• For patients who have completed Maintenance Phase of Medication Management:
  • Anxiety symptoms have been in sustained remission
  • No function impairment for at least 3 months
  • Medication Management: Phases of Treatment

Tapering Medication

• Begin slow taper off medication over several months to reduce risk of discontinuation syndrome.
• Tapering must be individualized to the patient, can consider 25% reduction weekly as tolerated
• How to Taper off Your Medications  
• Discontinuation Syndrome:

  Symptoms include:

  Dizziness, fatigue, chills, headaches Nausea, vomiting Insomnia, anxiety and irritability

Monitoring

• Monitor for several months off medication to assess for relapse

• Patients who successfully wean from medication and there are no concerns for relapse can be discharge back to the care of the PCP
• Patients requiring ongoing medication management can be discharged to PCP if able to monitor every 3 months to wean medication and will review:
  • Medication adherence
  • Dose optimization
  • Side effects
  • Anxiety symptoms, patient function, transitions, stressors

Process

The goal of treatment is to achieve recovery with no or few residual symptoms of anxiety and restoration of functioning. Upon achieving recovery, discharge is recommended.

• In preparing for discharge, it is important to engage in relapse/recurrence prevention, which should include the following:
  • Importance of ongoing monitoring of anxiety and mood
  • Education about the differences between normal anxiety and a relapse/recurrence
  • Discussion about signs of a relapse/recurrence
  • Identification of likely triggers for a relapse/recurrence
  • Review skills that can be used to prevent or treat a relapse/recurrence

Discontinuation or discharge from therapy may not coincide with the end of medication management. Ongoing Medication Management may be needed.

Upon discharge from therapy, a warm handoff with the BH medication provider (if applicable) and/or PCP should occur. This warm handoff should include information about the course of therapy and an assessment of the patient’s current state.

PCP continues monitoring of patient anxiety, as appropriate, documenting improvements and any need for re- evaluation of therapy or higher-level care, if relapse/recurrence.