Anxiety disorders may occur as primary conditions (generalized anxiety, panic disorder); or may be associated with other psychiatric syndromes such as major depression or dementia. Benzodiazepines are the most widely prescribed anxiolytics. However, antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) also have potent anxiolytic properties; these agents are often safer and more effective in the long-termtreatment of generalized anxiety and panic attacks. Buspirone is occasionally effective for relatively milder forms of generalized anxiety. Neurologists evaluating anxious patients should have a high suspicion for the diagnosis of depression, because major depression can present with predominant anxiety symptoms, particularly in the elderly in whom agitation associated with depression may mimic severe anxiety (Schoevers et al., 2003). The neurologist may also encounter anxiety symptoms in patients with Alzheimer’s disease, vascular dementia, or following stroke. General medical causes of anxiety symptoms should be included in the differential diagnosis before anxiolytic treatment is begun. Such medical etiologies include hyperthyroidism, respiratory distress, cardiac arrhythmias, hypoglycemia, and pheochromocytoma. Moreover, physical discomfort may provoke anxiety symptoms in cognitively impaired patients who cannot express their physical symptoms to caregivers. Generalized anxiety, especially if accompanied by depression, is best treated with antidepressant agents. Benzodiazepines may produce benefits in the short term, if distress is great, but the long-term use risks the induction of physiologic dependence. The SSRIs sertraline and paroxetine, as well as the SNRI venlafaxine, are effective for generalized anxiety. Each drug should be started at low doses (sertraline 25mg daily, paroxetine 10mg QHS, extended-release venlafaxine 37.5mg daily) and slowly increased as tolerated. Final doses are similar to those required for the treatment of major depression, and slow dose escalation minimizes early exacerbation of anxiety symptoms. See Chapter 15 for further description of these agents, including side effects. TCAs are second-line agents for the treatment of generalized anxiety. Nortriptyline is the best tolerated TCA. It should be started at low doses (10mg QHS) and slowly increased as tolerated. Final doses generally need to achieve serum levels similar to those required for the treatment of major depression. Details of nortriptyline use can be found in Chapter 15.