Anxiety disorders
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of anxiety.
Alternative Names
Obsessive-compulsive disorder; Panic disorder; Phobias; Post-traumatic stress disorder
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 phobias, respond well to treatment. They may, however, require long-term treatment. For instance, one study reported that two-thirds of patients with GAD who were treated for only 6 weeks had a recurrence, and half of these patients required additional medications. Nevertheless, most patients do not receive appropriate care for anxiety disorders. In one study, about two-thirds of people with GAD never received any treatment. According to a 2006
Lancet
study, only 19 - 40% of patients with panic disorder receive appropriate care.
Treatment Options
The standard current approach to most anxiety disorders is a combination of cognitive-behavioral therapy (CBT) with medications, typically a selective serotonin reuptake inhibitor (SSRI) or, less commonly, a tricyclic antidepressant.
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
|
|
Anxiety Disorder
|
Medications
|
Cognitive-Behavioral (CBT) and other Non-Drug Therapies
|
|
Generalized Anxiety Disorder
|
Benzodiazepines; buspirone; SSRIs and some tricyclic antidepressants, particularly extended release venlafaxine (Effexor). Antipsychotics in severe cases. Investigative drugs include pregabalin and other anticonvulsants.
|
Cognitive-behavioral (individual or group), interpersonal therapy, stress management, biofeedback.
|
|
Panic Attacks
|
SSRIs are treatment of choice. If patients do not respond to SSRIs, other drugs include beta-blockers, buspirone, benzodiazepines, tricyclics, or anticonvulsants (such as valproate). In 2005, the designer antidepressant venlafaine (Effexor) was approved for panic disorder in adults. Benzodiazepines used only when necessary and for the shortest time possible.
|
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.
|
|
Phobias
|
SSRIs, beta-blockers, benzodiazepines. SSRIs are first-line treatments for social anxiety. Other drugs include anticonvulsants, newer antidepressants, and MAOIs.
|
Cognitive-behavioral therapy, hypnosis. CBT may also prevent progression of phobias to full-blown anxiety in high-risk people.
|
|
Obsessive-Compulsive Disorder
|
SSRIs are the first choice. Clomipramine (a tricyclic) is alternative. Combinations of these drugs are likely. MAO inhibitors or atypical antipsychotics for those who do not respond to other drugs. Antipsychotics used for tics.
|
Cognitive-behavioral therapy (exposure and response prevention).
|
|
Post-traumatic Stress Disorder
|
Antidepressants, particularly SSRIs (sertraline and paroxetine approved at this time). Clonidine. Sleep medications in certain patients who suffer from sleep disorders.
|
Cognitive-behavioral therapy (group therapy). Children should particularly start with CBT. Behavioral measures for improving sleep. 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.
|
|
Note: For anxiety disorders in adults, the most effective treatments are usually combinations of drugs and behavioral techniques.
|
-
Review Date: 12/4/2006
-
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
|
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's
accreditation program
is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s
editorial process
. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
|
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
