Treatment Plan

Step 1 (Mild cases):

• Active monitoring

Step 2 (Low-intensity psychological interventions):

• Individualised facilitated/non-facilitated self-help
• Group therapies

Step 3 (High-intensity interventions):

• Applied relaxation
• CBT +/- medications

Medications:

• First-line: SSRIs (sertraline, paroxetine, escitalopram)
• SNRIs: duloxetine, venlafaxine
• Pregabalin (contraindicated in pregnancy, associated with blurred vision)

Follow-up:

• Review 2-4 weeks for the first 3 months, then 3 monthly
• Benefits are usually seen around 6 weeks
• Patients <30: increased risk of suicidal ideations/symptom worsening in the first week; review within 1 week
• If treatment is effective, continue for at least one year (for panic disorder, continue it for at least six months)

Referral criteria:

• Self-harm ideation
• Not tolerating primary care
• Functional impairment
• Complex issues
• Treatment-resistant