August 2025
INTRODUCTION —
Anxiety disorders are the most common psychiatric disorders diagnosed in childhood and adolescence [1,2]. Anxiety disorders that may begin in childhood include generalized anxiety disorder, social anxiety disorder, selective mutism, panic disorder, agoraphobia, separation anxiety disorder, and specific phobia. Pediatric anxiety disorders are associated with increased difficulty in school performance and peer relationships [3-5]. When left untreated, anxiety disorders starting in childhood tend to persist into adulthood, and are frequently associated with depression [6], substance use disorder [7,8], occupational impairment [9], and suicidal behavior [10]. Effective management of anxiety disorders in youth may include pharmacotherapy, psychotherapy, or a combination of the two.
This topic discusses our preferred treatment including pharmacotherapy for children or adolescents with anxiety disorders. Epidemiology, clinical manifestations, pathogenesis, assessment, diagnosis, course, and psychotherapy for anxiety disorders in children and adolescents are discussed elsewhere. Topics related to posttraumatic stress disorder and obsessive-compulsive disorder in children and adolescents are also discussed elsewhere.
●(See "Psychotherapy for anxiety disorders in children and adolescents".)
●(See "Anxiety disorders in children and adolescents: Assessment and diagnosis".)
●(See "Overview of fears and phobias in children and adolescents".)
●(See "Obsessive-compulsive disorder in children and adolescents: Treatment overview".)
●(See "Posttraumatic stress disorder in children and adolescents: Trauma-focused psychotherapy".)
CHOOSING BETWEEN PHARMACOTHERAPY, PSYCHOTHERAPY, OR COMBINATION
How we choose treatment — All treatment decisions are made using shared decision making and involve the patient and their parent or guardian. We base our choice of initial treatment modality on the severity of symptoms, patient age, past treatment history, patient willingness and ability to participate in the suggested modality, treatment availability, and the presence of co-occurring disorders. Consent by parent/guardian and assent from patient understanding the potential antidepressant adverse events and the association between medication treatment and increased risk of suicidal ideation in youth is also considered. Some patients may prefer one treatment or another rather than combined treatment. We do not withhold treatment in this case. We agree to treatment with the chosen modality and, if needed, continue to encourage adding a second modality as treatment progresses [11,12]. (See 'Adverse effects and suicidality' below.)
Determine severity — We determine severity by using standardized scales such as the Screen for Child Anxiety Related Emotional Disorders (SCARED) child and parent versions [13]. The SCARED is completed by youth (child version) and/or parents or guardians (parent version), and scores range from 0 to 82; it can be administered at pretreatment and throughout the treatment course to help determine change in anxiety severity. The SCARED also provides subscales for panic disorder, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and school avoidance.
Other scales commonly used include the clinical severity rating section of the Anxiety and Related Disorders Interview Schedule for DSM-5, Child and Parent Versions, which is a clinician-administered diagnostic instrument in which the clinician determines clinical severity ratings ranging from zero to eight for all diagnosed disorders [14], or the Clinical Global Impression Scale-Severity (CGI-S).
Instruments used in determining severity and to monitor progress during treatment are discussed elsewhere [13,15,16]. (See "Anxiety disorders in children and adolescents: Assessment and diagnosis", section on 'Instruments for screening or assessment' and 'Monitoring' below and 'Severe anxiety disorder' below.)
Mild or moderate anxiety disorder
Youth age seven and older — For youth age seven and older, our preference is to begin treatment with monotherapy with either pharmacologic management or psychotherapy. We weigh the benefits of each treatment against the potential risks (eg, increased suicidal ideation in youth treated with selective serotonin reuptake inhibitor [SSRI]) and discuss them with the patient and their parent or guardian. Our decision is made using shared decision making. Either treatment appears to be effective and data from trials do not consistently demonstrate that one is more effective than another. (See 'Efficacy of SSRIs' below and 'Adverse effects and suicidality' below.)
Youth younger than seven years — For youth younger than seven years, we prefer treatment with family-based psychotherapy (ie, cognitive-behavioral therapy [CBT]). There is a relative dearth of data on the efficacy and safety of treatment of mild or moderate anxiety with SSRIs in children under the age of seven years [17].
