiety, promoting self-care, building coping skills, strengthening social support, and supporting treatment adherence.

Nursing Problem Priorities

1. Assess anxiety levels and triggers.
2. Establish therapeutic rapport.
3. Administer prescribed anti-anxiety medication.
4. Monitor for panic or distress.
5. Implement relaxation techniques and a calming environment.
6. Educate on anxiety management.
7. Collaborate with the multidisciplinary team.

Nursing Assessment

Assess for the following, sorted by disorder:

• Generalized anxiety disorder: restlessness, irritability, difficulty concentrating, muscle tension, fatigue, sleep disturbance.
• Panic disorder: rapid heart rate, chest pain, shortness of breath, trembling, fear of future attacks driving avoidance.
• Social anxiety disorder: avoidance of social interaction, public speaking, or performing; excessive self-consciousness, blushing, sweating, trembling.
• Specific phobias: immediate anxiety on exposure to the feared object or situation; avoidance or extreme distress.
• Obsessive-compulsive disorder: anxiety from obsessions, relief sought through compulsions (handwashing, checking, counting rituals).
• Post-traumatic stress disorder: intrusive memories, flashbacks, nightmares; avoidance of reminders, emotional numbing, hypervigilance, heightened arousal.

Nursing Diagnosis

Formulate the diagnosis from your assessment and clinical judgment. The label matters less than the priorities you set and the care you deliver.

Nursing Goals

The patient will:

• Stay free from injury.
• Discuss feelings of dread and anxiety.
• Respond to relaxation techniques with a lower anxiety level.
• Discuss phobic objects or situations and function in their presence without panic by discharge.
• Decrease ritualistic behavior and learn to interrupt obsessive thoughts.
• Demonstrate effective coping and verbalize early signs of escalating anxiety with steps to keep it manageable.
• Participate in decisions about their own care and problem-solve ways to take control of their situation.
• Attend therapy and group activities, initially with a trusted support person.
• Take over their own ADLs willingly.
• State correct information about medications and adverse effects, and verbalize understanding of the disease process, risk factors, and regimen.

Nursing Interventions and Actions

1. Controlling and Managing Anxiety and Fear

Patients with anxiety disorders carry fear and worry out of proportion to any real threat, with physical symptoms like racing heart, shortness of breath, and trembling alongside intrusive thoughts and avoidance.

Assess physical and behavioral symptoms: heart rate, sweating, restlessness. Anxiety drives somatoform symptoms such as pain, nausea, weakness, and dizziness with no physical cause. Any patient presenting with new physical complaints that suggest anxiety needs a physical exam and basic labs first to rule out a medical cause.

Assess the patient's anxiety triggers, situational and historical. Triggers include medications, herbals, substance abuse, trauma, childhood experiences, and panic disorder. These patients imagine the worst case and avoid what they think is dangerous, such as crowds, heights, or social contact.

Perform a mental status assessment. Cover appearance, behavior, cooperation, activity level, speech, mood, affect, thought process and content, insight, and judgment. Two elements are non-negotiable: ask directly about suicidal or homicidal ideation and plans, and test orientation and recall.

Build a trusting relationship: listen, stay warm, answer questions directly, offer unconditional acceptance, stay available, respect personal space. To a highly anxious patient you are a stranger and a potential threat. Use clear, brief statements that name what you see, such as "It seems to me that you are anxious," to reassure and keep anxiety from escalating.

Stay calm and non-threatening. Anxiety transfers both ways between you and the patient. A calm posture and active listening give the patient a sense of security even without words.

Stay with the patient when anxiety is severe or at panic level, and reassure them of their safety. Safety is the priority. A highly anxious patient left alone escalates. Staying also tells them they are valued and worth your time.

Move the patient to a quiet area with minimal stimuli: dim lighting, few people, a small room or seclusion space. External stimuli fuel anxious behavior. A smaller space feels secure where a large one leaves the patient feeling lost and panicked. Keep the environment quiet, allow personal space, and let the patient feel safe enough to verbalize feelings.

Provide reassurance and comfort measures. Emotional work is impossible while the patient is in physical distress. What relaxes one patient does nothing for another, so try options like music or aromatherapy.

Teach the patient and family that anxiety disorders are treatable. Medication, psychotherapy, or both usually relieve symptoms, with the course depending on the type of disorder. Anxiety disorders are among the most treatable mental health conditions.

