Anxiety medical therapy: Difference between revisions
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{{CMG}};{{AE}}{{Vbe}} | {{CMG}};{{AE}}{{Vbe}} | ||
== Overview== | == Overview== | ||
The mainstay of therapy for [[anxiety]] is the administration of [[pharmacotherapy]] and [[psychotherapy]]. | The mainstay of [[therapy]] for [[anxiety]] is the administration of [[pharmacotherapy]] and [[psychotherapy]]. | ||
Antidepressants | [[Antidepressants]] : [[Benzodiazepines]] (some concern over dependency), [[buspirone]], [[tricyclic antidepressant]]s , [[SSRI]]s ([[selective serotonin reuptake inhibitors]]). | ||
[[Benzodiazepines]] (some concern over dependency), [[buspirone]], [[tricyclic antidepressant]]s , [[SSRI]]s ([[selective serotonin reuptake inhibitors]]). | |||
==Medical Therapy== | ==Medical Therapy== | ||
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[[Generalized anxiety disorder|Generalized anxiety disorde]]<nowiki/>r: | [[Generalized anxiety disorder|Generalized anxiety disorde]]<nowiki/>r: | ||
The first line treatment for generalized anxiety disorder is SSRI: | The first line [[Treatment-resistant depression|treatment]] for [[generalized anxiety disorder]] is [[SSRI]]: | ||
* | * Preferred regimen: Oral dose of 25 mg once daily for 1 week, increase it based on response and tolerability; maximum dose is 200mg/day. | ||
* Alternative regimen: | * Alternative regimen: | ||
**[[Citalopram]] (Celexa): Oral (initial dose-10mg) with daily dose ranging from 10-40mg. | **[[Citalopram]] (Celexa): Oral (initial dose-10mg) with daily dose ranging from 10-40mg. | ||
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**Usually [[SSRIs]] are most effective at highest tolerable doses. | **Usually [[SSRIs]] are most effective at highest tolerable doses. | ||
Alernative regimen: | |||
SNRI's- | SNRI's- | ||
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*[[Venlafaxine]]: Oral (initial dose 75mg) with daily dose ranging from 75-225mg. | *[[Venlafaxine]]: Oral (initial dose 75mg) with daily dose ranging from 75-225mg. | ||
[[Benzodiazepines]]: | [[Benzodiazepines]]: | ||
* Alternative regimen: [[Lorazepam]] (Ativan) - Started at 0.5-1mg orally t.i.d. and titrated up to 1.5mg q.i.d daily as needed. | * Alternative regimen: [[Lorazepam]] (Ativan) - Started at 0.5-1mg orally t.i.d. and titrated up to 1.5mg q.i.d daily as needed. | ||
* Alternatively[[Diazepam]] (Valium) started at 2.5mg to 5mg orally once or twice daily and titrated up to 10mg ,two or three times daily as needed. | * Alternatively[[Diazepam]] (Valium) started at 2.5mg to 5mg orally once or twice daily and titrated up to 10mg ,two or three times daily as needed. | ||
* Alternatively [[Clonazepam]] (Klonopin) can be started at 0.25-0.5 mg orally once or twice daily and titrated up to 1mg (b.i.d or t.i.d) daily as needed. | * Alternatively [[Clonazepam]] (Klonopin) can be started at 0.25-0.5 mg orally once or twice daily and titrated up to 1mg (b.i.d or t.i.d) daily as needed. | ||
*There is increased risk of dependence and [[tolerance]] , so maintain caution in long term use, [[Selective serotonin reuptake inhibitor|SSRIs]] are therefore first line treatment for [[Anxiety Disorders|anxiety]] disorders in long term use. | *There is increased risk of dependence and [[tolerance]] , so maintain caution in long term use, [[Selective serotonin reuptake inhibitor|SSRIs]] are therefore first line [[Treatment-resistant depression|treatment]] for [[Anxiety Disorders|anxiety]] disorders in long term use. | ||
Other drugs to consider: | Other drugs to consider: | ||
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* Alternatively[[Buspirone]] (Buspar)- initial dose is 10mg with daily dose ranging from 10-60mg. | * Alternatively[[Buspirone]] (Buspar)- initial dose is 10mg with daily dose ranging from 10-60mg. | ||
* Alternatively[[Pregabalin]] (Lyrica)- initial dose is 50mg with daily dose ranging from 50-300mg. | * Alternatively[[Pregabalin]] (Lyrica)- initial dose is 50mg with daily dose ranging from 50-300mg. | ||
* | *Alternatively Second generation anti psychotics like [[Quetiapine]]( SEROQUEL)- Start with initial dose of 25mg/day and titrated at 25-50mg intervals weekly or biweekly to a maximum dose of 300mg/day. | ||
