Alcohol , consider Benzodiazepines

Specific factors to consider are both psychiatric and physical contraindications. For example, bupropion is contraindicated in a depressed patient with a history of seizures due to the increased risk of recurrence while on this agent. Conversely, it may be an appropriate choice for a bipolar disorder with intermittent depressive episodes that is otherwise under good control with standard mood stabilizers. This consideration is based on the limited data suggesting that bupropion is less likely to induce a manic switch in comparison with standard heterocyclic antidepressants. Another example is the avoidance of benzodiazepines for the treatment of panic disorder in a patient with a history of alcohol or sedative-hypnotic abuse due to the increased risk of misuse or dependency. In this situation, a selective serotonin reuptake inhibitor (SSRI) may be more appropriate. 

An additional psychotropic medication that may be worth considering specifically for GAD is buspirone. One major benefit of buspirone can be found in the virtual absence of dependence and abuse liability. Although it is not effective for the acute relief of anxiety or panic disorders (anxiolytic effects may take up to a week to be established), buspirone may be indicated for patients with a history of alcohol abuse or among those who fear physiologic and psychological dependence with benzodiazepines. 

I Fixed-Schedule Therapy. Over the years, benzodiazepines given regularly at a fixed dosing interval have been considered the gold standard therapy for alcohol withdrawal. Chlordiazepoxide 50 to 100 mg oraUy every 6 hours for 1 day followed by 2 days at 25 to 50 mg every 6 hours is known to prevent dehrium tremens and seizures. 

Except in instances in which rapid response is required (i.e., loss of a job), benzodiazepines are considered second-line agents. Because of the risk of dependency, benzodiazepines should be used only after several trials of antidepressants have failed. " Because of potential emergence of depressive symptoms during treatment, benzodiazepines should not be used as monotherapy in a patient who is clinically depressed or has a history of depression. In patients whose illness is complicated by a history of alcohol or drug abuse, benzodiazepine use should be avoided. Data support the combined use of SSRIs and benzodiazepines in the Hrst weeks of treatment to offset the delay in the SSRI effect. ... 

For treatment-resistant patients who do not respond to SSRIs or TCAs, or to the combination of TCAs/SSRIs with benzodiazepines, other antidepressants have shown at least some beneficial effects in alleviating PD symptoms (e.g. mirtazapine, moclobemide, nefazodone, phenelzine, reboxetine, and venlafaxine). Other agents have also been reported to exert beneficial effects in PD, especially when combined with SSRIs/TCAs (lithium, pindolol, and propranolol). In cases where all treatments have failed, valproate or olanzapine should be considered.2 - ° In order to optimize treatment, patients should avoid or reduce the consumption of compounds that could potentially induce/exacerbate panic attacks (e.g. caffeine, alcohol, and nicotine) and should exercise regularly. i... 

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