What is the recommended treatment for anxiety?

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 considered the most effective treatments, as suggested by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology 1.

Key Treatment Components

• Psychotherapy: CBT is considered the most effective form of psychotherapy, helping patients identify and change negative thought patterns.
• Medication: SSRIs like sertraline (Zoloft, 50-200mg daily) or escitalopram (Lexapro, 10-20mg daily) are often first-line treatments, usually requiring 4-6 weeks to reach full effectiveness and continued for at least 6-12 months after symptom improvement.
• Lifestyle modifications: Regular exercise (30 minutes daily), adequate sleep (7-9 hours nightly), stress management techniques (meditation, deep breathing), limiting caffeine and alcohol, and maintaining social connections can significantly reduce anxiety symptoms.

Important Considerations

• 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.
• The choice of anxiolytic should be informed by the adverse effect profiles of the medications, tolerability of treatment, and patient preference, as noted in the American Society of Clinical Oncology guideline adaptation 1.
• A stepped care model can be used to tailor intervention recommendations based on variables such as current symptomatology level, presence/absence of DSM-V diagnoses, and patient preference, as suggested by the ASCO guideline update 1.

Treatment Approach

• The treatment approach should be based on shared decision making, taking into account availability, accessibility, patient preference, likelihood of adherence, and cost, as noted in the management of anxiety and depression in adult survivors of cancer guideline update 1.
• If there is little improvement in symptoms despite good adherence, the treating clinician should adjust the regimen, such as adding a psychological or pharmacologic intervention, changing the medication, or referring to individual therapy, as recommended by the ASCO guideline update 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 the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) 3, 4, 5, 6, 7.

• SSRIs: Sertraline is a commonly used SSRI that has been shown to be effective in treating anxiety disorders, including social anxiety disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder 3, 7.
• SNRIs: Venlafaxine, duloxetine, and milnacipran are examples of SNRIs that have been found to be effective in treating anxiety disorders, with venlafaxine being approved for generalized anxiety disorder, social anxiety disorder, and panic disorder 5, 6.
• Dose-Response Curve: The dose-response curve of SSRIs and SNRIs in anxiety disorders has been studied, with results suggesting that higher doses of SSRIs are associated with greater symptom improvement and likelihood of treatment response, while higher doses of SNRIs are not 4.
• Tolerability and Safety: The tolerability and safety profiles of SSRIs and SNRIs vary, with sertraline being generally well-tolerated and having a favorable safety profile in overdose 3, 7. SNRIs, such as venlafaxine, may have a higher risk of dose-dependent blood pressure elevation and other adverse effects 5, 6.

Key Findings

• SSRIs and SNRIs are effective treatments for anxiety disorders 3, 4, 5, 6, 7.
• Sertraline is a commonly used SSRI with a favorable tolerability and safety profile 3, 7.
• SNRIs, such as venlafaxine and duloxetine, are also effective in treating anxiety disorders, but may have a higher risk of adverse effects 5, 6.