Although our analyses offer little insight into clinical decision making at the individual patient level, the observed antipsychotic prescribing trends appear to reflect a shift in the balancing of risks versus compelling clinical need in office-based psychiatry. Despite limited controlled data for several common anxiety disorders and emerging safety concerns, prescribing patterns suggest a growing acceptance of antipsychotics in the outpatient psychiatric treatment of common anxiety disorders. With increased antipsychotic use, there will be increased need for metabolic monitoring, especially in patient populations with known risk factors for diabetes and cardiovascular disease. Prudence further suggests that renewed clinical efforts should be made to limit use of these medications to clearly justifiable circumstances. At the same time, a new generation of research is needed to assess the efficacy and safety of antipsychotic regimens for anxiety disorders, especially in patients who have not responded to other treatments.