Severe anxiety disorder
Youth age seven and older — For youth age seven and older with a severe anxiety disorder, our preference is first-line treatment with a combination of CBT and an SSRI [18].
Youth younger than seven years — Given the dearth of data on SSRI medication in younger children, we recommend a monotherapy of CBT with high parent or guardian involvement. However, if severe symptoms persist after 8 to 12 weeks, SSRI medication should be considered.
Comparing treatment modalities — Interpretation of trials comparing the efficacy of serotonin reuptake inhibitor medication versus CBT for anxiety disorders in children have not consistently reported one modality is more effective than another [10,18-22]. The largest trial found similar rates between groups [19] while another found CBT to be superior to the SSRI, fluoxetine [20]. While combination therapy may be more effective than either modality alone, the absolute benefit for patients with mild or moderate anxiety is likely small [22].
●In a randomized trial, 488 children (age 7 to 17) with a primary diagnosis of social anxiety disorder, generalized anxiety disorder, or separation anxiety disorder were randomly assigned to receive 12 weeks of treatment with CBT, sertraline, combined CBT-sertraline, or a drug placebo [19]. A greater proportion of patients assigned to receive CBT alone or sertraline alone experienced response to treatment (CGI-I score ≤2) as compared with patients assigned to placebo (59.7 and 54.9 versus 23.7 percent, respectively). Response was similar between active treatment groups. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. Positive treatment outcomes were maintained across treatment groups at 24- and 36-week follow-up [22].
●In a randomized trial, the efficacy of a Social Effectiveness Therapy for Children (SET-C), a type of CBT for children and adolescents, was compared with fluoxetine in the treatment of social anxiety disorder [20]. In the trial, 122 youth (age 7 to 17) with social anxiety disorder were randomly assigned to 12 weeks of treatment with fluoxetine, SET-C, or pill placebo. At treatment end, a greater proportion of participants receiving SET-C no longer met diagnostic criteria for social anxiety disorder compared with patients receiving fluoxetine or placebo (53 versus 21.2 or 3.1 percent). SET-C was superior to fluoxetine; both were superior to placebo in reducing social distress and behavioral avoidance, and increasing general functioning.
Combined modalities — Trials investigating combined treatment of youth with social phobia, generalized anxiety disorder, separation anxiety disorder, and school refusal have shown a greater likelihood of improvement at 12 weeks with combined treatment as compared with monotherapy with either treatment. However, at 24 and 36 weeks follow-up, the response rates of monotherapy treatment was similar to those receiving combined treatment [19,22]. In these trials, the combination of CBT and an SSRI, as compared with either CBT or SSRI as monotherapy, led to a greater percentage of patients with treatment response at 12 weeks (80.7 versus 59.7 versus 54.9 percent, respectively) while at week 36 response rates were 82.7 versus 71.5 versus 70.5, respectively [19,22].
Some anxiety disorders (eg, agoraphobia, specific phobia) have not been subject to clinical trials of monotherapy or combination therapy in youth.
SPECIFIC COMPONENTS OF TREATMENT
Psychotherapy — Treatment of anxiety disorders in youth with psychotherapy is discussed elsewhere. (See "Psychotherapy for anxiety disorders in children and adolescents", section on 'Cognitive-behavioral therapy'.)
SSRI as preferred pharmacotherapy — Our first choice in pharmacotherapy for anxiety disorders in youth is treatment with a selective serotonin reuptake inhibitor (SSRI) rather than other antidepressants. While other medications (eg, serotonin-norepinephrine reuptake inhibitors [SNRI]), tricyclic antidepressants (TCAs) have shown efficacy for the treatment of anxiety disorders in youth, SSRIs are the most extensively studied class and are generally better tolerated than the other antidepressants [21,23-40].
Clinical trials do not consistently support one agent over another in the treatment of anxiety disorders in youth. However, from among SSRIs, fluoxetine has the most consistent high-quality evidence for efficacy in the treatment of depression in youth and is typically our preferred agent in the treatment of anxiety disorders. Choice of pharmacologic agent in the treatment of depression in youth is found elsewhere. (See "Pediatric unipolar depression and pharmacotherapy: Choosing a medication", section on 'Choice of medication for acute treatment' and "Overview of prevention and treatment for pediatric depression", section on 'Choice of therapy'.)
