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Table 1 Patient presentation and treatment timeline

From: Substance-induced anxiety disorder after one dose of 3,4-methylenedioxymethamphetamine: a case report

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

  1. MDMA 3,4-Methylenedioxymethamphetamine, SSRI Selective serotonin reuptake inhibitor