Which agent is best for the acute management of anxiety with a rapid onset of effect?

The best agent for the acute management of anxiety with a rapid onset of effect is lorazepam. Lorazepam belongs to the benzodiazepine class of medications, which are known for their quick action in alleviating anxiety symptoms. When administered, lorazepam can produce therapeutic effects within minutes to hours, making it especially effective for situations where immediate anxiety relief is necessary, such as acute anxiety episodes or panic attacks.

Benzodiazepines work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, leading to anxiolytic, sedative, muscle relaxant, and anticonvulsant properties. This rapid action is what makes lorazepam the preferred choice for managing acute anxiety situations.

In contrast, agents such as buspirone, venlafaxine, and escitalopram are not suitable for immediate relief. Buspirone typically takes several weeks to exert its full effect, as it primarily functions as a serotonin receptor partial agonist and is more suited for chronic anxiety management. Venlafaxine, an antidepressant that works on both serotonin and norepinephrine reuptake inhibition, may take days to weeks to show benefit for anxiety. Similarly, esc