* | * Alternatively[[Hydroxyzine]] (Vistaril)- doses between 50 to 150 mg a day in divided doses as PRN, is effective for [[anxiety]] [[disorders]]. | ||
* Alternatively[[Mirtazapine]] (Remeron)_ doses between 15 mg to 45 mg used as monotherapy or adjunctive treatment in [[Generalized anxiety disorder]]. | * Alternatively[[Mirtazapine]] (Remeron)_ doses between 15 mg to 45 mg used as monotherapy or adjunctive treatment in [[Generalized anxiety disorder]]. | ||
* | * Preferred regimen for[[Panic disorder]]- SSRIs, SNRIs , benzodiazepines preferred regimen in acute exacerbation and as needed basis. Doses are used in the same range as for generalized [[anxiety]] disorders. | ||
* Preferred regimen for [[Social anxiety]]- [[SSRIs]] and [[beta-blockers]] <nowiki/> | * Preferred regimen for [[Social anxiety]]- [[SSRIs]] and [[beta-blockers]] <nowiki/> for [[social anxiety disorder]]. | ||
===Psychotherapy=== | ===Psychotherapy=== | ||
*[[CBT]] is a type of [[psychotherapy]] that can help people with [[anxiety]] disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. [[Cognitive-behavioral therapy|CBT]] can also help people learn and practice [[social skills]], which is vital for treating [[social anxiety disorder]]. | *[[CBT]] is a type of [[psychotherapy]] that can help people with [[anxiety]] disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. [[Cognitive-behavioral therapy|CBT]] can also help people learn and practice [[social skills]], which is vital for treating [[social anxiety disorder]]. | ||
*Two specific stand-alone components of CBT used to treat social anxiety disorder are [[cognitive]] therapy and [[exposure]] therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying [[anxiety]] disorders. | *Two specific stand-alone components of CBT used to treat [[social anxiety disorder]] are [[cognitive]] therapy and [[exposure]] therapy. [[Cognitive therapy]] focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying [[anxiety]] disorders. | ||
*[[Exposure therapy]] focuses on confronting the fears underlying an [[anxiety]] disorder in order to help people engage in activities they have been avoiding. [[Exposure therapy]] is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that [[cognitive therapy]] was superior to exposure therapy for treating [[Social anxiety disorder|social anxiety]] disorder. | *[[Exposure therapy]] focuses on confronting the fears underlying an [[anxiety]] [[Disorder (medicine)|disorder]] in order to help people engage in activities they have been avoiding. [[Exposure therapy]] is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that [[cognitive therapy]] was superior to exposure therapy for treating [[Social anxiety disorder|social anxiety]] disorder. | ||
*[[CBT]] may be conducted individually or with a group of people who have similar problems. [[Group therapy]] is particularly effective for [[social anxiety]] disorder. Often “homework” is assigned for participants to complete between sessions.<ref name="pmid26795939">{{cite journal |vauthors=Kivity Y, Huppert JD |title=Does cognitive reappraisal reduce anxiety? A daily diary study of a micro-intervention with individuals with high social anxiety |journal=J Consult Clin Psychol |volume=84 |issue=3 |pages=269–83 |year=2016 |pmid=26795939 |doi=10.1037/ccp0000075 |url=}}</ref> | *[[CBT]] may be conducted individually or with a group of people who have similar problems. [[Group therapy]] is particularly effective for [[social anxiety]] disorder. Often “homework” is assigned for participants to complete between sessions.<ref name="pmid26795939">{{cite journal |vauthors=Kivity Y, Huppert JD |title=Does cognitive reappraisal reduce anxiety? A daily diary study of a micro-intervention with individuals with high social anxiety |journal=J Consult Clin Psychol |volume=84 |issue=3 |pages=269–83 |year=2016 |pmid=26795939 |doi=10.1037/ccp0000075 |url=}}</ref> | ||
Revision as of 14:23, 12 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
The mainstay of therapy for anxiety is the administration of pharmacotherapy and psychotherapy.
