It is not uncommon for a resident to try multiple medications to manage anxiety disorder before finding a tolerated and effective psychotropic. An SSRI or SNRI are usually the first-line agent for pharmacotherapy. Concern for anxiety is often brought up by caregivers when patients demonstrate disruptive behaviors related to anxiety such as yelling out, resisting care, becoming frightened with personal care, and repetitive behaviors such as pushing a call light many times a day, pacing, or restlessness. First-line agents in the treatment of anxiety disorders in long-term care include SSRIs and SNRIs. Second-line agents or supporting agents may incude buspirone, mirtazapine, propranolol, and trazodone. Avoid benzodiazepines and anticholinergics. Strategies to address difficult to manage anxiety include reconsidering the first-line agent for appropriate dose and duration, adding an augmenting agent, switching from an SSRI to and SNRI, and considering the possibility of low-grade psychosis and a potential contributing factor to anxiety.