Anxiety disorder

Case Assignment
AX is a 19 year old female and is in her freshman year of college. During an appointment at the
university’s mental health clinic, she reports excessive worry, anticipation of the worst, insomnia,
loss of appetite, and tension. She is diagnosed with GAD, scoring a 27 on the HAM-A.
Question 1:
Based on AX’s score on the HAM-A, how severe is her generalized anxiety disorder?
a) Moderately-severe anxiety
b) Moderate anxiety
c) Severe anxiety
d) Mild anxiety
Question 2:
AX is interested in medication options. What medication regimen would you recommend?
Why?
a) Bupropion 75mg BID
b) Vilazodone 40mg daily
c) Citalopram 10mg daily
d) Fluoxetine 20mg daily
AX responds well to antidepressant therapy with paroxetine over the next several years with her
anxiety in remission. She stopped antidepressant treatment after college graduation, however
her anxiety symptoms returned despite completing dozens of sessions of CBT. AX restarted
treatment with paroxetine after failure of CBT. She is now 25 years old, prescribed paroxetine
40 mg daily, and would like to start planning for pregnancy.
Question 3:
What is the most appropriate agent for AX given her plans for pregnancy? Please provide
rationale.
a) Change paroxetine to sertraline
b) Continue paroxetine
c) Taper off paroxetine and start lorazepam to be used only as needed
d) Taper off paroxetine and remain off antidepressant medication