From the Guidelines
For short-term anxiety related to a particular event, physician-prescribed SSRIs or anxiolytics, such as benzodiazepines, with consideration of short-term duration, are recommended. When selecting a medication, it is crucial to consider the side-effect profiles, interactions, response, patient age, and preference, as highlighted in the 2023 ASCO guideline update 1.
Key Considerations
- The choice between SSRIs and anxiolytics should be informed by the patient's specific needs and medical history.
- Interventions with short-term duration are preferred to minimize the risk of dependence and adverse events.
- Regular monitoring for adherence, side effects, and adverse events is essential.
Medication Options
- Benzodiazepines, such as lorazepam or alprazolam, can provide rapid relief but should be limited to 1-2 weeks due to dependency risks.
- SSRIs, such as fluoxetine or sertraline, can be effective for short-term anxiety but may take longer to exert their effects.
Non-Pharmacologic Interventions
- Cognitive behavioral techniques, including deep breathing exercises, progressive muscle relaxation, and mindfulness meditation, can be beneficial in managing short-term anxiety.
- Maintaining a healthy lifestyle, including regular exercise, healthy sleep habits, and a balanced diet, can also help reduce anxiety levels.
From the FDA Drug Label
The data cited in the two tables below are estimates of untoward clinical event incidence among patients who participated under the following clinical conditions: relatively short duration (i.e., four weeks) placebo-controlled clinical studies with dosages up to 4 mg/day of alprazolam tablets (for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety)
The treatment for short-term anxiety related to a particular event is alprazolam.
- Dosage: up to 4 mg/day
- Duration: relatively short duration (i.e., four weeks) This information is based on placebo-controlled clinical studies 2.
From the Research
Treatment Options for Short-Term Anxiety
- Benzodiazepines, such as diazepam and lorazepam, can be effective in reducing acute anxiety symptoms, particularly for short-term use 3, 4
- Hydroxyzine, an anti-histamine medication, has been shown to be more effective than placebo in alleviating symptoms of generalized anxiety disorder, although its use is limited by a high risk of bias in included studies 5
- Mindfulness-based stress reduction (MBSR) has been found to be noninferior to escitalopram, a commonly used antidepressant, in reducing anxiety symptoms in adults with anxiety disorders 6
- Cognitive behavioral therapy (CBT) and adapted MBSR have been shown to be equally effective in reducing principal disorder severity in patients with heterogeneous anxiety disorders, although CBT may be more effective in reducing anxious arousal and adapted MBSR may be more effective in reducing worry and comorbid disorders 7
Considerations for Treatment
- The type and level of anxiety should be assessed before undertaking drug treatment 3
- Short-term use of benzodiazepines is justified in patients with severe symptomatic distress and/or impairment of ability to cope, while long-term use is only justified in patients with chronic severe anxiety 3
- MBSR and CBT may be effective alternatives to pharmacological treatments for anxiety disorders, particularly for patients who prefer non-pharmacological interventions or have not responded to traditional treatments 6, 7
Adverse Effects and Limitations
- Benzodiazepines can have adverse effects such as intoxication, dependence, rebound, withdrawal, hostility, and affective disturbances 3, 4
- Hydroxyzine can cause sleepiness/drowsiness and has a high risk of bias in included studies 5
- MBSR and CBT may have limitations in terms of accessibility and availability, and may not be suitable for all patients with anxiety disorders 6, 7