How do you approach antidepressant choices for patients with generalized anxiety disorder when the patient reports excessive sedation on low doses of SSRIs?  

We forget that bupropion, despite systemic misconceptions, has a very good anxiolytic effect. It is the darling of the centers treating refractory anxiety disorders.

One size rarely fits all. I agree with Dr. @Mowerman and would add that buspirone, SNRIs, and gabapentin may also be helpful for different patients. Isn't it frustrating that we cannot test patients to predict what will be the right chemistry for them before our trial-and-error process?

I've found that buspirone is helpful for patients with anxiety who are sensitive to the side effects of sedation.

I would go back and carefully look over my initial review of systems with the patient, looking for any indication of hypothyroidism. I would also look for any other general medical illnesses that could provide an explanation for unusual side effects. I would then either call the patient's internist,...