Support the patient's defenses early. Defenses manage an unconscious conflict, and stripping them too soon spikes anxiety. The goal is to replace maladaptive defenses with effective ones over time, not to tear them down at once.

Stay aware of your own discomfort. Being with an anxious patient raises your anxiety. Recognize it, slow your breathing, and watch your own body language, posture, and speech cadence. Modeling calm shows the patient another way to handle it.

Use short, simple directions during a panic attack. The patient's ability to handle complexity is gone, and they may feel they are dying of a heart attack or suffocating. Reassure them that they are not dying and the symptoms will pass on their own.

Do not force the patient to make choices. At high anxiety the patient cannot make sound decisions and may not be able to decide at all. Forcing it undermines trust and damages the relationship.

Tell the patient that as-needed medication may be ordered for high anxiety, and watch for adverse effects. Medication can bring anxiety down to where the patient feels safe. Benzodiazepines act fast but carry physiologic and psychologic dependence. Starting an antidepressant can briefly worsen anxiety, agitation, and irritability.

Teach relaxation exercises: deep breathing, progressive muscle relaxation, guided imagery, meditation. These are effective nonchemical ways to lower anxiety. Progressive muscle relaxation targets muscle tension, and applied relaxation builds relaxation into a usable skill for real settings.

Teach the signs of escalating anxiety and ways to interrupt it: relaxation, deep breathing, brisk walks, jogging, meditation. Catching early signs lets the patient stop the climb and builds their confidence that they control it. Somatic fear of cardiac or respiratory death is a common focus during panic attacks and often lands these patients in the emergency department.

Administer SSRIs as ordered. Panic attacks respond to SSRI antidepressants, which are first-line for long-term management, with control achieved gradually over a 2 to 4-week course depending on dose increases. Fluoxetine's very long half-life suits patients who struggle to take medication consistently.

Help the patient see that mild anxiety can be a useful signal, not something to avoid. Anxiety is part of the fight-or-flight response that protects against danger. Mild anxiety can flag a situation that needs attention or a change.

Cognitive-behavioral therapy

Exposure therapy is among the most used CBT methods for anxiety. It activates the pathological fear structure, then introduces information that disconfirms the unrealistic associations, so fear decreases as the patient confronts the feared stimulus.

Cognitive therapy works from Beck's model that thoughts, feelings, and behaviors are interrelated. It targets distorted thinking by identifying inaccurate thoughts, examining evidence for and against them, and replacing maladaptive thoughts and behaviors.

Behavioral therapy exposes the patient to progressively greater anxiety-provoking stimuli until they become desensitized.

Respiratory training controls hyperventilation during panic attacks through controlled breathing.

When anxiety drops, explore the likely cause with the patient. Recognizing precipitating factors is the first step to interrupting the escalation. Early childhood trauma raises the risk of later anxiety disorders, and patients vary in resilience versus vulnerability to the stress that precipitates a disorder.

Reinforce information about interpersonal psychotherapy (IPT). IPT is a time-limited, evidence-based approach aimed at improving interpersonal relationships and social functioning. Eight trials of IPT for anxiety disorders found large effects versus controls, with no evidence that IPT is less effective than CBT.

Managing fear

Determine the type of fear through rational questioning and active listening. This builds trust and rapport and encourages the patient to be open about symptoms and feelings, which leads to better treatment. Fear is a future-oriented state, a cognitive, affective, physiological, and behavioral response to an anticipated threat.

Explore the patient's perceived threat to physical integrity or self-concept. Understanding how the patient sees the phobic object or situation guides desensitization. Panic triggers include injury, illness, interpersonal conflict or loss, cannabis, stimulants (caffeine, decongestants, cocaine), certain settings like stores and public transportation, sertraline, and the SSRI discontinuation syndrome.

Discuss the reality of the situation, separating what can change from what cannot. The patient has to accept reality before fear reduction can progress. Anxiety drives excessive worry about the future or past and rumination on negative thoughts, disconnecting the patient from the present.

Reassure the patient of their safety. At panic-level anxiety the patient may fear for their life. Untreated panic attacks can subside on their own within 20 to 30 minutes, especially with reassurance and a calm environment.

Have the patient substitute positive thoughts for negative ones. Emotion is tied to thought, and a more positive thought lowers anxiety and offers a different angle on the problem.

