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Anxiety comes in many forms and diagnoses, and it is the No. 1 mental health diagnosis in the world. Medicine and psychology, however, have found both separate and combined ways to relieve the suffering of anxiety.
Medications are an important first step in treating certain forms of anxiety.
Benzodiazepines (Xanax and Klonopin) can provide relief of certain anxiety symptoms. They can also be used on an as-needed basis. They are useful for a person who has an extreme fear of social situations. Alternative forms of psychological treatment include cognitive behavior therapy and exposure therapy. Often, the most effective form of treatment is a combination of drugs and psychological treatment.
Some prescribing guidelines caution about the use of benzodiazepines for PTSD and panic disorder, and in the long-term treatment (greater than 4 weeks) of a generalized anxiety disorder.
Selective serotonin reuptake inhibitors (SSRI) and serotonin and noradrenaline reuptake inhibitors (SNRI) are considered the first line of treatment for a generalized anxiety disorder. Usual starting doses are lower than those used for the treatment of depression. Psychological help (therapy, CBT, exercise, relaxation and mindfulness therapy) are also very helpful tools.
Those individuals with an obsessive-compulsive disorder (OCD) are very pleased when they are prescribed an SSRI (or clomipramine as a first-line treatment.) They are glad when their ‘loud’ obsessive thoughts are quieted. Some have related the experience to the taking of morphine during a prior medical procedure.
Combined drug and psychological treatment can make the treatment of OCD even more effective. OCD is a disorder that often waxes and wanes, bringing some relief with time.
Guidelines suggest that body dysmorphic disorder first be addressed with CBT; an SSRI and buspirone may be added.
In the past, I have found that certain patients had a significant thinking/reasoning disorder with their intense anxiety. Both aspects were reduced by a medical prescription of an anti-psychotic. My addition of CBT, and relaxation and breathing techniques added to the efficacy of the prescribed medications.
Medication has been found to be helpful in more rare forms of anxiety, such as excoriation (skin-picking disorder) and trichotillomania (hair-pulling.) Research studies have found that the antioxidant, N-acetylcysteine, has been helpful in bringing relief.
Panic disorder is a frightening experience for the individual who suffers from it. Short-term use of a benzodiazepine can have a rapid effect of relief, but the panic symptoms return once the drug is withdrawn. A long-term effective treatment plan for panic disorder includes an SSRI, CBT and self-help anxiety techniques. Some guidelines question the consistent helpfulness of combined medical and psychological treatments, but a patient in a panic state would welcome all forms of treatment that could bring relief. Research studies have suggested that the length of treatment may be from 8 months to 3 years.
Not all relief of anxiety comes from a mental health professional. It can come from a religious advisor. There are also many self-help books on the market that can bring relief from mental suffering, such as anxiety and sadness. I highly recommend The Little Book of Inner Peace, by Ashley Davis Bush. It contains many techniques to relieve stress and attain an inner sense of peace.
Finally, the 10th edition of Your Perfect Right, by Alberti and Emmons, can help those shy individuals with social anxiety become more assertive. The two books are inexpensive and available on Amazon.
Philip Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a post-doctoral degree in clinical psychopharmacology (the use of drugs to treat mental disorders.) His year-long internship in clinical psychology was served at the University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.