Table 1.

Patient presentation and treatment timeline

Day 0	Patient reports having ingested MDMA
Day 3	Development of acute anxiety and physiological arousal
Day 9	Patient presents to clinic for evaluation and is prescribed uptitration of buspirone
Week 2	Patient is prescribed lorazepam
Week 3	Patient is taking full dose of buspirone with no significant improvement in anxiety; rare lorazepam use Prescribed SSRI but does not start taking First visit with behavioral health consultant, total of six visits every 1–4 weeks
Week 4	Seen by psychiatrist and given tentative diagnosis of substance-induced anxiety disorder SSRI recommended
Week 6	Begins SSRI sertraline and begins buspirone taper
Week 7	Reports some improvement in anxiety and sleep
Week 7.5	Reports acute worsening of anxiety with suicidal ideation Sertraline dose is lowered, and in 3 days, patient no longer has suicidal ideation
Weeks 8–10	Continues sertraline, reaching dose of 50 mg once daily with continued improvement in anxiety
Weeks 10+	Seen by psychiatrist 2, who concurs with diagnosis of substance-induced anxiety disorder Patient continues sertraline 50 mg/day for several more months without resurgence of anxiety symptoms

MDMA 3,4-Methylenedioxymethamphetamine, SSRI Selective serotonin reuptake inhibitor