Treatment of anxiety disorders

Abstract

Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.

Impact of the coronavirus 2019 (COVID-19) pandemic on anxiety diagnosis in general practices in Germany

“…As psychiatric disorders are associated with an important social stigma ( Rössler, 2016 ), previous research may have been biased and it is possible that anxiety may have been underreported. Besides, anxiety symptoms and anxiety disorders are distinct entities, and anxiety symptoms frequently correspond to an adaptive and physiological response to a stressor requiring little, if any, specific treatment and management ( Bandelow et al, 2017 ; Steimer, 2002 ). In this context, further data on the impact of the COVID-19 pandemic on the diagnosis of anxiety disorder are urgently needed.…”

The neuropsychiatric manifestations of COVID-19: Interactions with psychiatric illness and pharmacological treatment

“…Accumulating evidence suggests that elevated inflammation contributes to the pathophysiology of anxiety disorders, such as post-traumatic stress disorder (PTSD) [ 173 ], and that anti-inflammatory drugs might be a new treatment strategy for PTSD [ 188 ]. Various clinically used anxiolytics have other actions and target redox-inflammatory processes indirectly, such as agomelatine [ 189 ] and the SSRIs [ 190 ]. These drugs are approved for the management of chronic anxiety-related disorders [ 190 ].…”

“…Various clinically used anxiolytics have other actions and target redox-inflammatory processes indirectly, such as agomelatine [ 189 ] and the SSRIs [ 190 ]. These drugs are approved for the management of chronic anxiety-related disorders [ 190 ]. However, given the central role that GABA plays in anxiety-related disorders [ 191 ].…”

The effects of analytic group therapy compared with pharmacotherapy in patients with anxiety disorders

“…In clinics, most patients with anxiety disorders who seek help are suffering from generalized anxiety disorder (GAD), pathological demand avoidance (PDA), and seasonal affective disorder (SAD) 10 . Their treatment can be performed most of the time in an outpatient setting 11 . Many studies have shown the efficacy of medications for GAD, PDA and SAD, but there are very few treatment studies for specific phobias 12 .…”

“…Supportive talks and attention to the emotional issues of anxiety patients are important in the treatment of these patients. Psychoeducation and provision of information on the physiology of symptoms of anxiety and available treatment options can be helpful 11 . Cognitive behavioral therapy (CBT) as a practical and structured form of psychotherapy has been shown to be effective in the treatment of anxiety disorders [13][14][15][16] .…”