Anxiety medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
The mainstay of therapy for anxiety is the administration of pharmacotherapy and psychotherapy
Antidepressants Benzodiazepines (some concern over dependency), buspirone, tricyclic antidepressants , SSRIs (selective serotonin reuptake inhibitors)
Medical Therapy
Pharmacotherapy
The first line treatment for generalized anxiety disorder is SSRI:
- Sertraline (Zoloft) is the initial drug of choice:
- Start with initial oral dose of 25 mg once daily for 1 week, increase it based on response and tolerability; maximum dose is 200mg/day.
- Alternatively SSRI's that can be used are :
- Citalopram(Celexa)(initial dose-10mg) with daily dose ranging from 10-40mg.
- Escitalopram(Lexapro) (initial dose-5-10mg)with daily dose ranging from 10-20mg.
- Paroxetine( Paxil)(initial dose 20mg) with daily dose ranging from 20-50mg.
- Usually SSRIs are most effective at highest tolerable doses.
Other classes of drugs that can be used are :
SNRI's-
Duloxetine(initial dose 30mg) with daily dose ranging from 60-120mg.
- Venlafaxine(initial dose 75mg) with daily dose ranging from 75-225mg.
- Benzodiazapines have been found efficacious in treatment of generalized anxiety disorder.
- Usually they are started at a low dose and titrated up as needed based on response.
- Lorazepam (ATIVAN) - Started at 0.5-1mg orally t.i.d. and titrated up to 1.5mg q.i.d daily as needed.
- Diazepam (Valium) started at 2.5mg to 5mg orally once or twice daily and titrated up to 10mg ,two or three times daily as needed.
- Clonazepam (Klonopin) can be started at 0.25-0.5 mg orally once or twice daily and titrated up to 1mg (b.i.d or t.i.d) daily as needed.
- there is increased risk of dependence and tolerance , so maintain caution in long term use, SSRIs are therefore first line treatment for anxiety disorders in long term use.
Other drugs to consider:
Buspirone (Buspar)- initial dose is 10mg with daily dose ranging from 10-60mg.
- Pregabalin (Lyrica)- initial dose is 50mg with daily dose ranging from 50-300mg.
- Second generation antipsychotics like Quetiapine( SEROQUEL)- Start with initial dose of 25mg/day and titrated at 25-50mg intervals weekly or biweekly to a maximum dose of 300mg/day.
- Hydroxyzine (Vistaril)- doses between 50 to 150 mg a day in divided doses as PRN, is effective for anxiety disorders.
- Mirtazapine (REMERON)_ doses between 15 mg to 45 mg used as monotherapy or adjunctive treatment in Generalized anxiety disorder.
- Panic disorder- SSRIs, SNRIs are treatment of choice, benzodiazepines are used in acute exacerbtions and as needed basis. Doses are used in the same range as for generalized anxiety disorders.
- Social anxiety- SSRIs and beta-blockers are used as first line treatment for social anxiety disorder.
Psychotherapy
- CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
- Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.
- Exposure therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.
- CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often “homework” is assigned for participants to complete between sessions.[1]
References
- ↑ Kivity Y, Huppert JD (2016). "Does cognitive reappraisal reduce anxiety? A daily diary study of a micro-intervention with individuals with high social anxiety". J Consult Clin Psychol. 84 (3): 269–83. doi:10.1037/ccp0000075. PMID 26795939.