What do you use for treatment-refractory anxiety where trials of antidepressants have not worked either from ability to tolerate or inadequate effect?  

I find gabapentin to be very helpful for anxiety. Other agents I've found helpful include the alpha-2 agonists clonidine and guanfacine, which I've found particularly helpful for people with trauma-related anxiety and anxiety with somatic symptoms. Both are also helpful for nightmares.  Regard...