Rule out medical causes (particularly important for panic attack patients and atypical presentations).
We emphasize integrated pharmacological and cognitive-behavioral treatment (CBT) for specifically diagnosed anxiety disorders. All anxiety disorders can be successfully treated with medication (SSRI) and/or CBT. If impairment is due to prominent avoidance (phobic) behavior or patient is reluctant to take medication, CBT is a good choice and these patients should be referred. If avoidance behavior is the primary cause of impairment, CBT alone may be preferred over medication. If medication is indicated and desired by the patient, initiation of an SSRI (citalopram is our preferred generic) at low dose with close follow up (anxiety can initially get worse) is appropriate. We discourage prn use of benzodiazepines. If rapid symptom control is needed, scheduled use of a long acting agent (e.g. clonazepam) is preferred.