Table 1 Patient presentation and treatment timeline
Day 0 | Patient reports having ingested MDMA |
Day 3 | Development of acute anxiety and physiological arousal |
Day 9 | Patient presents to clinic for evaluation and is prescribed uptitration of buspirone |
Week 2 | Patient is prescribed lorazepam |
Week 3 | Patient is taking full dose of buspirone with no significant improvement in anxiety; rare lorazepam use Prescribed SSRI but does not start taking First visit with behavioral health consultant, total of six visits every 1–4 weeks |
Week 4 | Seen by psychiatrist and given tentative diagnosis of substance-induced anxiety disorder SSRI recommended |
Week 6 | Begins SSRI sertraline and begins buspirone taper |
Week 7 | Reports some improvement in anxiety and sleep |
Week 7.5 | Reports acute worsening of anxiety with suicidal ideation Sertraline dose is lowered, and in 3 days, patient no longer has suicidal ideation |
Weeks 8–10 | Continues sertraline, reaching dose of 50 mg once daily with continued improvement in anxiety |
Weeks 10+ | Seen by psychiatrist 2, who concurs with diagnosis of substance-induced anxiety disorder Patient continues sertraline 50 mg/day for several more months without resurgence of anxiety symptoms |