Initiation, titration, and trial length — When treating anxiety disorders in youth, we typically begin pharmacologic management at the lowest dose available. After one week, and based on effect and tolerability, we slowly increase the dose to the lower end of the maintenance dose range [41]. We monitor for symptomatic improvement and tolerability. However, if there is minimal to partial response consider increasing the dose every one to two weeks for those SSRIs with shorter half-lives and three to four weeks for those with longer half-lives. Throughout the medication titration careful monitoring is needed to assess for response and adverse events. Due to rapid metabolism in children, antidepressants often require doses similar to those in adults for a full therapeutic effect.
As an example, we typically begin sertraline at a starting dose of 12.5 to 25 mg per day. We continue this dose for a minimum of seven days then titrate to 50 mg per day (ie, lower end of maintenance dose range). We monitor for improvement and tolerability over one to two weeks prior to increasing the dose further. If adequate response is not seen we would increase the medication slowly (eg, 25 to 50 mg per week) to a maximum daily dose of 200 mg/day, if tolerated.
A table summarizes initial daily doses, therapeutic ranges, and suggested dose titration rates for SSRIs in anxiety disorders in children (table 1).
Adverse effects and suicidality — Adverse effects of treatment with SSRI in youth include an increase in suicidal ideation or behavior, worsening anxiety, headaches, gastric distress, and sleep disturbance [41,42].
In all youth (children, adolescents, adults up to 25 years) treated with SSRI there is an associated increased risk of suicidal thoughts or behavior [11,12,43]. We assess for suicidal ideation prior to starting medication and weigh this risk against the potential benefit of medication. If symptoms of suicidality are present, we refer on an emergent basis for further evaluation of safety risk and possible admission. In those who we begin treatment with an SSRI, we monitor for suicidality at each subsequent visit. We typically use standardized scales such as the nine-item Patient Health Questionnaire (PHQ-9; modified for teens) (table 2) or the Columbia-Suicide Severity Rating Scale [44]. Further discussion of assessment and management of suicidality are discussed elsewhere. (See 'Monitoring' below and "Suicidal ideation and behavior in children and adolescents: Prevention and treatment" and "Suicidal ideation and behavior in children and adolescents: Evaluation and disposition" and "Effect of antidepressants on suicide risk in children and adolescents".)
Efficacy of SSRIs
Anxiety disorders in general — Treatment of anxiety disorders in youth with an SSRI is supported by meta-analyses and other clinical trials [21,24,31-36,45].
As an example, a systematic review and meta-analysis of nine trials investigated the efficacy and tolerability of various SSRIs (fluoxetine, fluvoxamine, paroxetine, and sertraline) and SNRIs (venlafaxine and duloxetine) in the treatment of anxiety disorders in youth. All antidepressants tested, as compared with placebo, led to significant improvement (Cohen's d = 0.64, CI 0.34-0.96; p = 0.0017) [21].
Additionally, each of these agents were found to have greater acceptability/tolerability as compared with placebo.
Specific anxiety disorders — Clinical trials or studies have supported the use of SSRI medications for the treatment of specific anxiety disorders such as generalized anxiety disorder [23,26,46], social anxiety disorder [20,27,47], panic disorder [48,49], selective mutism [28-30], and mixed disorders [31] in youth. There have been no clinical trials of SSRIs in children with agoraphobia or separation anxiety disorder alone:
As examples:
●Generalized anxiety disorder – In a randomized trial, 22 participants (age 5 to 17) with generalized anxiety disorder were assigned to 9 weeks of treatment with either sertraline (up to 50 mg) or placebo. Treatment with sertraline as compared with placebo, led to greater symptom reduction on measures of anxiety at treatment end (Hamilton Anxiety Rating Scale improvement 12.8 versus 2.3) [23].
●Social anxiety disorder – In a randomized trial, 322 participants (age 8 to 17) with social anxiety disorder were assigned to 16 weeks of treatment with paroxetine versus placebo. Paroxetine led to a higher response rate than placebo (78 versus 38 percent) [27]. In another randomized trial including 122 participants with social anxiety disorder, treatment with fluoxetine as compared with placebo led to a greater proportion of patients no longer meeting criteria for social anxiety disorder (21.2 versus 3.1 percent) [20].
