What is your approach to using clonidine for anxiety?

It definitely helps in patients with autism with anxiety, 0.1 mg po bid but not my first line because of the blood pressure drop or rebound. I don’t use it as a first line for anxiety, as I haven’t seen any improvement if it’s just used for anxiety.

Strattera has some evidence for anxiety in autism, especially nonverbal.

I use clonidine for agitation when I do consults.

My first question would be to clarify what is meant by "anxiety." Anxiety is a normal and adaptive response in humans; we all have anxiety! Pathological anxiety, such as that meeting criteria for GAD, social phobia, etc., typically responds best to psychotherapy interventions (such as CBT) with or without SSRIs. I typically don't use clonidine strictly for anxiety disorders, as there is not much evidence that it is helpful. In my pediatric patient population, I do often utilize alpha-2 agonists (clonidine & guanfacine) for PTSD related hyperarousal, which does have a component of anxiety. It can also be helpful in neurodivergent youth (e.g., those with ASD) for hyperactivity and impulsivity, which can sometimes be interpreted as anxiety, or...