Anxiety Health Article

Medications

Medications are often prescribed to relieve the physical and psychological symptoms of anxiety. Most agents work by counteracting the biochemical and muscular changes involved in the fight-or-flight reaction. Some work directly on the chemicals in the brain that are thought to cause the anxiety.

ANXIOLYTICS. Most anxiolytic drugs (sometimes called tranquilizers) are either benzodiazepines or barbiturates. Barbiturates, once commonly used, are now rarely involved in clinical practice. Barbiturates work by slowing down the transmission of nerve impulses from the brain to other parts of the body. They include such drugs as phenobarbital (Luminal) and pentobarbital (Nembutal). Benzodiazepines work by relaxing the skeletal muscles and calming the limbic system. They include such drugs as chlordiazepoxide (Librium) and diazepam (Valium). Both barbiturates and benzodiazepines are potentially habit-forming and may cause withdrawal symptoms, but benzodiazepines are far less likely than barbiturates to cause physical dependency. Benzodiazepines are associated with a high rate of anxiety relapse if use is discontinued. Both drugs also increase the effects of alcohol and should never be taken in combination with it. Longer-acting benzodiazepines, such as flurazepam and diazepam, should generally not be used in the elderly.

Two other types of anxiolytic medications include meprobamate (Equanil), which is now rarely used, and buspirone (BuSpar), a new type of anxiolytic that appears to work by increasing the efficiency of the body's own emotion-regulating brain chemicals. Buspirone has several advantages over other anxiolytics. It is not known to cause dependency, does not interact with alcohol, and does not affect the patient's ability to drive or operate machinery. Buspirone is also associated with a lower rate of relapse when use is discontinued. Buspirone is also far less likely to lead to tolerance over time than the benzodiazepines, so it is effective for a much longer period of time. However, buspirone is not effective against certain types of anxiety, such as panic disorder.

ANTIDEPRESSANTS AND BETA-BLOCKERS. For some anxiety disorders such as obsessive-compulsive disorder and panic-type anxiety, selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Paxil, are the treatment of choice. SSRIs are most commonly used to treat depression. Because anxiety often coexists with symptoms of depression, many doctors prescribe antidepressant medications for anxious/depressed patients. While SSRIs are more common, antidepressants, including tricyclic antidepressants such as imipramine (Tofranil) or monoamine oxidase inhibitors (MAO inhibitors) such as phenelzine (Nardil), are prescribed. The tricyclic antidepressants are also somewhat effective in relieving insomnia in many patients.

Beta-blockers are medications that work by blocking the body's reaction to the stress hormones that are released during the fight-or-flight reaction. These include drugs like propranolol (Inderal) or atenolol (Tenormin). Beta-blockers are sometimes given to patients with post-traumatic anxiety symptoms. More commonly, the beta-blockers are given to patients with a mild form of social phobic anxiety, such as fear of public speaking.

Psychotherapy

Most patients with anxiety will be given some form of psychotherapy along with medication. Many patients benefit from insight-oriented therapies, which are designed to help them uncover unconscious conflicts and defense mechanisms in order to understand how their symptoms developed. Patients who are extremely anxious may benefit from supportive psychotherapy, which aims at symptom reduction rather than personality restructuring.

Two newer approaches that work well with anxious patients are cognitive-behavioral therapy (CBT) and relaxation training. In CBT, the patient is taught to identify the thoughts and situations that stimulate his or her anxiety, and to view them more realistically. In the behavioral part of the program, the patient is exposed to the anxiety-provoking object, situation, or internal stimulus (like a rapid heartbeat) in gradual stages until he or she is desensitized to it. Relaxation training, which is sometimes called anxiety management training, includes breathing exercises and similar techniques intended to help the patient prevent hyperventilation and relieve the muscle tension associated with the fight-or-flight reaction. Both CBT and relaxation training can be used in group therapy as well as individual treatment. In addition to CBT, support groups are often helpful to anxious patients because they provide a social network and lessen the embarrassment that often accompanies anxiety symptoms. Biofeedback training is also used in an approach similar to relaxation training.

Psychosurgery

Surgery on the brain is very rarely recommended for patients with anxiety; however, some patients with severe cases of obsessive-compulsive disorder (OCD) have been helped by an operation on a part of the brain that is involved in OCD. Normally, this operation is attempted after all other treatments have failed.