What are the treatment options for anxiety?

From the Guidelines

Treatment options for anxiety should prioritize cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) as first-line treatments, considering the most recent and highest quality study available 1. Anxiety is a prevalent mental health concern that can be effectively managed with a combination of medication and non-medication approaches.

• Medication options include SSRIs like sertraline, escitalopram, or fluoxetine, which are typically first-line treatments, usually requiring 4-6 weeks for full effect and often continued for 6-12 months.
• Non-medication treatments include CBT, typically 8-12 weekly sessions, which helps identify and change negative thought patterns.
• Regular exercise, mindfulness meditation, and breathing exercises are also effective lifestyle interventions.
• A combination of medication and therapy often provides the most effective results, especially for moderate to severe anxiety, as suggested by the most recent guideline update 1. Key considerations in managing anxiety include:
• Patient preference for treatment modality
• Severity of symptoms
• Presence of comorbid conditions
• Potential for medication side effects or interactions The integration of behavioral health providers into primary care settings can improve treatment options for anxiety, as they can deliver evidence-based psychological interventions like CBT 1. Overall, a comprehensive treatment plan for anxiety should be tailored to the individual patient's needs and preferences, with a focus on maximizing treatment efficacy while minimizing potential harms.

From the FDA Drug Label

The efficacy of sertraline in the treatment of social anxiety disorder was established in two placebo-controlled trials of adult outpatients with a diagnosis of social anxiety disorder as defined by DSM-IV criteria Treatment for patients with anxiety should be initiated with a dose of 0.25 to 0.5 mg 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. A dose range of 20 to 30 mg/day is recommended for fluoxetine in the treatment of panic disorder. Treatment should be initiated with a dose of 10 mg/day. After 1 week, the dose should be increased to 20 mg/day.

Treatment Options for Anxiety:

• Alprazolam (PO): 0.25 to 0.5 mg given three times daily, with a maximum daily dose of 4 mg.
• Fluoxetine (PO): 10 to 60 mg/day, with a recommended dose range of 20 to 30 mg/day for panic disorder.
• Sertraline (PO): effective in the treatment of social anxiety disorder, with a recommended dose not specified in the provided text.

2, 3, 4

From the Research

Treatment Options for Anxiety

The treatment options for anxiety disorders include:

• Psychotherapy
• Pharmacotherapy
• A combination of both 5, 6 Some of the specific treatment options are:
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line drugs 5, 6
• Benzodiazepines, but not recommended for routine use due to their possible addiction potential 5, 6
• Pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others 5, 6
• Cognitive behavioral therapy (CBT) as an effective first-line treatment for anxiety disorders 7, 8
• Combination of drug treatment with CBT as the most successful treatment strategy for panic disorder 9

Cognitive Behavioral Therapy (CBT)

CBT is a front-line psychological intervention for the treatment of anxiety disorders, based on the cognitive behavioral model of anxiety disorders 8 The core components of CBT include:

• Psychoeducation
• Cognitive restructuring
• Exposure therapy
• Relapse prevention 8 CBT has a strong evidence base supporting its short-term and long-term efficacy and effectiveness 7, 8

Pharmacological Treatment

The pharmacological treatment of anxiety disorders includes:

• Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors as standard treatments 5, 6, 9
• Tricyclic antidepressants, but less well tolerated 9
• Benzodiazepines, such as alprazolam, for short-term treatment and in non-responsive cases 9 The treatment plan should consider efficacy, adverse effects, interactions, costs, and the preference of the patient 6