Prescribing Trends, Adherence, and Tolerability of Antianxiety Medications in an Indian Tertiary Care Psychiatry Outpatient Department: A Cross-Sectional Study.

Background Pharmacological therapy, particularly the use of selective serotonin reuptake inhibitors (SSRIs), plays a central role in managing anxiety spectrum disorders. However, real-world clinical practice can deviate from evidence-based recommendations, leading to challenges such as prolonged benzodiazepine use, polypharmacy, and low rates of generic prescribing. Evaluating these real-world prescribing patterns, alongside patient adherence and adverse drug reactions (ADRs), is crucial for optimizing treatment. This study aimed to describe the prescribing patterns of anti-anxiety medications in a tertiary-care psychiatry outpatient department and to evaluate patient adherence and the incidence of ADRs. Methodology A cross-sectional observational study was conducted over six months, enrolling 150 consecutive adult patients (aged 18 to 60 years) diagnosed with anxiety or related disorders based on the International Classification of Diseases, 10th Revision (ICD-10) criteria. Sociodemographic details, clinical diagnoses, and complete prescription data were recorded. Medications were categorized by drug class, with polytherapy defined as the concurrent use of two or more anxiolytic agents. Medication adherence was assessed using the 10-item Medication Adherence Rating Scale (MARS-10). ADRs were documented through targeted patient interviews based on a symptom checklist. Results The study cohort had a mean age of 37.6±11.2 years and was predominantly made up of women (62%). Generalized anxiety disorder was the most frequent primary diagnosis (30%), followed by panic disorder (14.7%) and obsessive-compulsive disorder (13.3%). Selective serotonin reuptake inhibitors (SSRIs) were the most widely prescribed medication class, utilized in 73.3% of patients, with sertraline (22.7%) and escitalopram (22.7%) being the preferred agents. Benzodiazepines were prescribed to 44.7% of the cohort. Polytherapy was highly prevalent, occurring in 70% of cases, whereas generic prescribing was observed in only 8% of prescriptions. Patients demonstrated high medication adherence, with a mean MARS-10 score of 8.1±1.7 (68.7% classified as highly adherent). ADRs were reported by 19.3% of patients, most commonly presenting as gastritis (7.3%) and insomnia or restlessness (4.7%). No severe ADRs were noted, and there were no significant subgroup differences in adherence or ADR incidence between SSRI and benzodiazepine users versus non-users (P>0.05). Conclusions The predominant use of SSRIs in this setting aligns with standard pharmacological management for anxiety disorders. However, the high prevalence of anxiolytic polytherapy, substantial concurrent use of benzodiazepines, and an overwhelming preference for brand-name prescriptions highlight critical areas for clinical optimization. While medication adherence is robust and medications are generally well-tolerated, prioritizing rational monotherapy, implementing planned benzodiazepine tapering, and encouraging generic prescribing could further enhance the cost-effectiveness and safety of psychiatric care.