Include the patient in choosing coping strategies. Choice gives a measure of control and raises self-worth, which lowers anxiety, and it lets you tailor the plan to the patient's needs.

Encourage the patient to explore the feelings behind irrational fears rather than suppress them. Verbalizing feelings in a non-threatening environment helps the patient work through unresolved issues. A broad opening like "What's on your mind today?" lets the patient direct the conversation.

Discuss thinking through the feared object or situation before it happens. Anticipating a phobic reaction lets the patient prepare for the physical signs. Exposure can be imaginal, in vivo (gradual approach to safely avoided places, objects, people, or situations), or interoceptive (deliberately inducing the physical sensations the patient fears).

Encourage the patient to share unnatural-seeming fears, especially with the nurse therapist. Patients often hide feelings for fear of ridicule. Once they start talking about the fears, the feelings become manageable. Be empathetic, non-judgmental, and validating.

Coach the patient to stop, wait, and not rush out of a feared situation, supported by relaxation exercises. Fleeing reinforces avoidance and never lets reality be tested. If the patient waits out the start of anxiety and brings it down with relaxation, they can keep confronting the fear.

Explore things that lower and hold down fear: singing while dressing, a mantra, positive self-talk in the feared situation. These give a sense of control and distract from the fear so it cannot build. Other distractions include controlled breathing, reading, watching TV, or a creative activity.

Desensitization techniques

Systematic desensitization is gradual, controlled exposure to the feared situation, letting the patient overcome and desensitize to the fear. Implosion or flooding (continuous, rapid presentation of the phobic stimulus) can work faster, but relapse is more common and the patient may become terrified and quit.

Expose the patient to a hierarchy of anxiety-provoking stimuli, least to most frightening. Facing fear in progressively harder but attainable steps shows the patient that the dreaded consequences will not happen, extinguishing conditioned avoidance. Desensitization begins with imaginary exposure, breaking the feared situation into manageable components.

Pair each anxiety-producing stimulus (for example, standing in an elevator) with an opposite effect strong enough to suppress anxiety (relaxation, exercise, biofeedback). This brings physical and mental relaxation as the anxiety becomes less uncomfortable. The patient starts with the least distressing action and works up.

Help the patient apply these techniques to real situations, with practice such as role-play. Continued confrontation builds control over fear, and practice accustoms the body to relaxation. What was learned can be unlearned.

Encourage the patient to set increasingly harder goals. This builds confidence and moves the patient toward better functioning and independence. They start by imagining themselves through a progression of fearful situations using relaxation, then carry the technique into real life.

Administer benzodiazepines, anti-anxiety agents, and beta-blockers as ordered, and watch for adverse effects. See Pharmacologic Management.

Provide information about cranial electrotherapy stimulators (CES). In 2019 the FDA cleared a CES device for anxiety, depression, and insomnia. CES delivers micro pulses of electrical current across the brain and in trials reduced anxiety, insomnia, and depressed mood.

2. Promoting Effective Coping

Isolated patients with anxiety disorders fall into reassurance-seeking, avoidance, and hypervigilance. The sense of lost control intensifies the anxiety and makes daily activities harder.

Assess the patient's ability to name their emotions and stressors. This shows how they perceive and respond to anxiety and lets you individualize the plan. A patient with a phobic disorder may show tremors or diaphoresis but can identify the reason for their anxiety.

Assess current coping strategies and how well they work. This surfaces maladaptive coping and guides more effective strategies. Coping ability matters for adapting to stressors and can protect against the factors that drive anxiety.

Assess how the patient's beliefs affect coping. Negative self-beliefs undercut coping. A proactive belief system, that one's course is self-determined and that life holds resources, lets the patient take responsibility for their outcomes.

Meet dependency needs early as needed. Cutting off all dependency at once creates anxiety and adds burden. Instrumental support means getting advice, information, and feedback from the patient's network, including bedside nurses. Older adults may resist seeking help because of stigma.

Encourage independence and reinforce independent behavior. Positive reinforcement raises self-esteem and repeats desired behavior. Higher anxiety makes reactions to negative cues more persistent, so build on the positive.

Early in treatment, allow time for rituals without judgment or disapproval. Denying the ritual can trigger panic-level anxiety, since rituals decrease anxiety that would otherwise impede function. Reduce them gradually as they become maladaptive.

