For a patient with excessive worry that has worsened over six months, what therapeutic approach is most appropriate to initiate?

In the context of a patient with excessive worry that has progressed over six months, the most appropriate initial therapeutic approach would involve using Sertraline at a starting dose that is half of what would typically be used for major depressive disorder. This approach is consistent with the treatment of generalized anxiety disorder (GAD), where selective serotonin reuptake inhibitors (SSRIs) like Sertraline are frequently utilized as first-line pharmacotherapy.

The rationale for starting at a lower dose is based on the principle that patients with anxiety disorders often have increased sensitivity to medication side effects. A lower starting dose allows for the careful monitoring of the patient's response and tolerability, minimizing potential adverse effects while still providing effective treatment for anxiety symptoms.

Additionally, Sertraline has a robust evidence base supporting its efficacy in treating GAD, and by starting lower and gradually titrating upwards, the clinician can help mitigate the risk of side effects, which can sometimes exacerbate anxiety symptoms.

This approach thus prioritizes patient safety and comfort while effectively addressing the underlying anxiety disorder.