●Selective mutism – Small randomized trials of an SSRI in children/adolescents with selective mutism (with and without co-occurring anxiety disorders) have found similar improvement between groups treated with SSRI and placebo [28,29]. However, an uncontrolled trial of fluoxetine in 21 youth showed improvement in symptoms of anxiety [30].
●Panic disorder – Three uncontrolled trials with a total of 46 pediatric participants with panic disorder treated with an SSRI experienced response rates between 75 and 90 percent [48,49].
●Specific phobia – An uncontrolled trial tested fluoxetine in six youths (age 10 to 17) who met criteria for specific phobia and at least one additional anxiety disorder [32]. Three of six were rated as “improved” and two were rated as “much improved” after nine weeks of treatment [31].
●Other disorders – Three randomized trials compared SSRIs with placebo in a total of 706 youth with a mix of anxiety disorders (generalized anxiety disorder, separation anxiety disorder, or social anxiety disorder). Response rates ranged from 54.9 to 76 percent of the mixed samples after 8 to 12 weeks of treatment [33,34,50].
Monitoring — We assess for clinical response, adverse effects, and suicidality at each visit.
We typically see patients for therapy on a weekly basis. We include the parent or guardian in all treatment decisions.
We typically see patients who are prescribed antidepressants on a weekly basis for four weeks. If the medication is tolerated and symptoms are improving we decrease the frequency to biweekly for four weeks, then monthly thereafter.
In those with difficulty tolerating the medication or without symptomatic improvement, we continue to meet on a weekly basis until improvement is seen. If symptoms increase or there is a decline in functioning, we see patients more frequently (twice weekly).
We monitor for suicidal ideation using the nine-item Patient Health Questionnaire (PHQ-9; modified for teens) (table 2) or the Columbia Suicide Severity Rating Scale [44] as discussed above. (See 'Adverse effects and suicidality' above.).
We monitor for improvement of symptoms using the Screen for Child Anxiety Related Emotional Disorders (SCARED) child and parent versions, or the Pediatric Anxiety Rating Scale at each visit. (See 'Adverse effects and suicidality' above.)
Further discussion of monitoring youth on antidepressants and assessing and addressing suicidality in youth is found elsewhere. (See "Anxiety disorders in children and adolescents: Assessment and diagnosis", section on 'Instruments for screening or assessment' and "Suicidal ideation and behavior in children and adolescents: Evaluation and disposition" and "Suicidal ideation and behavior in children and adolescents: Prevention and treatment".) [41,42]
SUBSEQUENT TREATMENT —
Our subsequent treatment depends on response to initial treatment.
Good response — We consider a good response to include a measurable decline in symptoms or improvement in psychosocial functioning. (See 'Monitoring' above.)
●Response to selective serotonin reuptake inhibitor (SSRI) treatment – If a patient demonstrates a good response (eg, decline in symptoms, improvement in psychosocial functioning) to treatment with an SSRI (medication (with or without psychotherapy) we continue medication for at least 6 to 12 months. At that time, if the patient has no signs of recurrence, is clinically stable, and is without anticipated life stressors we often agree to a slow taper typically during school vacation or other low-stress periods.
However, in individuals who have had an increase in symptoms with tapering of medication, or in those whose symptoms were difficult to control, we continue medication for a longer period of time. Depending on treatment history this can be for several years.
We typically taper medications by 25 to 50 percent each week, going more slowly as the dose decreases. We do this to avoid discontinuation symptoms. We monitor for recurrence of symptoms or other adverse events throughout the taper period. If symptoms recur, we stop tapering and increase meds back to the stable treatment dose. (See "Antidepressant discontinuation syndrome and discontinuing antidepressants in adults".)
●Response to psychotherapy – If a patient demonstrates good symptom response following a course of cognitive-behavioral therapy (CBT; eg, 12 to 20 sessions), we typically transition to less frequent maintenance sessions. Given the possibility of relapse following remission of anxiety symptoms [19], maintenance sessions every 6 to 12 months are recommended for youth with good treatment response [19,50]. Further discussion of CBT for anxiety disorders in children and adolescents is found elsewhere [19,50]. (See "Psychotherapy for anxiety disorders in children and adolescents".)
