How do you approach antidepressant choices for patients with generalized anxiety disorder when the patient reports excessive sedation on low doses of SSRIs?
Do you find bupropion to be an effective treatment for refractory generalized anxiety disorder?
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We forget that bupropion, despite systemic misconceptions, has a very good anxiolytic effect. It is the darling of the centers treating refractory anxiety disorders.
One size rarely fits all. I agree with Dr. @Dr. First Last and would add that buspirone, SNRIs, and gabapentin may also be helpful for different patients. Isn't it frustrating that we cannot test patients to predict what will be the right chemistry for them before our trial-and-error process?
I would go back and carefully look over my initial review of systems with the patient, looking for any indication of hypothyroidism. I would also look for any other general medical illnesses that could provide an explanation for unusual side effects. I would then either call the patient's internist, get TSH, Free T3 and Free T4 lab tests, or both.
I've found that buspirone is helpful for patients with anxiety who are sensitive to the side effects of sedation.