Finding The Right Options

Success of treatment varies. Some may respond to treatment after a few weeks or months, while others may need more than a year. Treatment may be complicated if people have more than one anxiety disorder or if they suffer from depression, substance abuse, or other co-existing conditions. This is why treatment must be tailored specifically for each individual.

Although treatment is individualized, several standard approaches have proved effective.
Your health care professional will use one or a combination of these treatments:

• Therapy
• Medication
• Complementary and alternative treatment

Is therapy the right treatment for you?

Cognitive-Behavioral Therapy (CBT) A well-established, highly effective, and lasting treatment is called cognitive-behavioral therapy, or CBT. It focuses on identifying, understanding, and changing thinking and behavior patterns. Benefits are usually seen in 12 to 16 weeks, depending on the individual.

In this type of therapy the patient is actively involved in his or her own recovery, has a sense of control, and learns skills that are useful throughout life. CBT typically involves reading about the problem, keeping records between appointments, and completing homework assignments in which the treatment procedures are practiced. Patients learn skills during therapy sessions, but they must practice repeatedly to see improvement.

Exposure Therapy A form of CBT, exposure therapy is a process for reducing fear and anxiety responses. In therapy, a person is gradually exposed to a feared situation or object, learning to become less sensitive over time. This type of therapy has been found to be particularly effective for obsessive-compulsive disorder and phobias.

Acceptance and Commitment Therapy (ACT) Also known as ACT, this type of therapy uses strategies of acceptance and mindfulness (living in the moment and experiencing things without judgment), along with commitment and behavior change, as a way to cope with unwanted thoughts, feelings, and sensations. ACT imparts skills to accept these experiences, place them in a different context, develop greater clarity about personal values, and commit to needed behavior change.

Dialectical Behavioral Therapy (DBT) Integrating cognitive-behavioral techniques with concepts from Eastern meditation, dialectical behavioral therapy, or DBT, combines acceptance and change. DBT involves individual and group therapy to learn mindfulness, as well as skills for interpersonal effectiveness, tolerating distress, regulating emotions.

Interpersonal Therapy (IPT) Often referred to as IPT, interpersonal therapy is a short-term supportive psychotherapy that addresses interpersonal issues in depression in adults, adolescents, and older adults. IPT usually involves 12 to 16 one-hour weekly sessions. The initial sessions are devoted to gathering information about the nature of a person’s depression and interpersonal experience.

Eye Movement Desensitization and Reprocessing (EMDR) Under certain conditions eye movements appear to reduce the intensity of disturbing thoughts. A treatment known as eye movement desensitization and reprocessing, or EMDR, seems to have a direct effect on the way that the brain processes information. Basically, it helps a person see disturbing material in a less distressing way.

EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Scientific research has established EMDR as effective for posttraumatic stress disorder. And clinicians also have reported success using it to treat panic attacks and phobias.

Finding the right medication

Medication treatment of anxiety is generally safe and effective and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions, and other individual circumstances. However, it often takes time and patience to find the drug that works best for you.

Medications are commonly prescribed by physicians (family practice, pediatricians, OB-GYNs, psychiatrists), as well as nurse practitioners in many states.

More than one in 10 Americans take antidepressants, the primary type of medication used by people ages 18 to 44. Learn more about how these drugs work.

Variety of Medications

Four major classes of medications are used in the treatment of anxiety disorders:

• Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs relieve symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood. SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline) generally produced fewer side effects when compared with tricyclic antidepressants. However, common side effects include insomnia or sleepiness, sexual dysfunction, and weight gain. They are considered an effective treatment for all anxiety disorders, although the treatment of obsessive-compulsive disorder, or OCD, typically requires higher doses.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) The serotonin-norepinephrine reuptake inhibitor, or SNRI, class (venlafaxine and duloxetine) is notable for a dual mechanism of action: increasing the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain. As with other medications, side effects may occur, including stomach upset, insomnia, headache, sexual dysfunction, and minor increase in blood pressure. These medications are considered as effective as SSRIs, so they are also considered a first-line treatment, particularly for the treatment of generalized anxiety disorder.
• Benzodiazepines This class of drugs is frequently used for short-term management of anxiety. Benzodiazepines (alprazolam, clonazepam, diazepam, and lorazepam) are highly effective in promoting relaxation and reducing muscular tension and other physical symptoms of anxiety. Long-term use may require increased doses to achieve the same effect, which may lead to problems related to tolerance and dependence.
• Tricyclic Antidepressants Concerns about long-term use of the benzodiazepines led many doctors to favor tricyclic antidepressants (amitriptyline, imipramine, and nortriptyline). Although effective in the treatment of anxiety, they can cause significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth, and blurry vision.

Contact your physician if you experience side effects, even if you are not sure a symptom is caused by a medication. Do not stop taking a medication without consulting with the prescribing physician; abrupt discontinuation may cause other health risks.

Medications will work only if they are taken according the explicit instructions of your physician, but they may not resolve all symptoms of an anxiety disorder.

Discussing Medications: What You Need to Know

Use these guidelines to talk to your health care professional about medications:

• To avoid potentially dangerous drug interactions, let your mental health care provider know all medications you are taking, including prescriptions and over-the-counter drugs, herbal or dietary supplements, and vitamins. And make sure your family doctor knows you are taking medications for an anxiety disorder.
• Ask these questions about a new prescription: How will the medication help me? What side effects might occur? Should I avoid any foods or beverages? Are drug interactions with other prescriptions a possibility?
• Learn when to take a new medication and how, such as on any empty stomach or with food, in the morning or evening, and how frequently.
• Find out how long it should take for the medication to start working and what you should expect when this happens.
• Ask for the prescribing physician’s after-hours phone number in case you develop side effects.
• A good source of information about medications and over-the-counter products is your pharmacist, who should have information about all your prescriptions to advise you about possible drug interactions, side effects, and instructions for use.
• Ask how often you should see the doctor for a medication check-up.
• If your physician does not want to spend the time to answer your questions, you may need a referral to a different physician.