Anxiety Follow Up

Monitoring

Generalized Anxiety Disorder  

Frequent follow-up is provided during the first 3 months (acute phase) of therapy. Adverse effects are monitored. Monitoring for risk of suicidal ideation and self-harm in patients with SAD who were given an SSRI, or a serotonin and norepinephrine reuptake inhibitor is done weekly. Response to therapy is also monitored. Therapy is then reassessed every month thereafter. The benefits of cognitive behavioral therapy are maintained over 1 to 5 years of follow-up.  

Panic Disorder  

Frequent follow-up is provided during the first 3 months (acute phase) of therapy. For patients receiving pharmacological therapy, adverse effects and response to therapy are monitored. Therapy is reassessed at 8 to 12 weeks intervals.  

Therapy Change  

Generalized Anxiety Disorder  

If the results are unsatisfactory after 4 to 8 weeks of treatment, consider expert referral, dose increase, adding or changing drug from another therapeutic class, and/or adding psychotherapy.  

Panic Disorder  

It must be noted that 12 weeks of treatment period is needed to assess efficacy. If the results are unsatisfactory consider a different treatment, adding psychotherapy or medication, expert referral, and/or re-evaluating the diagnosis.  

Social Anxiety Disorder  

A treatment period of 12 weeks is needed to evaluate effectiveness. If the results are unsatisfactory, consider switching to a different drug from the same class of first-line agents or changing to a second-line agent, switching to psychotherapy, expert referral, and/or re-evaluating the diagnosis.

Long-Term Treatment  

Generalized Anxiety Disorder  

Patients who respond to a 12-week trial of treatment should continue to be monitored for 6 to 12 months. The goals of therapy are symptom remission and returning to full functioning. Late-onset drug adverse effects are managed. If the medication is effective, treatment is continued for at least 1 year as the likelihood of relapse is high. Once full functioning has returned, withdrawing treatment is attempted. Careful medication taper may be attempted. If after 2 careful attempts to discontinue medications, the patient is still experiencing anxiety symptoms, long-term maintenance is considered.  

Panic Disorder  

For patients receiving pharmacological therapy, the patient is monitored continuously. Symptom remission and return to full functioning are the goals of therapy. Late-onset adverse effects are managed. The general recommendation is to continue medication for ≥1 year to maintain symptom reduction and to reduce the risk of recurrence. Discontinuation is attempted after this time and close follow-up is maintained. It must be noted that relapse is common and that re-institution of medication seems to help.  

For patients receiving psychotherapy, the frequency of visits may generally be decreased. It is then discontinued after several months. Adding psychosocial treatment, particularly CBT, to pharmacological therapy may enhance long-term outcomes by reducing the likelihood of relapse when pharmacotherapy is stopped. Some studies show remission of several years is possible with CBT. However, the effectiveness of resuming CBT for patients whose relapse has not been studied.  

Social Anxiety Disorder  

Once medication has taken effect, in vivo exposure exercises may be initiated. The patient is continuously monitored. Symptom remission and return to full functioning are the goals of therapy. Late-onset adverse effects are managed. It is important that therapy continues for 6 to 12 months. Tapering and discontinuation are attempted after this time while follow-up is closely maintained. Should symptoms recur after the drug has been stopped or dose has been lowered, a dose increase, drug reintroduction, or individual CBT is considered.