Effective treatments for anxiety disorders are available, and
research is yielding new, improved therapies that can help most
people with anxiety disorders lead productive, fulfilling lives.
You should seek information and treatment if you think you have
an anxiety disorder.
Before treatment can begin, the doctor must conduct
a careful diagnostic evaluation to determine whether your symptoms
are due to an anxiety disorder, which anxiety disorder(s) you
may have, and what coexisting conditions may be present. Anxiety
disorders are not all treated the same, and it is important to
determine the specific problem before embarking on a course of
treatment. Sometimes alcoholism or some other coexisting condition
will have such an impact that it is necessary to treat it at the
same time or before treating the anxiety disorder.
Effective treatments for each of the anxiety disorders
have been developed through research. In general, two types of
treatment are available for an anxiety disorder-medication and
specific types of psychotherapy (sometimes called "talk therapy").
Both ways can be effective for most disorders. The choice of one
or the other, or both, depends on the patient's and the doctor's
preference, and also on the particular anxiety disorder. For example,
only psychotherapy has been found effective for specific phobias.
When choosing a therapist, you should find out whether medications
will be available if needed.
If you have been treated previously for an anxiety
disorder, be prepared to tell the doctor what treatment you tried.
If it was a medication, what was the dosage, was it gradually
increased, and how long did you take it? If you had psychotherapy,
what kind was it, and how often did you attend sessions? It often
happens that people believe they have "failed" at treatment,
or that the treatment has failed them, when in fact it was never
given an adequate trial.
When you undergo treatment for an anxiety disorder,
you and your doctor or therapist will be working together as a
team. Together, you will attempt to find the approach that is
best for you. If one treatment doesn't work, the odds are good
that another one will. And new treatments are continually being
developed through research. So don't give up hope.
Psychiatrists or other physicians can prescribe medications for
anxiety disorders. These doctors often work closely with psychologists,
social workers, or counselors who provide psychotherapy. Although
medications won't cure an anxiety disorder, they can keep the
symptoms under control and enable you to lead a normal, fulfilling
life. The major classes of medications used for various anxiety
disorders are described below:
A number of medications that were originally approved for treatment
of depression have been found to be effective for anxiety disorders.
If your doctor prescribes an antidepressant, you will need to
take it for several weeks before symptoms start to fade. So it
is important not to get discouraged and stop taking these medications
before they've had a chance to work.
Fluoxetine, sertraline, fluvoxamine, paroxetine,
and citalopram are among the SSRIs commonly prescribed for panic
disorder, OCD, PTSD, and social phobia. SSRIs are often used to
treat people who have panic disorder in combination with OCD,
social phobia, or depression. Venlafaxine, a drug closely related
to the SSRIs, is useful for treating GAD.
Other newer antidepressants are under study in anxiety
disorders, although one, bupropion,
does not appear effective for these conditions. These medications
are started at a low dose and gradually increased until they reach
a therapeutic level.
Similarly, antidepressant medications called tricyclics
are started at low doses and gradually
increased. Tricyclics have been around longer than SSRIs and have
been more widely studied for treating anxiety disorders. For anxiety
disorders other than OCD, they are as effective as the SSRIs,
but many physicians and patients prefer the newer drugs because
the tricyclics sometimes cause dizziness, drowsiness, dry mouth,
and weight gain. When these problems persist or are bothersome,
a change in dosage or a switch in medications may be needed.
Tricyclics are useful in treating people with co-occurring
anxiety disorders and depression. Clomipramine, the only antidepressant
in its class prescribed for OCD, and imipramine, prescribed for
panic disorder and GAD, are examples of tricyclics.
Monoamine oxidase inhibitors, or MAOIs, are the
oldest class of antidepressant medications. The most commonly
prescribed MAOI is phenelzine, which is helpful for people with
panic disorder and social phobia. Tranylcypromine and isoprocarboxazid
are also used to treat anxiety disorders. People who take MAOIs
are put on a restrictive diet because these medications can interact
with some foods and beverages, including cheese and red wine,
which contain a chemical called tyramine. MAOIs also interact
with some other medications, including SSRIs. Interactions between
MAOIs and other substances can cause dangerous elevations in blood
pressure or other potentially life-threatening reactions.
· Anti-Anxiety Medications
High-potency benzodiazepines relieve symptoms quickly and have
few side effects, although drowsiness can be a problem. Because
people can develop a tolerance to them-and would have to continue
increasing the dosage to get the same effect-benzodiazepines are
generally prescribed for short periods of time. One exception
is panic disorder, for which they may be used for 6 months to
a year. People who have had problems with drug or alcohol abuse
are not usually good candidates for these medications because
they may become dependent on them.
Some people experience withdrawal symptoms when
they stop taking benzodiazepines, although reducing the dosage
gradu-ally can diminish those symptoms. In certain instances,
the symptoms of anxiety can rebound after these medications are
stopped. Potential problems with benzodiazepines have led some
physicians to shy away from using them, or to use them in inadequate
doses, even when they are of potential benefit to the patient.
Benzodiazepines include clonazepam, which is used for social phobia
and GAD; alprazolam, which is helpful for panic disorder and GAD;
and lorazepam, which is also useful for panic disorder.
Buspirone, a member of a class of drugs called azipirones,
is a newer anti-anxiety medication that is used to treat GAD.