Support the patient's effort to explore the meaning of the behavior. The patient may not see the link between emotional problems and compulsions. Recognition and acceptance come before change. Remind them that anxiety has many causes and is not a personal flaw.

Gradually limit time for ritualistic behavior as the patient engages in unit activities. Anxiety drops when the patient replaces rituals with adaptive behavior. Compulsions compensate for the ego-dystonic feelings of obsessional thoughts and can sharply reduce function.

Encourage the patient to recognize what provokes obsessive thoughts or rituals. Spotting precipitating factors is the first step to interrupting escalation. Awareness of triggers helps the patient manage stress even when the trigger cannot be avoided.

Provide positive reinforcement for nonritualistic behavior, and avoid reinforcing maladaptive behavior. Reinforcement strengthens whatever behavior it follows, so deliver it for good behavior and not for maladaptive coping, and deliver it promptly.

Teach the different coping styles. Proactive coping uses social and non-social resources with goal setting and pursuit. Preventive coping identifies stressors early and prepares for them. Reflective coping brainstorms and mentally compares alternative plans. Avoidance coping simply avoids thinking about stressors.

Promote a balanced diet and adequate hydration. A balanced diet and healthy lifestyle help protect against anxiety and depression. Helpful elements include balanced nutrients, good hydration with limited alcohol and caffeine, complex carbohydrates, magnesium, zinc, omega-3 fatty acids, probiotics, B vitamins, and antioxidants.

Encourage social support, especially from family. Family support helps the patient adapt. Because of your access to family members, you can guide them in constructive ways to help.

Provide referrals for support resources. A support system, in person or online, that understands anxiety and shares coping tips is valuable to the patient and family.

Help the patient identify what they can and cannot control, and encourage verbalizing feelings about both. Anxiety blocks problem-solving, and the patient needs support to weigh alternatives. Patients with an internal locus of control believe they can change a situation and put in more effort; those with an external locus believe outside factors run their lives.

Note behaviors that signal hopelessness. Listen for "they don't care" or "it won't make any difference." These reflect the patient's ability to manage change. A patient with panic disorder may have anxious mood and speech that reflects urgency.

Determine the degree of life mastery and locus of control. Life mastery predicts success in adjusting to the condition. A patient with an external locus benefits from positive affirmation.

Have the patient take as much responsibility for self-care as possible. Choice and responsibility increase the sense of control. Self-efficacy, the belief in one's ability to perform tasks and reach goals, supports persistence and effective coping.

Help the patient set realistic goals. Unrealistic goals set up failure and reinforce powerlessness. Many people with anxiety lead full lives by learning what works, staying connected, and staying positive.

Identify where the patient can achieve, encourage participation, and reinforce it. Both positive and negative reinforcement aim to make a behavior recur; positive adds something to strengthen it, negative removes something.

Build the patient's daily routine into the home or hospital schedule. Routine maintains control and independence. Predictability and a sense of control over the environment reduce anxiety.

Discuss needs openly and act on them. Open discussion empowers the patient, counters manipulative behavior, and helps the patient recognize when needs go unmet, which itself can trigger anxiety.

Plan for the future and include family. Planning builds control and hope. Give family information about how anxiety affects mood, behavior, and relationships, and enlist them to reinforce treatment and monitor symptom severity and response.

Identify the extent of social isolation. Social functioning can stay impaired for up to 18 months after remission from panic disorder, from residual symptoms, social scarring, or an underlying vulnerability to affective disorders.

Assess for depression. Impaired social functioning is most severe in patients with comorbid anxiety and depression, and loneliness raises depression risk. An estimated 50 to 70% of anxiety and depression cases co-occur, likely from shared pathophysiology.

Convey acceptance through brief, frequent contacts, and show unconditional positive regard. An accepting attitude raises self-worth and builds trust. Loneliness is a strong contributor to poor physical health, and the absence of close friends and relatives raises the risk of clinical anxiety and depression.

Stay with the patient during group activities that frighten them. A trusted presence provides emotional security. Stronger social connection is associated with better adherence to treatment.

Be honest and empathetic, and keep your promises. Honesty and dependability build trust. Empathy shapes the relationship that drives positive outcomes and safe care.

Be cautious with touch, and give the patient space and a clear exit if they get too anxious. At panic-level anxiety, touch can read as a threat. Use silence and active listening, and let the patient break the silence.

