We often receive questions wondering what the correct dosage of different anxiety medications. It certainly can be confusing with so many different medications and each medication having a different dosing structure. While this is a question that should be discussed with your physician, Dr. Matthew White, the clinical instructor of Psychiatry and Behavioral Science-Behavioral Medicine at Stanford University in California, published information on the most effective dose of medications for social anxiety disorder, generalized anxiety disorder (GAD) and panic disorder: "Medication Dosing in Anxiety Disorders: What the Evidence Shows." It is also important to note that many of the medications have a range of doses that are effective because of the difference in the severity of symptoms and because each person reacts differently to medications.
Benzodizepines
- Clonazepam (Klonopin), at an average dose of 2.4 mg/day, using twice daily dosing
- Alprazolam (Xanax), at an average dose of 4.2 mg/day, using four divided doses
SSRIs/SNRIs
- Paroxetine (Paxil), with a range between 20-40 mg/day. Different studies showed 20, 36, 40 and44 mg to be effective, therefore a range is indicated. Higher doses of 60 mg was not found to be more effective. The controlled release for this medication was found to be effective at 32 mg.
- Sertraline (Zoloft) was effective at between 99 mg and 180 mg.
- Escitalopram (Lexapro), at an average dose of 18 mg wit 5 mg to be a good starting point with increased doses up to 20 mg as needed.
- Fluvoxamine (Luvox) was effective at average doses of 150 mg in one study and 202 mg in a second study.
- Venlafaxine ER (Effexor) showed improved symptoms in average doses ranging from 152 to 202 mg/day.
- Mirtazapine (Remeron) was found to be effective at 30 mg/day in a small, women only study
Anticonvulsants
- Gabapentin (Fanatrex, Gabarone, Neurontin) was used in minimum doses of 900 mg/day and maximum doses of 3600 mg/day (divided into 3 doses) and was found to be effective
- Pregabalin (Lyrica) was found to be effective at 600 mg/day divided into three doses per day
Benzodizepines
- Alprazolam (Xanax)was found to be effective for GAD at 1.5 mg, 1.9 mg and 2.0 mg, in four divided doses
- Lorazepam (Ativan) was effective at 2.0 mg, 3 mg, 3.6 mg, 4 mg and 6 mg.
- Diazepam (Valium, Valrelease), at 15 mg per day, divided into 3 equal doses throughout the day. Additional studies found this medication to be effective at 20 mg, 21 mg and 26 mg.
SSRIs/SNRIs
- Paroxetine (Paxil), at an average dose of between 20 mg and 50 mg, however a second study showed 20 mg to be ineffective so this may be a starting point and effective doses may be closer to 40 mg.
- Escitalopram (Lexapro), at a dose between 10 mg and 20 mg.
- Venlafaxine ER (Effexor), at an average dose of between 151 mg and 171 mg. Some studies show this medication to be effective at a dose of 75 mg and some found 37.5 to be effective in some people.
- Duloxetine (Cymbalta) was effective in a range of between 60 and 120 mg
Buspirone