Inadequate response — For inadequate response to treatment with either psychotherapy or medication management, we assess for issues that may be limiting response (eg, nonadherence to medication, missed appointments, unmotivated for work in psychotherapy) and address these prior to making further changes.
Combine modalities — Our next step is to combine treatment modalities (if not already done). For example, an individual treated with pharmacotherapy only, we would suggest adding psychotherapy to pharmacotherapy. If inadequate response persists despite the above measures, our next step is to change to another SSRI medication. However, there is no clear evidence on the approach to switching to other SSRIs or serotonin-norepinephrine reuptake inhibitor (SNRIs).
Second SSRI trial — For individuals with inadequate response to combined treatment (or in those that refuse or are unable to work in psychotherapy) our next step is to change the first SSRI medication to a different SSRI medication. Sertraline is often a reasonable choice as an alternative first-line treatment or for those who have not responded to treatment with first-line medication (eg, fluoxetine). In most cases, we do this by tapering the first medication while slowly titrating the second medication. This can typically be done over two weeks. As with the first SSRI trial, we are vigilant to starting at a low dose and offering an adequate trial of up to 12 weeks. (See 'Specific components of treatment' above.)
SNRI trial — For individuals with ongoing inadequate response despite two different SSRI trials (each combined with psychotherapy, if available and acceptable), we prefer tapering off of the SSRI while titrating an SNRI such as extended-release venlafaxine or duloxetine.
Clinical trials have supported the use of SNRIs as compared with placebo in the treatment of anxiety disorders in youth [21,24,25,46,47]. As examples:
●In two randomized trials, a total of 320 youths (age 6 to 17) with generalized anxiety disorder were treated with eight weeks of extended-release venlafaxine versus placebo. In pooled analysis, the extended-release venlafaxine, as compared with placebo led to a greater decrease in primary outcome measures of anxiety and a greater proportion of individuals with response to treatment (69 versus 48 percent) [46].
●Other randomized trials investigating SNRIs have shown a greater percentage of patients achieving response to extended-release venlafaxine as compared with placebo (56 versus 37 percent, respectively) [47] in the treatment of social anxiety disorder, and greater percentage of patients reaching symptomatic remission with duloxetine as compared with placebo, in the treatment of generalized anxiety (50 versus 37 percent, respectively) [25].
When using SNRIs we start at a low dose and titrate slowly to avoid side effects. For example, when using extended-release venlafaxine, we typically begin at 25 to 37.5 mg per day and titrate by 37.5 mg per week to a typical dose range of 150 to 225 mg. Some patients experience weight changes, hypertension, and elevated cholesterol with SNRI medication.
Further discussion of the use of SNRI for depression in children and adolescents is found elsewhere. (See "Pediatric unipolar depression and pharmacotherapy: General principles" and "Pediatric unipolar depression and pharmacotherapy: Choosing a medication".)
Limited role for other agents — Other agents such as buspirone, benzodiazepines, stimulants, guanfacine, tricyclic antidepressants (TCAs), and atypical antipsychotic medications have been proposed for the treatment or augmentation of treatment of anxiety in youth. However, minimal evidence supports these strategies [35-41,51-56].
●Benzodiazepines – Benzodiazepines have a limited role in the treatment of pediatric anxiety disorders [57]. We typically limit their use to those whose symptoms of anxiety persist despite that above agents. Benzodiazepines have a rapid onset of anxiolysis (minutes to hours) compared with antidepressants, which can take as long as several weeks. Benzodiazepines are, however, associated with significant adverse effects (drowsiness, irritability, oppositional behavior) and can be subject to misuse or diversion.
If a benzodiazepine is used, we typically use agents with a longer half-life and titrate from a low starting dose. For example, when using clonazepam we start at 0.25 mg/day to observe response. If tolerated we increase the dose to 0.5 mg/day. Further increases are based on response and tolerability.
Clinical trials of benzodiazepines for anxiety disorders have had multiple limitations and have generally reported similar symptom reduction as compared with placebo [51,52,58]. However, clinical trials of benzodiazepines for anxiety disorders in adults provide indirect evidence for efficacy in children [53,54].
●Tricyclic antidepressants – We do not generally use TCAs in the treatment of anxiety disorders in youth unless symptoms are refractory to each of the treatments listed above.
