Anti-Anxiety Meds Vs. Therapy: Which Is Better For Anxiety Disorders?

Management of anxiety disorder should be intervened as early as possible to avoid secondary complications.(1) The intervention objectives are:

  • To avoid the occurrence of anxiety
  • To suppress anticipatory anxiety
  • To end episodes of anxiety.

Anti-Anxiety Meds Vs. Therapy: Which Is Better For Anxiety Disorders?

The management of anxiety disorder is based on three therapeutic measures which must be offered jointly:

  • Psychotherapeutic treatments: behavioral and cognitive therapies
  • Drug treatments
  • The hygiene-dietetic rules

Which One Is Better?

All three therapeutic measures have shown good results to treat anxiety disorder – anti-anxiety drugs, antidepressants, and cognitive-behavioral therapy. Analysis has shown that psychotherapy is generally better than medicinal intervention in the long run. Medicines also have not shown to enhance psychotherapy effect significantly.

If the anxiety attacks are repeated, it is essential to quickly set up a treatment to avoid the evolution of persistent panic disorders. This treatment usually includes cognitive and behavioral psychotherapy and anxiety medication. Learning relaxation techniques can also be beneficial.(2)

Is Psychotherapy Effective In The Treatment Of Anxiety Disorders?

In the least severe cases, psychotherapy alone can treat an anxiety disorder. Cognitive and behavioral psychotherapies are currently the most used in the treatment of anxiety disorder. The therapist helps the person to recognize the modes of thought which make him misinterpret the reactions of his body and think that he is going to have something wrong. It teaches the person to become less sensitive to frightening physical sensations and feelings of terror, by helping him to gradually confront the situations he avoided. He can also teach the patient about deep breathing and muscle relaxation techniques.

This type of therapy usually takes eight to twelve weeks (at least two sessions per week) to produce a positive effect. Some cases require longer treatment.

Analytical-inspired psychotherapy is not used for the rapid relief of anxiety disorders but is useful if the patient feels the need to go back to the source of the problem.(1)(3)

What Drugs Are Prescribed For Anxiety Disorder?

To relieve an anxiety attack, the doctor prescribes anxiolytic benzodiazepines that work quickly, especially in the form of tablets that melt under the tongue. In severe cases, a neuroleptic can be used. In times of crisis, an injection can be given for a quicker effect. The basic treatment of anxiety disorders aims to prevent the onset of attacks and is mainly based on antidepressant drugs (certain drugs of the family of serotonin reuptake inhibitors or IRS). Sometimes other antidepressants are used, such as certain imipramines.

As the action of antidepressants is felt only after a month and a half to three months, the doctor can associate benzodiazepines with anxiolytics at the start of treatment.

The dosage of these anxiolytics is gradually reduced and stopped completely when the action of the antidepressant is felt and symptoms are diminished. Drug treatment for anxiety disorders generally lasts several months to avoid the risk of relapse, sometimes several years in cases of severe anxiety disorders.(2)(4)

Psychotherapeutic Treatments For Anxiety Disorders

Cognitive-behavioral therapies are the most used psychotherapy choice.

This technique combines different exposure techniques such as for the treatment of phobias, relaxing approaches and a cognitive program to work on erroneous catastrophic thoughts.

When the patient cannot move due to his disorder, the therapist can go to his home or in extreme cases, hospitalization may be necessary.

Behavioral and cognitive therapies have shown real and lasting effects on the management of anxiety disorder.(3)

Drug Treatments For Anxiety Disorders

The drug treatments recommended in anxiety disorder are antidepressants. They act with a delay of action of a few weeks and are considered as long-term treatments with a long-term action that aims to decrease the level of anxiety and reduce the occurrence and frequency of anxiety attacks.

Contrary to popular belief, these antidepressant treatments are not addictive.

Benzodiazepine-type anxiolytics are sometimes prescribed for symptomatic purposes. These treatments are only temporary and do not constitute a basic treatment.

Consumed over periods longer than a few weeks, they cause significant addictions which will aggravate the anxiety disorder.

Antidepressants For Anxiety Disorders

Two types of drugs are effective in treating anxiety disorder:

Antidepressants selective serotonin reuptake inhibitors (SSRIs)

Tricyclic antidepressants (ATC)(4)

Hygienic-Dietetic Rules For Anxiety Disorders

Physical Exercise: Physical exercise should be recommended in all cases as well as the reduction of consumption of exciting substances (coffee, tea, tobacco, alcohol).

It is recommended to have a calm and structured lifestyle for sleep hours and a healthy and balanced diet.

Relaxation: Relaxation is strongly recommended. It can be practiced during cognitive and behavioral therapy sessions, but not exclusively. The majority of relaxation techniques are effective.

Ventilation Regulation Techniques: The techniques of ventilation regulation, which consist of controlling the rhythm and the ventilation amplitude, have proved effective. Learning can be done in 3 or 4 sessions.(5)

References:

  1. Robichaud M, Koerner N, Dugas MJ. Cognitive behavioral treatment for generalized anxiety disorder: From science to practice. Routledge; 2019.
  2. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues in clinical neuroscience. 2017;19(2):93.
  3. Hofmann SG, Otto MW. Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder specific treatment techniques. Routledge; 2017.
  4. Carl E, Witcraft SM, Kauffman BY, et al. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy. 2020;49(1):1-21.
  5. Márquez PHP, Feliu-Soler A, Solé-Villa MJ, et al. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. Journal of human hypertension. 2019;33(3):237-247.

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