Usually, anxiety disorders are treated with medications, special kinds of psychotherapy or combinatorially, using both methods together. 14 The choice of course of treatment depends on the problem and personal preferences of the patient. Before starting treatment, the physician must conduct a thorough diagnostic examination to determine what causes the symptoms: an anxiety disorder or a somatic problem. If the doctor diagnoses an anxiety disorder, it is necessary to establish the type of disorder or combination of existing disorders, and to identify any attendant conditions, such as depression or substance misuse.
Sometimes alcoholism, depression or other concomitant diseases have such a strong impact on a person that you have to postpone the treatment of anxiety disorders until co-occurring conditions are taken under control.
Patients who had previously undergone treatment for anxiety disorders should tell their current physician about it in detail. If they took the medicine, then it is necessary to say which of them, from which doses the course started, whether the dose was adjusted during the treatment, whether there were side effects and whether treatment helped them. If they underwent a course of psychotherapy, then it is necessary to tell about the type of therapy, the frequency of sessions and how effective this treatment was.
Often people believe that they "failed" the treatment, or that the treatment did not help them, although in reality the problem may be that initially the treatment course was chosen incorrectly or did not last long enough. Sometimes a person has to try several different methods of treatment or a combination of several methods before an effective course is selected for him.
Medications do not cure anxiety disorders, but with their help the disease can be kept under control while the patient undergoes a course of psychotherapy. Medicines are prescribed by a doctor, usually a psychiatrist who can either conduct psychotherapy himself, or work together with psychologists, social workers or counselors who provide psychotherapeutic help. The main drugs used for anxiety disorders are: antidepressants, sedatives and beta-blockers (for the treatment of certain somatic symptoms). With proper treatment, many people with anxiety disorders can lead a normal, full life.
Antidepressants have been developed to treat depression, but they are effective in the treatment of anxiety disorders. Although the effect of these drugs on the chemical processes of the brain begins after the first admission, in order to achieve the full effect, serious changes must occur; Usually passes 4 to 6 weeks before the symptoms begin to gradually subside. For antidepressants to work, it is very important to continue taking them long enough.
A group of modern antidepressants is called "selective serotonin reuptake inhibitors" (or SSRIs). SSRIs change the level of serotonin - the neurotransmitter (neurotransmitter) of the brain. Serotonin, like other neurotransmitters, helps the brain cells to contact each other.
Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®) and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia.
SSRIs are also used to treat panic attacks with concomitant ROC, social phobia or depression. Venlafaxine (Effexor®), a drug closely associated with SSRIs, is used to treat COT. These drugs are prescribed first in small doses, and then gradually increase them until a positive therapeutic effect.
SSRIs have fewer side effects than antidepressants of previous generations, but sometimes at the very beginning of treatment against the background of their admission, the patient may have a slight nausea or nervous arousal. Over time, these symptoms gradually disappear. In some patients, when SSRI is taken, sexual dysfunction is observed, which can be eliminated by correcting the dose or by transferring the patient to another drug.
Tricyclic antidepressants belong to an earlier generation than SSRIs, but are also applicable to anxiety disorders (with the exception of ROC). They are also taken with low doses with a gradual increase. Tricyclic antidepressants sometimes cause dizziness, drowsiness, dry mouth, weight gain. These side effects usually disappear after changing the dose or transferring the patient to another drug of the same group.
Tricyclic antidepressants include imipramine (Tofranil®), which is prescribed for panic disorders and COT, and clomipramine (Anafranil®), the only tricyclic antidepressant used to treat OCD.
Inhibitors of monoamine oxidase (MAOI) belong to the antidepressants of the earliest generation. The MAOI, most commonly prescribed for anxiety disorders, includes phenelzine (Nardil®), tranylcypromine (Parnate®) and isocarboxazide (Marplan®). These drugs are used in the treatment of panic disorders and social phobia. Host MAOI should refrain from eating food and beverages containing tyramine (including cheese and red wine); From taking certain medications, in particular some types of contraceptives, pain medications (such as Advil®, Motrin®, Tylenol®), drugs used for acute upper respiratory tract infections, and antiallergic agents and herbal supplements. The interaction of tyramine with MAO inhibitors can cause a dangerous increase in blood pressure. The development of MAOI in the form of patches will help reduce the risk of such a reaction. MAOI can also give an unwanted reaction in combination with SSRIs. Their interaction is fraught with serious consequences, causing the so-called "serotonin syndrome", in which disorientation, hallucinations, increased sweating, rigidity of muscles, convulsions, changes in blood pressure or heart rhythm, as well as other potentially life-threatening symptoms.
