From the Guidelines
Several effective anxiety treatments exist beyond benzodiazepines, with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) being suggested as first-line treatments, as indicated by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology clinical practice guideline for social anxiety disorder 1, 2.
Key Treatment Options
- Selective serotonin reuptake inhibitors (SSRIs) like sertraline, escitalopram, and fluoxetine are first-line medications that work by increasing serotonin levels in the brain, typically taking 2-6 weeks to reach full effectiveness.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine can also be effective, as suggested by the clinical practice guideline 1, 2.
Non-Medication Approaches
- Cognitive behavioral therapy (CBT) is a recommended psychotherapy for social anxiety disorder in adults, which typically involves 12-16 weekly sessions to change thought patterns and behaviors 3.
- Mindfulness meditation, regular exercise, and breathing techniques like the 4-7-8 method can also be beneficial in managing anxiety.
Important Considerations
- The effectiveness of treatments for anxiety has been evaluated by trials summarized in systematic reviews of psychological and pharmacologic therapies, with psychological therapy being the initial treatment approach for most patients 4, 5, 6, 7.
- Harms of treatment, including common adverse events and discontinuation rates, have been reported in systematic reviews, but the overall benefits of treatment are considered to outweigh the risks 4, 5, 6, 7.
From the FDA Drug Label
The efficacy of sertraline in the treatment of social anxiety disorder (also known as social phobia) was established in two multicenter placebo-controlled studies (Study 1 and 2) of adult outpatients who met DSM-IV criteria for social anxiety disorder The efficacy of sertraline in the treatment of PTSD was established in two 12-week placebo-controlled trials of adult outpatients whose diagnosis met criteria for the DSM-III-R category of PTSD Sertraline Hydrochloride Oral Concentrate is indicated for the treatment of social anxiety disorder, also known as social phobia in adults The efficacy of fluoxetine in the treatment of anxiety was reported in 12% to 16% of patients treated with Prozac and 7% to 9% of patients treated with placebo reported anxiety, nervousness, or insomnia
Anxiety treatments besides benzodiazepines include:
- Sertraline: effective in the treatment of social anxiety disorder and PTSD 8, 9
- Fluoxetine: reported to have anxiety as a common adverse event, but may be used to treat anxiety disorders 10
From the Research
Anxiety Treatments Besides Benzodiazepines
There are several alternatives to benzodiazepines for treating anxiety, including:
- Serotonin norepinephrine reuptake inhibitors (SNRIs) 11, 12, 13
- Selective serotonin reuptake inhibitors (SSRIs) 14, 15
- Non-SSRIs, such as venlafaxine, nefazodone, trazodone, and mirtazapine 14
- Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) 14
- Anticonvulsants, such as carbamazepine, valproic acid, topiramate, and gabapentin 14
- Atypical antipsychotics 14
- Buspirone, a non-benzodiazepine anxiolytic 14
Mechanism of Action
SNRIs work by selectively inhibiting the reuptake of norepinephrine and serotonin, which can help to alleviate symptoms of anxiety 11, 12, 13. SSRIs, on the other hand, work by selectively inhibiting the reuptake of serotonin 14, 15.
Efficacy and Tolerability
SNRIs have been shown to be efficacious in treating a variety of anxiety disorders, with some potential clinical advantages over SSRIs 11, 13. SSRIs are also effective in treating anxiety disorders, but may have a more limited therapeutic range compared to SNRIs 14, 15. The tolerability of SNRIs and SSRIs can vary, with some patients experiencing adverse effects such as nausea, sexual dysfunction, and withdrawal problems 12, 13, 15.