Possible side effects include dizziness, headaches, and nausea.
Unlike the benzodiazepines, buspirone must be taken consistently
for at least two weeks to achieve an anti-anxiety effect.
· Other Medications
Beta-blockers, such as propanolol, are often used to treat heart
conditions but have also been found to be helpful in certain anxiety
disorders, particularly in social phobia. When a feared situation,
such as giving an oral presentation, can be predicted in advance,
your doctor may prescribe a beta-blocker that can be taken to
keep your heart from pounding, your hands from shaking, and other
physical symptoms from developing.
Before taking medication
for an anxiety disorder:
· Ask your doctor to tell you about the effects and side
effects of the drug he or she is prescribing.
· Tell your doctor about any alternative therapies or over-the-counter
medications you are using.
· Ask your doctor when and how the medication will be stopped.
Some drugs can't safely be stopped abruptly; they have to be tapered
slowly under a physician's supervision.
· Be aware that some medications are effective in anxiety
disorders only as long as they are taken regularly, and symptoms
may occur again when the medications are discontinued.
· Work together with your doctor to determine the right
dosage of the right medication to treat your anxiety disorder.
Psychotherapy involves talking with a trained mental health professional,
such as a psychiatrist, psychologist, social worker, or counselor
to learn how to deal with problems like anxiety disorders.
· Cognitive-Behavioral and Behavioral Therapy
Research has shown that a form of psychotherapy that is effective
for several anxiety disorders, particularly panic disorder and
social phobia, is cognitive-behavioral therapy (CBT). It has two
components. The cognitive component helps people change thinking
patterns that keep them from overcoming their fears. For example,
a person with panic disorder might be helped to see that his or
her panic attacks are not really heart attacks as previously feared;
the tendency to put the worst possible interpretation on physical
symptoms can be overcome. Similarly, a person with social phobia
might be helped to overcome the belief that others are continually
watching and harshly judging him or her.
The behavioral component of CBT seeks to change
people's reactions to anxiety-provoking situations. A key element
of this component is exposure, in which people confront the things
they fear. An example would be a treatment approach called exposure
and response prevention for people with OCD. If the person has
a fear of dirt and germs, the therapist may encourage them to
dirty their hands, then go a certain period of time without washing.
The therapist helps the patient to cope with the resultant anxiety.
Eventually, after this exercise has been repeated a number of
times, anxiety will diminish. In another sort of exposure exercise,
a person with social phobia may be encouraged to spend time in
feared social situations without giving in to the temptation to
flee. In some cases the individual with social phobia will be
asked to deliberately make what appear to be slight social blunders
and observe other people's reactions; if they are not as harsh
as expected, the person's social anxiety may begin to fade. For
a person with PTSD, exposure might consist of recalling the traumatic
event in detail, as if in slow motion, and in effect re-experiencing
it in a safe situation. If this is done carefully, with support
from the therapist, it may be possible to defuse the anxiety associated
with the memories. Another behavioral technique is to teach the
patient deep breathing as an aid to relaxation and anxiety management.
Behavioral therapy alone, without a strong cognitive compo-nent,
has long been used effectively to treat specific phobias. Here
also, therapy involves exposure. The person is gradually exposed
to the object or situation that is feared. At first, the exposure
may be only through pictures or audiotapes. Later, if possible,
the person actually confronts the feared object or situation.
Often the therapist will accompany him or her to provide support
If you undergo CBT or behavioral therapy, exposure
will be carried out only when you are ready; it will be done gradually
and only with your permission. You will work with the therapist
to determine how much you can handle and at what pace you can
A major aim of CBT and behavioral therapy is to reduce anxiety
by eliminating beliefs or behaviors that help to maintain the
anxiety disorder. For example, avoidance of a feared object or
situation prevents a person from learning that it is harmless.
Similarly, performance of compulsive rituals in OCD gives some
relief from anxiety and prevents the person from testing rational
thoughts about danger, contamination, etc.
To be effective, CBT or behavioral therapy must be directed at
the person's specific anxieties. An approach that is effective
for a person with a specific phobia about dogs is not going to
help a person with OCD who has intrusive thoughts of harming loved
ones. Even for a single disorder, such as OCD, it is necessary
to tailor the therapy to the person's particular concerns. CBT
and behavioral therapy have no adverse side effects other than
the temporary discomfort of increased anxiety, but the therapist
must be well trained in the techniques of the treatment in order
for it to work as desired. During treatment, the therapist probably
will assign "homework" -- specific problems that the
patient will need to work on between sessions.
CBT or behavioral therapy generally lasts about
12 weeks. It may be conducted in a group, provided the people
in the group have sufficiently similar problems. Group therapy
is particularly effective for people with social phobia. There
is some evidence that, after treatment is terminated, the beneficial
effects of CBT last longer than those of medications for people
with panic disorder; the same may be true for OCD, PTSD, and social
Medication may be combined with psychotherapy, and for many people
this is the best approach to treatment. As stated earlier, it
is important to give any treatment a fair trial. And if one approach
doesn't work, the odds are that another one will, so don't give
If you have recovered from an anxiety disorder,
and at a later date it recurs, don't consider yourself a "treatment
failure." Recurrences can be treated effectively, just like
an initial episode. In fact, the skills you learned in dealing
with the initial episode can be helpful in coping with a setback.