Strongly acting benzodiazepine-class drugs treat anxiety. Besides drowsiness, they have a number of side effects. Since they are addictive and require a constant dose increase to achieve the effect, benzodiazepines are usually prescribed for a short time, especially for alcoholics and drug addicts, as well as for those who are easily addicted to drugs. The only exception to this rule is people with panic disorder; They can take benzodiazepines throughout the year without any harm to themselves.
Clonazepam (Klonopin®) is used in social phobia and COT, lorazepam (Ativan®) helps with panic, alprazolam (Xanax®), is used in both panic disorder and COT.
A sharp discontinuation of taking benzodiazepines instead of phasing out can cause withdrawal symptoms and the return of symptoms of anxiety. Because of these potential problems, some doctors prefer to avoid these drugs or prescribe them in insufficient doses.
Buspir® is an anxiolytic, one of the newest sedative drugs used to treat COT. Possible side effects: dizziness, headaches and nausea. Unlike benzodiazepines, to achieve a sedative effect, buspirone must be taken systematically for at least 2 weeks.
Beta-blockers, for example, propranolol (Inderal®), used to treat heart disease, can prevent the appearance of physical symptoms accompanying certain types of anxiety disorders, in particular social phobia. When a frightening situation is predicted in advance and expected (for example, a report), the doctor can prescribe a beta-blocker to prevent the manifestation of physical symptoms of anxiety.
Psychotherapy consists of interviews with an experienced psychiatrist, for example, a psychiatrist, a psychologist or a social worker, and the goal is to identify the causes of anxiety disorder and find ways to overcome his symptoms.
Cognitive-behavioral therapy (CBT) is very successfully used in the treatment of anxiety disorders. The cognitive component of therapy helps people overcome stereotypes of thinking that serve as the basis for their fears; And the behavioral component helps change the response to anxiety-provoking situations.
For example, CBT can help a person with panic disorder understand and understand that his panic attacks are not really a heart attack. To a person with social phobia, CBT will help you learn how to overcome the feeling that everyone is looking at you and discussing you. If a person is ready to resist his fears, he will be taught how to apply the technique of "collision" with the situations causing him fear and anxiety, to make himself insensitive to the triggers of the problem. People with OCD, who are afraid of dirt and bacteria, are forced to get their hands dirty and do not wash them immediately, but wait for a while, and the waiting time increases all the time. A psychologist helps a person cope with the anxiety caused by waiting. After a certain number of such exercises, anxiety disappears. People with social phobia are invited to spend time in social situations frightening for them, overcoming the temptation to escape and fear of making mistakes, and watching the reaction of people.
Since the reaction of others, as a rule, is not so terrible as the patient feared, the alarms are smoothed out. People with post-traumatic stress are created with conditions that they remember and survive their traumatic experience in a safe environment, which helps to reduce the sense of fear caused by these memories. Specialists in cognitive-behavioral therapy also teach deep breathing and other exercises that help reduce anxiety and stimulate relaxation.
The method of behavioral therapy, based on the principle of colliding a patient with situations that cause their fears and anxiety, has been used for many years to treat specific phobias. A person is "confronted" with objects or situations, which he is afraid of, gradually. First, he is shown pictures, photos or video-audio records, and only after that a person must face the problem face to face. In many cases, the therapist accompanies the patient in an intimidating situation to support and guide him.
The CST is resorted to when a person decides that he is ready for this, with his permission and with his cooperation. To be successful, therapy should focus on the specific fears of the individual patient and be adapted to her or his needs. With CT, there are no side effects, except for the discomfort of the temporary increase in anxiety.
The course of CBT or behavioral therapy usually lasts about 12 weeks. It can be done individually or in a group together with people with similar problems. Group therapy is extremely effective in the treatment of social phobia. Often during a break between sessions, participants receive a "homework". There is evidence that in the treatment of panic disorder, favorable results of CBT have a longer lasting effect than the results of drug treatment. These data can also be applied to the treatment of OCD, PTSD, and social phobia. In the case of a relapse of the disorder, it is possible to use the same therapeutic method successfully for the second time.
In the treatment of specific anxiety disorders, a combination therapy course can be used, combining drugs and psychotherapy. This technique is the most suitable for many patients.
Before starting taking medication to treat an anxiety disorder:
