Pharmacotherapeutic considerations in anxiety disorders.

Anxiety disorders comprise a variety of syndromes that require varied pharmacotherapeutic, psychotherapeutic, and behavioral interventions. Benzodiazepines have now replaced older sedatives and hypnotics as the preferred drug treatment for generalized anxiety. For panic disorder and agoraphobia with panic, the tricyclic antidepressants, the monoamine oxidase inhibitors, and the atypical benzodiazepine alprazolam have proved effective. When a simple phobia is severe enough to require treatment, behavioral approaches, with the possible adjunctive use of benzodiazepines, are recommended. Careful diagnostic inquiry, individual titration of doses, and use of conservative dosage schedules (with interrupted periods of treatment) will permit pharmacotherapy with maximum benefit and a minimum of adverse consequences.