Limited support for TCAs in the treatment of anxiety disorders in youth is reported in clinical trials. Furthermore, side effects of TCAs include anticholinergic effects (blurred vision, dry mouth, constipation), tachycardia, arrhythmia, irritability) and are less well tolerated than other antidepressants (eg, SSRI, SNRI) [37-40,53,54,57].
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Anxiety and trauma-related disorders in children".)
INFORMATION FOR PATIENTS —
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
●Basics topic (see "Patient education: Anxiety in children and teens (The Basics)")
SUMMARY AND RECOMMENDATIONS
●Choosing initial treatment modality – Our choice of treatment modality for youth with anxiety disorders is based primarily on the severity of symptoms, past treatment history, age, patient willingness and ability to participate in the suggested modality. Treatment availability and the potential association between treatment with selective serotonin reuptake inhibitors (SSRIs) and increased risk of suicidal ideation in youth are also considered. All treatment decisions are made using shared decision making. (See 'Choosing between pharmacotherapy, psychotherapy, or combination' above and 'Adverse effects and suicidality' above.)
•Mild or moderate anxiety disorder – For most youth with a mild or moderate anxiety disorder, the choice between pharmacologic management or psychotherapy is determined by individual considerations of risk, as well as patient preference and treatment availability; both treatment modalities are effective in providing symptomatic relief. (See 'Mild or moderate anxiety disorder' above.)
However, in children under seven years of age with a mild or moderate anxiety disorder, we suggest treatment with psychotherapy (ie, cognitive-behavioral therapy [CBT]) rather than medication (Grade 2C); limited data exist for the safety and efficacy of pharmacologic management of mild or moderate anxiety in young children. (See 'Mild or moderate anxiety disorder' above.)
•Severe anxiety disorder – For youth with severe anxiety disorder, we suggest combined treatment with pharmacologic management and psychotherapy rather than either treatment alone (Grade 2B).
However, for youth under the age of seven with a severe anxiety disorder, we begin treatment with CBT with parent or guardian involvement. We augment with SSRI medication if severe symptoms do not remit in six to eight weeks. (See 'Severe anxiety disorder' above.)
●Psychotherapy – We typically use CBT (either with or without medication management) in the treatment of anxiety disorders in youth. Treatment of anxiety disorders in youth with psychotherapy is found elsewhere. (See 'Psychotherapy' above and "Psychotherapy for anxiety disorders in children and adolescents".)
●SSRI as first pharmacologic option – For youth with an anxiety disorder of any kind, who will be treated with pharmacologic management, we suggest an SSRI as first option rather than other antidepressants (table 1) (Grade 2C). SSRIs have demonstrated efficacy compared with placebo; comparative efficacy studies with other medications are lacking. (See 'SSRI as preferred pharmacotherapy' above.)
●Adverse effects and suicidality – Treatment with SSRIs is associated with increased risk of suicidal thoughts or behavior in children, adolescents and young adults. We discuss these risks with patients and parents/guardians prior to initiating therapy.
Other adverse effects of SSRIs include worsening anxiety, headache, gastric distress, and sleep disturbance. (See 'Adverse effects and suicidality' above.)
●Monitoring – We monitor using standardized scales for improvement of symptoms and suicidal ideation at each visit. We see youth starting an antidepressant on a weekly basis for four weeks, then biweekly for four weeks, then monthly. We see patients in psychotherapy on a weekly basis. We see patients experiencing increased symptoms or decline in function at more frequent intervals. (See 'Monitoring' above.)
●Further management after good response to treatment – If after six months of treatment, the patient continues to demonstrate a good response to treatment, we typically slowly taper off of medications. We monitor for symptoms of recurrence during the taper. If symptoms recur we stop the taper and increase the medication back to the effective dose.
If a patient demonstrates good symptom response following a course of CBT (eg, 12 to 20 sessions), we typically transition to less frequent maintenance sessions.
●Further management after inadequate response – For inadequate response to treatment, we address concerns that may be limiting response to treatment (nonadherence to medication, missed appointments, low motivation for psychotherapy).
Our next steps, if not already done, are sequential trials of combined SSRI/CBT, a second SSRI agent, and a serotonin-norepinephrine reuptake inhibitor (SNRI). (See 'Inadequate response' above.)
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