Treatment
Anxiety disorders require treatment; simply trying to talk oneself out of anxiety is as futile as trying to talk oneself out of a heart or stomach problem. Most anxiety disorders, especially the phobias, respond well to treatment. They may, however, require long-term treatment. For instance, one study reported that two-thirds of GAD patients who were treated for only six weeks had a recurrence, and half of these patients required additional medications. Nevertheless, most adults in the US do not receive appropriate care for anxiety disorders. In one study, for example, about two-thirds of people with GAD never received any treatment.
Treatment Options
The standard current approach to most anxiety disorders in adults is a combination of cognitive-behavioral therapy (CBT) with medications, typically a selective serotonin reuptake inhibitor (SSRI) or, less commonly, a tricyclic antidepressant. Of note, a 2002 study suggested that SSRIs and psychotherapy affected the same regions of the brain, which indicates they have similar mechanisms of action. Specific options vary depending on the type of anxiety disorder.
Lifestyle Measures
A healthy lifestyle that includes exercise, adequate rest, and good nutrition can help to reduce the impact of anxiety attacks. Rhythmic aerobic and yoga exercise programs lasting for more than 15 weeks have been found to help reduce anxiety. Strength, or resistance, training does not seem to help anxiety.
Treatment Options for Specific Anxiety Disorders
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Anxiety Disorder
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Medications
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Cognitive-Behavioral (CBT) and other Non-Drug Therapies
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Generalized Anxiety Disorder
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Benzodiazepines; buspirone; antidepressants, particularly extended release venlafaxine (Effexor) and some tricyclics. SSRIs and newer designer antidepressants showing promise. Antipsychotics in severe cases. Agents being studied include gabapentin and other anti-seizure agents.
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Cognitive-behavioral (individual or group), interpersonal therapy, stress management, biofeedback.
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Panic Attacks
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SSRIs are treatment of choice. Benzodiazepines used only when necessary and for the short term if possible. Drugs to consider for increasing effectiveness in patients who do not respond to SSRIs alone include beta-blockers, buspirone, benzodiazepines, tricyclics, or anticonvulsants (such as valproate).
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Cognitive-behavioral therapy. Studies suggest that CBT offers the best chance for a persistent response. CBT is also effective in preventing the development of panic disorder in high-risk people and for helping patients withdraw from SSRIs.
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Phobias
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SSRIs, beta-blockers, benzodiazepines. SSRIs are first-line treatments for social anxiety. Agents being studied include the anti-seizure agent gabapentin and newer antidepressants and MAOIs.
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Cognitive-behavioral therapy, hypnosis. CBT may also prevent progression of phobias to full-blown anxiety in high-risk people.
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Obsessive-Compulsive Disorder
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SSRIs are the first choice. Clomipramine (a tricyclic) is alternative. Combinations of these drugs likely. MAO inhibitors or atypical antipsychotics for those who do not respond to other drugs. Antipsychotics used for tics.
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Cognitive-behavioral therapy (exposure and response prevention).
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Post-traumatic Stress Disorder
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Antidepressants, particularly the SSRIs (sertraline and paroxetine approved at this time). Clonidine. Sleep medications in certain patients who suffer from sleep disorders.
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Cognitive-behavioral therapy (group therapy). Children should particularly start with CBT. Behavioral measures for improving sleep. Note: Single debriefing sessions after major disasters without follow-up appear to provide no benefit to trauma victims and may pose a risk for worse outcome than no intervention at all.
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Note: For anxiety disorders in adults, the most effective treatments are usually combinations of drugs and behavioral techniques
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