Anxiety Disorders: Management

Degree of anxiety disorders	GAD-2 Score	Treatment	Consultation with expert
Minimal	< 3	Relaxation techniques
Significant	≥ 3	Recommend relaxation techniques Consider benzodiazepines, mainly clonazepam or lorazepam for a short period of time (less than 4 weeks) Consider antidepressant treatment with SSRI⁽ⁱ⁾ Consider psychotherapeutic intervention: Cognitive Behavioral Therapy Cognitive Behavioral Stress Management Mindfulness-based Cognitive Therapy Peer Support Counseling	Always if treating doctor is unfamiliar with use of antidepressants If anxiety not responding to treatment If person has suicidal ideation In case of complex situations such as drug addiction, personality disorders, acute severe life events Clinical improvement with antidepressants may take up to 4 weeks; there is no need to change antidepressants before this time Dose increment of antidepressant may be considered
Generalized anxiety disorder		Start antidepressant treatment with SSRI and benzodiazepine if needed (to reduce anxiety faster)^{(i, ii)} Refer to mental health expert to start psychotherapeutic intervention

i See Drug-drug Interactions between Anxiolytics and ARVs
ii Mental health professionals should always be consulted if there is a risk of suicide