What role do pharmacological treatments play in the management of Illness Anxiety Disorder?

Pharmacological treatments have a limited and non-primary role in the management of Illness Anxiety Disorder (IAD). The UK NICE guidelines and related sources do not specifically recommend drug treatment for IAD, focusing instead on psychological interventions and active monitoring.

Where pharmacological treatment is considered, it is generally extrapolated from management principles of related anxiety disorders such as Generalized Anxiety Disorder (GAD) or panic disorder, where selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors (SNRIs) are first-line options if psychological interventions are insufficient or declined.

Benzodiazepines and antipsychotics are not recommended for anxiety disorders due to poor long-term outcomes and side effect profiles, and this caution extends to IAD.

In summary, pharmacological treatment in IAD is not routinely indicated and should be considered only after psychological therapies, guided by patient preference and clinical judgment, with SSRIs or SNRIs as the preferred agents if medication is used.

Close monitoring for adverse effects, especially in younger patients, and consideration of pregnancy-related risks are important if pharmacotherapy is initiated.

Overall, the management of IAD prioritizes psychological approaches and active monitoring, with pharmacological treatments playing a secondary, adjunctive role when necessary.

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