By Dr Ananya Mandal, MD
Anxiety disorders can be distressing and may often need therapy.
The most important part of treatment of this condition is patient education. The guidelines especially for panic disorders, where patient may suffer sudden attacks without warning, recommend education for the family as well.
The symptoms of an anxiety attack may appear similar to a heart attack or other medical ailments. Patients as well the family need to be educated regarding these symptoms.
If a medical condition like high blood pressure, irregular heart rates and rhythms or overactive thyroid is found then appropriate medical therapy may be needed.
Therapy includes psychotherapy and management with medications. The aim of therapy is to ensure that the patient functions adequately in their day-to-day life. (1, 2, 3, 4, 5)
Psychotherapy for Anxiety
Psychotherapy includes cognitive-behavioral therapy, anxiety management therapy and applied relaxation therapy.
Cognitive-behavioral therapy (CBT) is provided by a psychotherapist. Patient needs to be committed to therapy.
Patients treated with a combination of CBT and medicines have better response than those who are undergoing usual treatment.
Some 10 to 20 visits to the therapist are needed over a few weeks. For panic attacks 12 - 16 sessions over 3 - 4 months may be needed.
These focus towards recreating fear symptoms and help patients change their response to them.
In OCD for children CBT is the first choice of therapy.
The therapy teaches the patient to identify and handle stress factors better.
Patients will learn to decrease the sense of helplessness by shutting out or neutralizing panic-causing thoughts.
He or she will be taught to avoid speculating that minor worries may turn to bigger problems.
Relaxation techniques will be taught.
For OCD the techniques are exposure and response prevention (ERP).
For patients with PTSD the psychological treatment will focus on the trauma with exposure therapy, cognitive therapy, and eye movement desensitization and reprocessing.
Patient will be advised to lead a healthier lifestyle with regular exercise, adequate rest and sleep and healthy balanced nutrition.
They will be taught to avoid excessive caffeine and illicit drugs, alcohol and cigarettes. Family and social interactions to lessen the impact of the condition will be advised.
Anxiety management therapy
Anxiety management therapy involves education, relaxation training, and exposure to anxiety-provoking stimuli.
However, there is no positive reconstruction technique to fight anxiety.
Applied relaxation therapy
Applied relaxation therapy helps patient relax each part of the body.
The therapy takes 12 to 15 hour-long sessions in a number of sittings and has been found to be effective.
Medication therapy for Anxiety
Medication therapy includes antidepressants, Benzodiazepines, SNRIs and so forth.
Antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs) that include fluoxetine, fluvoxamine, escitalopram, paroxetine, sertraline etc. show good effectiveness in panic disorders, Obsessive compulsive disorders, Post-traumatic stress disorders, social anxiety disorder and generalized anxiety disorder.
Within 3 to 4 weeks in most cases, and 8 to 12 weeks in OCD cases, there may be improvement.
The drugs should be started at low doses and slowly their doses may be increased to higher levels,
Benzodiazepines have been used in the past to treat anxiety disorders. The drugs include clonazepam, lorazepam alprazolam, diazepam etc.
They are useful in short term management and are often given alongside initiation of CBT or SSRIs.
SSRIs have better tolerability and lesser risk of addiction and dependence and so they are preferred therapy for the anxiety disorders in the long run over benzodiazepines.
Short acting benzodiazepines like alprazolam carry a risk of rebound anxiety when withdrawing from the drug and are thus not preferred.
Venlafaxine may also be prescribed. It belongs to a group of medicines known as selective serotonin and noradrenaline reuptake inhibitors (SNRIs).
This type of medicine increases the amount of the neurotransmitters serotonin and noradrenaline in the brain, helping restore the chemical imbalance that sometimes causes GAD.
Buspirone may also be prescribed for anxiety instead of benzodiazepines. It belongs to a group of medicines known as anxiolytics.
It has to be taken for two weeks before a response is seen.
There are no risks of dependence or abuse with this medication unlike benzodiazepines. However, it is only recommended as a short-term form of medication.
Beta blockers like Propranolol. This drug is used to treat high blood pressure.
In the short term it may easy symptoms of anxiety like palpitations etc.
For patients of PTSD who do not respond to SSRIs along an atypical antipsychotic – Olanzapine, used to treat psychosis and other psychiatric ailments may be added.
Pregabalin is used for seizures. Sometimes it may be effective in treating anxiety disorders not responding to other therapies.
Treatment for specialist groups
Certain populations are more vulnerable to ill effects and complications of anxiety disorders. These people also commonly have coexisting mental disorders that need prompt diagnosis and therapy. These include drug addicts and those with chronic obstructive pulmonary disease (COPD) or other respiratory or heart illness.
Pregnant and the elderly are also at a heightened risk.
Benzodiazepines are considered generally unsafe during pregnancy and may be abused by patients who have a substance abuse problem.
These patients may need combined treatment of an SSRI with CBT therapy.
Anxiety disorders are not easy to cure. They may recur along with ups and downs of life. Most patients however respond to medication and behavioural therapy.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
What is Anxiety?