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Treatment of Anxiety Disorders

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 approaches can be effective for most disorders. Before treatment can begin, the mental health
professional must conduct a careful diagnostic evaluation. 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.

Medications

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.

Antidepressants

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.

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. These medications
act in the brain on a chemical messenger called serotonin. SSRIs tend to have fewer side effects than older
antidepressants. Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram are among the SSRIs commonly
prescribed for panic disorder, OCD, PTSD, and social phobia. 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. 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.

Anti-Anxiety Medications

High-potency benzodiazepines relieve symptoms quickly and have few side effects. 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. 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. 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.

Types of Psychotherapy

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 component, 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 and guidance.

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 proceed.

 

Used with permission from the web site of The National Institute of Mental Health’s (NIMH)  www.nimh.nih.gov

NIH Publication No. 02-3879
Printed 1994, 1995, 2000; Reprinted 2002.Copyright 2002. All rights reserved.

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This content was last modified on: 09/24/2008

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