Antidepressants : Benzodiazepines (some concern over dependency), buspirone, tricyclic antidepressants , SSRIs (selective serotonin reuptake inhibitors).
Medical Therapy
Pharmacotherapy
The first line treatment for generalized anxiety disorder is SSRI:
- Preferred regimen: Oral dose of 25 mg once daily for 1 week, increase it based on response and tolerability; maximum dose is 200mg/day.
- Alternative regimen:
- Citalopram (Celexa): Oral (initial dose-10mg) with daily dose ranging from 10-40mg.
- Escitalopram (Lexapro): Oral (initial dose-5-10mg) with daily dose ranging from 10-20mg.
- Paroxetine ( Paxil): Oral(initial dose 20mg) with daily dose ranging from 20-50mg.
- Usually SSRIs are most effective at highest tolerable doses.
Alernative regimen:
SNRI's-
- Duloxetine; Oral (initial dose 30mg) with daily dose ranging from 60-120mg.
- Venlafaxine: Oral (initial dose 75mg) with daily dose ranging from 75-225mg.
- Alternative regimen: Lorazepam (Ativan) - Started at 0.5-1mg orally t.i.d. and titrated up to 1.5mg q.i.d daily as needed.
- AlternativelyDiazepam (Valium) started at 2.5mg to 5mg orally once or twice daily and titrated up to 10mg ,two or three times daily as needed.
- Alternatively Clonazepam (Klonopin) can be started at 0.25-0.5 mg orally once or twice daily and titrated up to 1mg (b.i.d or t.i.d) daily as needed.
- There is increased risk of dependence and tolerance , so maintain caution in long term use, SSRIs are therefore first line treatment for anxiety disorders in long term use.
Other drugs to consider:
- AlternativelyBuspirone (Buspar)- initial dose is 10mg with daily dose ranging from 10-60mg.
- AlternativelyPregabalin (Lyrica)- initial dose is 50mg with daily dose ranging from 50-300mg.
- Alternatively Second generation anti psychotics like Quetiapine( SEROQUEL)- Start with initial dose of 25mg/day and titrated at 25-50mg intervals weekly or biweekly to a maximum dose of 300mg/day.
- AlternativelyHydroxyzine (Vistaril)- doses between 50 to 150 mg a day in divided doses as PRN, is effective for anxiety disorders.
- AlternativelyMirtazapine (Remeron)_ doses between 15 mg to 45 mg used as monotherapy or adjunctive treatment in Generalized anxiety disorder.
- Preferred regimen forPanic disorder- SSRIs, SNRIs , benzodiazepines preferred regimen in acute exacerbation and as needed basis. Doses are used in the same range as for generalized anxiety disorders.
- Preferred regimen for Social anxiety- SSRIs and beta-blockers for social anxiety disorder.
Psychotherapy
- CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
- Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.
- Exposure therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.
- CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often “homework” is assigned for participants to complete between sessions.[1]
References
- ↑ Kivity Y, Huppert JD (2016). "Does cognitive reappraisal reduce anxiety? A daily diary study of a micro-intervention with individuals with high social anxiety". J Consult Clin Psychol. 84 (3): 269–83. doi:10.1037/ccp0000075. PMID 26795939.