Administer tranquilizing medication as ordered, and monitor adverse effects. Short-term anti-anxiety medication reduces anxiety in most patients. Buspirone is a nonsedating agent unrelated to benzodiazepines, barbiturates, and other sedative-hypnotics, comparable to benzodiazepines for anxiety with fewer sedative and withdrawal effects.

Teach the signs of rising anxiety and ways to interrupt it: breathing exercises, thought-stopping, relaxation, meditation. Maladaptive behavior shows up as anxiety climbs. Mindfulness, prayer, and deep breathing slow the anxious processing of thoughts and bring the patient into the present.

Recognize and reinforce voluntary interaction with others. Positive reinforcement raises self-esteem and works best delivered immediately, enthusiastically, and frequently.

Make sure assistive aids work, such as hearing aids and eyeglasses. Correcting hearing loss reduces the social isolation that compounds anxiety in older adults.

Provide referrals to support groups and community resources. Social prescribing connects patients to nonclinical community support, through voluntary organizations or referrals that directly address isolation.

Reinforce information about psychotherapy. CBT and mindfulness-based approaches reduce loneliness and improve social interaction. Lonely patients interpret social contact more negatively and perceive more social threat, feeding a cycle of withdrawal.

3. Assisting in Self-Care

Anxiety crowds out self-care. Worry and preoccupation make it hard to prioritize exercise, nutrition, rest, and activities that bring relief, which feeds the cycle.

Keep strict records of food and fluid intake. This supports an accurate nutritional assessment. Discontinue or cut caffeine in coffee, tea, and colas, and review over-the-counter and herbal products carefully, since ephedrine and other compounds can precipitate or worsen anxiety.

Assess the patient's ability to self-manage. Self-management skill depends on symptom severity, and more severe anxiety reduces self-management activity.

Urge the patient to do normal ADLs to their level of ability. Successful independent activity raises self-esteem. Daily self-management behaviors apply well to depression and anxiety, at work and in everyday life.

Encourage independence and step in only when the patient cannot perform. Safety and comfort are the priorities. The patient can self-manage by seeking support, maintaining a healthy lifestyle, staying active, and staying focused on recovery.

Recognize and reinforce independent accomplishments. A shorter gap between behavior and reinforcement makes a stronger connection, so reinforce quickly.

Show the patient how to perform activities they struggle with. At high anxiety the patient may need simple, concrete demonstrations of tasks they would do easily otherwise. When teaching a new behavior, reinforce every time it occurs.

Offer nutritious snacks and fluids between meals. The patient may not tolerate large meals and needs extra nourishment. Diet patterns linked to lower anxiety, the Mediterranean and anti-inflammatory diets among them, emphasize vegetables, fruit, limited sugar and refined grains, and minimally processed foods.

Promote exercise and physical activity. Exercise works as a first-line, low-intensity intervention for mild to moderate anxiety. Aerobic and anaerobic activity both work, so match the patient's preference. Sessions should last at least 30 minutes, 3 times a week.

Help the patient choose self-care activities within their abilities. Exercise, relaxation, and taking medication are encouraged by professionals, largely free or low-cost, and do not demand a large investment of time, which makes them the most common and most helpful strategies.

4. Initiating Patient Education and Health Teachings

Teach the patient about their condition, symptoms, and triggers, and about treatment options including therapy, medication, and self-help. Knowledge gives them the tools to manage anxiety and make informed decisions.

Assess for nausea, headache, nervousness, insomnia, agitation, and sexual dysfunction. These are common SSRI adverse effects. Start low and increase gradually. Fluoxetine's long half-life minimizes SSRI withdrawal when a patient runs out or stops abruptly. Reassess periodically for continued need.

Assess for fatigue, drowsiness, and cognitive impairment. These are common benzodiazepine effects. Chronic use brings tolerance, withdrawal, and treatment-emergent anxiety, so weigh the addiction risk carefully before use.

Assess the patient's and family's understanding of anxiety disorders. Anxiety is the most common mental disorder in older adults yet gets scant attention. Give family information about its effect on mood, behavior, and relationships, and enlist them to reinforce treatment and supervision.

Assess barriers to learning about and accepting treatment. Social stigma is a major one. Social taboo, shame, family stigma, and self-stigma all keep patients from seeking diagnosis or treatment, as does low mental health awareness among non-mental-health professionals.

