What is the recommended treatment for excessive nervousness and anxiety?

From the Guidelines

The most effective treatment for excessive nervousness and anxiety is individual or group therapy with cognitive-behavioral therapy (CBT), behavioral activation (BA), structured physical activity and exercise, or psychosocial interventions with empirically supported components, as recommended by the most recent guidelines 1. This approach is considered the most effective because it helps individuals identify and change negative thought patterns while developing coping strategies. Some key points to consider when treating excessive nervousness and anxiety include:

• Individual or group therapy with CBT, BA, structured physical activity and exercise, or psychosocial interventions with empirically supported components, such as relaxation and problem-solving, can be effective in reducing symptoms of anxiety 1.
• Medications such as selective serotonin reuptake inhibitors (SSRIs) may also be considered, but should be used cautiously and under the guidance of a healthcare professional 1.
• Lifestyle modifications, such as regular exercise, adequate sleep, stress management techniques, limiting caffeine and alcohol, and maintaining social connections, are also important in managing anxiety 1. It's worth noting that the treatment of anxiety should be tailored to the individual's specific needs and circumstances, and may involve a combination of these approaches. Regular follow-up and reassessment are also crucial to ensure that the treatment is effective and to make any necessary adjustments 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. INDICATIONS AND USAGE Anxiety Disorders Alprazolam tablets are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder) or the short-term relief of symptoms of anxiety

The recommended treatment for excessive nervousness and anxiety is alprazolam. The initial dose should be 0.25 to 0.5 mg given three times daily, and 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 2. Alprazolam is indicated for the management of anxiety disorder or the short-term relief of symptoms of anxiety 2.

• Key points:
  • Initial dose: 0.25 to 0.5 mg three times daily
  • Maximum daily dose: 4 mg in divided doses
  • Indication: anxiety disorder or short-term relief of anxiety symptoms
  • Alprazolam should be used with caution and the dose should be increased gradually to avoid adverse effects.

From the Research

Treatment Options for Excessive Nervousness and Anxiety

• Cognitive-behavioral therapy (CBT) is a recommended treatment for anxiety disorders, offering longer-term maintenance of treatment gains 3, 4, 5.
• CBT is an effective first-line treatment for anxiety disorders, including generalized anxiety disorder, social anxiety disorder, and panic disorder 3, 4, 5, 6.
• Pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), is also a first-line treatment for anxiety disorders 6, 7.
• Combination therapy, including CBT and pharmacotherapy, may provide the best treatment outcome for patients with anxiety disorders 3, 7.

Effectiveness of Treatment Options

• CBT has been shown to be highly efficacious in the treatment of anxiety disorders, with large effect sizes compared to placebo 5, 6.
• SSRIs and SNRIs have been shown to be effective in the treatment of anxiety disorders, with small to medium effect sizes compared to placebo 6.
• The choice of treatment should be based on patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care 6.

Recommendations for Treatment

• Clinicians should consider CBT and pharmacotherapy, such as SSRIs and SNRIs, as first-line treatments for anxiety disorders 6.
• Combination therapy, including CBT and pharmacotherapy, may be considered for patients who do not respond to single treatments 3, 7.
• Brief screening measures, such as the Generalized Anxiety Disorder-7, can aid in the diagnosis of anxiety disorders and guide treatment decisions 6.