From the Guidelines
The recommended treatment for anxiety typically involves a combination of psychotherapy, medication, and lifestyle changes, with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) being first-line treatments. For medication, SSRIs like sertraline (Zoloft, 50-200mg daily), escitalopram (Lexapro, 10-20mg daily), or fluoxetine (Prozac, 20-80mg daily) are often first-line treatments, typically requiring 4-6 weeks to reach full effectiveness and continued for at least 6-12 months 1. Benzodiazepines such as lorazepam (Ativan, 0.5-2mg as needed) may be prescribed for short-term relief but aren't recommended long-term due to dependency risks. Lifestyle modifications that help manage anxiety include:
- Regular exercise (30 minutes daily)
- Adequate sleep (7-9 hours nightly)
- Stress reduction techniques (meditation, deep breathing)
- Limiting caffeine and alcohol
- Maintaining a balanced diet These treatments work by addressing both the psychological components of anxiety and the underlying neurochemical imbalances, particularly involving serotonin and GABA neurotransmitter systems that regulate mood and stress responses 1. It is essential to consider the patient's individual needs, preferences, and circumstances when selecting a treatment approach, and to regularly assess and adjust the treatment plan as needed 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dosage should be individualized for maximum beneficial effect. While the usual daily dosages given below will meet the needs of most patients, there will be some who require doses greater than 4 mg/day. In such cases, dosage should be increased cautiously to avoid adverse effects Anxiety Disorders and Transient Symptoms of Anxiety Treatment for patients with anxiety should be initiated with a dose of 0.25 to 0. 5 mg given three times daily. The recommended treatment for anxiety is to initiate with a dose of 0.25 to 0.5 mg of alprazolam, given three times daily. The dose may be increased to achieve a maximum therapeutic effect, at intervals of 3 to 4 days, to a maximum daily dose of 4 mg, given in divided doses.
- The lowest possible effective dose should be employed and the need for continued treatment reassessed frequently.
- The risk of dependence may increase with dose and duration of treatment. 2
From the Research
Recommended Treatment for Anxiety
The recommended treatment for anxiety includes several medication options, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) 3, 4, 5, 6, 7.
Medication Options
- SSRIs: Sertraline is an example of an SSRI that has been found to be effective in treating anxiety disorders, including social anxiety disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder 3.
- SNRIs: Venlafaxine is an example of an SNRI that has been found to be efficacious in treating anxiety disorders, with comparable tolerability to SSRIs 5.
Efficacy and Tolerability
- Studies have shown that SSRIs and SNRIs are effective in treating anxiety disorders, with no significant differences in efficacy between the two classes of medications 6.
- Higher doses of SSRIs, but not SNRIs, have been associated with significantly greater symptom improvement and likelihood of treatment response 6.
- The tolerability of SNRIs varies within the class, with venlafaxine being the least well-tolerated due to serotonergic adverse effects and dose-dependent cardiovascular phenomena 7.