Use psychometric tools to assess stress and related factors. Ecological momentary assessment (EMA) repeatedly measures momentary experiences in real time and naturalistically. It suits anxiety symptomatology, avoids recall biases like recency and telescoping, and captures diurnal variation.

Explain how SSRIs relieve anxiety. Anxiety responds to these agents. Fluoxetine works, especially when panic disorder occurs with depression, though patients may tolerate it poorly at first because it can increase anxiety except at very low starting doses. Its long half-life suits marginally compliant patients, and it alters metabolism of cytochrome P-450 2D6-cleared agents.

Reinforce that benzodiazepines need gradual tapering at discontinuation. Abrupt stops cause anxiety to recur. A benzodiazepine can serve as an initial adjunct while SSRIs are titrated, then taper over 4 to 12 weeks while the SSRI continues. Clonazepam is a favored choice for its longer half-life and fewer withdrawal reactions.

Encourage the patient and family to join mental health education programs. Mental health resources are limited and unevenly distributed, especially in rural areas, so education campaigns support earlier recognition and better access.

Promote smoking cessation and reduced alcohol intake. Excessive drinking and current or former smoking are strongly associated with generalized anxiety disorder. Per CDC data, 30% of patients with mild anxiety and 45% of those with severe anxiety use tobacco, and nicotine withdrawal can mimic anxiety in a feeding loop.

Provide self-help guides. Bibliotherapy, or guided self-help, is a low-cost, widely available alternative using CBT, Acceptance and Commitment Therapy, or mindfulness models, useful as a first step or complement to formal treatment. A stepped-care approach starting with bibliotherapy prevented late-life anxiety and depressive episodes.

Refer to reliable internet sources. Internet-based self-help is a low-cost option. The Anxiety Disorders Association of America and the Geriatric Mental Health Foundation offer psychoeducation for late-life anxiety online.

Monitor benzodiazepine effects in older adults. These drugs are still common for geriatric anxiety but bring falls, disability, and cognitive decline, at doses lower than the usual effective dose. Use them as short-term adjuncts only, with long-term use a last resort.

Emphasize followup consultations. Interview the patient about perceived side effects. Patients often attribute preexisting symptoms to the medication, and adherence suffers from vigilance and catastrophizing. Prompt contact reassures them that they are being monitored closely.

Encourage family to ask questions. Family involvement supports adherence. Patients have additional concerns after a prescription, especially around the first dose. Tell patients and families that questions are natural, and provide 24-hour contact information.

Evaluate maintenance treatment and relay results to the patient and family. Anxiety is chronic, so treatment is usually long-term with maintenance medication or booster psychotherapy. Maintenance needs less frequent oversight but still requires monitoring of clinical changes, side effects, and co-prescribed medications.

5. Administer Medications and Provide Pharmacologic Support

Common anxiety medications include SSRIs, benzodiazepines, and buspirone, which regulate neurotransmitter levels and calm symptoms. Beta-blockers manage physical symptoms like rapid heart rate and palpitations.

Selective serotonin reuptake inhibitors (SSRIs) raise serotonin, a neurotransmitter that regulates mood:

• Escitalopram (Lexapro): generalized anxiety disorder and social anxiety disorder.
• Sertraline (Zoloft): panic disorder, social anxiety disorder, PTSD, and OCD.
• Fluoxetine (Prozac): approved for panic disorder, OCD, and bulimia nervosa; used off-label for social anxiety disorder.
• Paroxetine (Paxil): panic disorder, GAD, social anxiety disorder, and PTSD.
• Citalopram (Celexa): primarily for depression, prescribed off-label for panic disorder, GAD, and social anxiety disorder.

Benzodiazepines may be involved in phobic and panic reactions. These drugs, particularly alprazolam (Xanax), produce a rapid calming effect and keep anxiety low during learning and desensitization. Weigh the addiction risk carefully, and do not use them in patients with a history of alcohol or other drug abuse.

Anxiolytics: buspirone is a nonsedating agent unrelated to benzodiazepines, barbiturates, and other sedative-hypnotics, comparable to benzodiazepines for anxiety with fewer cognitive and psychomotor effects, which makes it preferable in older adults. Its limits are no anti-panic activity and reduced effect in patients recently withdrawn from benzodiazepines.

Beta-blockers control physical symptoms such as rapid heart rate, trembling voice, sweating, dizziness, and shaky hands. They are most helpful for phobias, particularly social phobias.