What are the recommended treatments for anxiety?

From the Guidelines

Recommended treatments for anxiety include both medication and non-medication approaches, with cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) being first-line treatments. For medication, SSRIs like sertraline (50-200mg daily), escitalopram (10-20mg daily), or fluoxetine (20-80mg daily) are typically first-line treatments, usually requiring 4-6 weeks to reach full effectiveness and often continued for at least 6-12 months 1. Benzodiazepines such as lorazepam (0.5-2mg) or alprazolam (0.25-0.5mg) may provide rapid relief for acute anxiety but should be limited to short-term use (2-4 weeks) due to dependency risks. Non-medication treatments include CBT, typically involving 8-16 weekly sessions, which helps identify and change negative thought patterns 1. Regular exercise (30 minutes of moderate activity 5 times weekly), mindfulness meditation (10-20 minutes daily), and breathing exercises (such as 4-7-8 breathing: inhale for 4 seconds, hold for 7, exhale for 8) are also effective.

Some key points to consider when treating anxiety include:

• The administration of CBT, developed specifically for the treatment of social anxiety disorder, through individual sessions by a skilled therapist, is suggested 1.
• If the patient does not want face-to-face CBT, then self-help with support based on CBT is suggested 1.
• Selective serotonin reuptake inhibitors (SSRIs) are suggested as a pharmacotherapy option for social anxiety disorder in adults 1.
• Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is also suggested as a pharmacotherapy option for social anxiety disorder in adults 1.

It's also important to note that after 8 weeks of treatment, 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 if group therapy has not been helpful 1.

Overall, the goal of treatment is to reduce symptoms of anxiety, improve quality of life, and enhance functional ability, with a focus on evidence-based treatments and individualized care.

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 Social anxiety disorder, as defined by DSM-IV, is characterized by marked and persistent fear of social or performance situations involving exposure to unfamiliar people or possible scrutiny by others and by fears of acting in a humiliating or embarrassing way The efficacy of sertraline in maintaining a response in adult patients with social anxiety disorder for up to 24 weeks following 20 weeks of sertraline treatment was demonstrated in a placebo-controlled trial 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 treatments for anxiety include:

• Sertraline: for the treatment of social anxiety disorder, with a demonstrated efficacy in maintaining a response in adult patients for up to 24 weeks following 20 weeks of treatment 2
• Alprazolam: for the treatment of anxiety disorders, with a recommended initial dose of 0.25 to 0.5 mg given three times daily, and a maximum daily dose of 4 mg 3 Key points to consider when treating anxiety:
• Dosage should be individualized for maximum beneficial effect
• The lowest possible effective dose should be employed
• The need for continued treatment should be reassessed frequently
• The risk of dependence may increase with dose and duration of treatment

From the Research

Recommended Treatments for Anxiety

The following are recommended treatments for anxiety:

• Psychological therapy, such as cognitive behavioral therapy 4
• Pharmacotherapy, including:
  • Selective serotonin reuptake inhibitors (SSRIs) 4, 5, 6
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) 7, 4, 8
  • Benzodiazepines (for short-term treatment or in non-responsive cases) 7, 8
  • Tricyclic antidepressants (less well tolerated) 7, 8
  • Pregabalin, buspirone, and moclobemide (other treatment options) 4
• Combination of psychological therapy and pharmacotherapy 4, 8

Treatment Considerations

When developing a treatment plan, the following factors should be considered:

• Efficacy of the treatment 4
• Adverse effects of the treatment 4
• Interactions with other medications 4
• Costs of the treatment 4
• Patient preference 4

Duration of Treatment

Medications should be continued for 6 to 12 months after remission 4