What is the recommended treatment for anxiety?

Treatment Recommendations for Anxiety

The recommended first-line treatments for anxiety disorders are Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), and Cognitive Behavioral Therapy (CBT). 1, 2

Pharmacotherapy Options

First-line Medications

• SSRIs are suggested as first-line pharmacotherapy for anxiety disorders with a weak recommendation but consistent evidence of effectiveness 1, 2
• Specific SSRIs with demonstrated efficacy include escitalopram, paroxetine, and sertraline 1, 2
• Sertraline has been shown to be effective for social anxiety disorder at doses of 50-200 mg/day, with maintenance treatment demonstrating lower relapse rates 3
• Venlafaxine, an SNRI, is also suggested as a first-line medication option with similar efficacy to SSRIs 1, 2

Medication Administration

• For adults with anxiety disorders, medication should be initiated at appropriate doses (e.g., sertraline starting at 50 mg/day) and titrated based on response and tolerability 3
• Treatment should be monitored at regular intervals (e.g., 4 and 8 weeks) using standardized validated instruments 4
• If initial treatment shows little improvement after 8 weeks despite good adherence, consider adjusting the regimen by changing the medication or adding a psychological intervention 4

Psychotherapy Options

Cognitive Behavioral Therapy

• CBT specifically developed for anxiety disorders is recommended, delivered through individual sessions by a skilled therapist 1
• Individual therapy is prioritized over group therapy due to superior clinical and economic effectiveness 1
• CBT should be structured with approximately 14 sessions performed over 4 months, with each session lasting 60-90 minutes 1
• Key components include:
  • Psychoeducation about anxiety 1
  • Cognitive restructuring 1
  • Gradual exposure to feared situations 1
  • Review and modification of core beliefs 1

Self-help Options

• For patients who do not want face-to-face CBT, self-help with support based on CBT principles is suggested 1
• Self-help typically consists of approximately nine sessions conducted over 3-4 months using CBT-based materials with professional support 1

Combination Therapy

• There is currently no definitive recommendation for the use of combined pharmacotherapy and psychotherapy for anxiety disorders 1
• For patients with resistant anxiety, adding a psychological intervention to pharmacotherapy may be considered if the initial treatment shows inadequate response 4

Special Considerations

Treatment Selection Factors

• When selecting treatment, consider:
  • Patient preference and prior treatment experiences 2
  • Comorbid medical and psychiatric conditions 2
  • Age, sex, and reproductive planning 2
  • Cost and access to care 2

Common Pitfalls to Avoid

• Inadequate dosing or premature discontinuation of medication before therapeutic effects can be observed 4
• Failure to monitor treatment response using standardized measures 4
• Not allowing sufficient time (8 weeks minimum) to evaluate medication effectiveness 4
• Overlooking the need for maintenance treatment, especially for conditions like social anxiety disorder which often require longer-term therapy 3

Treatment Monitoring

• Regularly assess treatment response, side effects, adverse events, and patient satisfaction 4
• For pharmacologic treatment, assessment should occur at regular intervals using standardized validated instruments 4
• For social anxiety disorder, maintenance treatment may be necessary as studies show continued benefit with longer-term therapy 3

The evidence consistently supports that both pharmacotherapy (particularly SSRIs and SNRIs) and psychotherapy (particularly CBT) are effective treatments for anxiety disorders, with the choice between them often guided by patient preference, availability, and specific clinical factors 1, 2.