Fast Five Quiz: Anxiety

Stephen Soreff, MD


August 09, 2021

Treatment of anxiety disorders usually consists of a combination of pharmacotherapy and/or psychotherapy. Behavioral therapy and CBT have demonstrated efficacy through controlled studies. Computerized CBT has been recommended for panic and phobia by the National Institute for Health and Care Excellence (NICE) guidelines. Psychodynamic therapy (or insight-oriented therapy) is rarely indicated as an exclusive treatment for phobias and is now mostly used for cases of phobic disorders that overlap personality disorders.

Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly newer agents such as SSRIs, which have a safer adverse-effect profile and are easier to use than the older TCAs.

CBT, with or without pharmacotherapy, is the treatment of choice for panic disorder, and it should be considered for all patients. This therapeutic modality has higher efficacy and lower cost, dropout rates, and relapse rates than do pharmacologic treatments. CBT may include countering anxious beliefs, exposure to fear cues, changing anxiety-maintaining behaviors, and preventing relapse.

Benzodiazepines act quickly but carry the liability of physiologic and psychologic dependence. They can be reasonably used as an initial adjunct while SSRIs are titrated to an effective dose, and they can then be tapered over 4-12 weeks while the SSRI is continued. This approach can improve short-term tolerability, although it may increase the risk for sedation and requires warnings not to operate motor vehicles after taking benzodiazepines or if feeling sedated.

If possible, avoid long-term benzodiazepines for chronic anxiety disorders. Benzodiazepines can achieve long-term control but should be reserved for patients with refractory panic disorder and should generate a psychiatric referral for pharmacologic management review and potentially a psychotherapist for any additional nonpharmacologic treatment options. The addictive power of benzodiazepines cannot be overstated.

Read more on the treatment of anxiety disorders.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Anxiety Disorders, Panic Disorder, and Social Phobia.

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