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Treatment of Anxiety

If you are feeling extremely anxious, you may be offered a short-term drug treatment to give immediate relief of your symptoms. These include:

 Benzodiazepines e.g. diazepam, alprazolam and lorazepam which are tranquillisers often prescribed to control physical symptoms such as shaking, palpitations and breathlessness. They work faster than other medicines and will make you less worried and more relaxed. However, they can be addictive and have serious side effects, including sleepiness, memory problems and dizziness. They are therefore only used as a short-term treatment – usually for no more than two to four weeks.

Hydroxyzine which is an antihistamine that may be prescribed if you are very anxious about a particular thing, such as an operation you need to have. It will make you feel calm and may make you feel sleepy. It is not normally prescribed for more than a couple of weeks.

There are a number of options for the long- term treatment of GAD that can help you get better and stay better. These include psycological therapies e.g. cognitive behavioural therapy (CBT), drug treatment e.g paroxetineand self help. You should always discuss the choice of treatment with your GP. Your GP may recommend a combination of psycological therapy and drug treatment.

Psycological therapies: Cognitive therapy is a talking treatment that aims to teach you how to recognise and control unhelpful or negative thoughts and replace them with more positive thoughts. You GP may offer you weekly sessions.

Applied relaxation is a psychological treatment, which aims to teach you how to relax. You may have weekly sessions with a therapist, where you learn to relax your muscles and to release the tension from your body and your mind. You may also learn how to avoid getting stressed in difficult situations. You will also be asked to practice between sessions.

Drug treatments:

Paroxetine is a SSRI (selective serotonin reuptake inhibitor) antidepressant that may also help with anxiety. It increases the level of a chemical in your brain called serotonin. Your GP may recommend you start on a low dose and then increase the dose slowly to reduce side effects, such as increased feelings of anxiety, nausea, upset stomach or diarrhoea.

You will probably have to wait at least three weeks before you begin to feel any better. Your GP should see you within 2 weeks of starting treatment and your medication should be reviewed regularly after that.

If you find that the prescribed antidepressant does not improve your symptoms within 12 weeks your GP may try another SSRI. If your anxiety symptoms are showing signs of improvement with a particular antidepressant, you should continue taking it for at least 6 months after the best dose is reached, You should see your doctor every couple of months to see how well you are doing.

 It’s important to be aware that you might have withdrawal symptoms, including nausea, dizziness and a return of your anxiety, if you stop the treatment suddenly. Always discuss stopping your medication with your GP who can advise on slowly reducing your dose.

Venlafaxime is another type of antidepressant that can help anxiety if an SSRI does not improve your symptoms. Your GP may refer you to a specialist in mental health who may prescribe Venlafaxime.

Venlafaxine can have side effects. These include nausea, diarrhoea and sexual problems (erection problems and problems with orgasm).

You will have your blood pressure measured and an electrocardiogram (ECG) to measure the electrical activity in your heart when you start to take Venlafaxine. Your blood pressure should be regularly monitored. Again, you should always discuss stopping your medication with your GP who can advise on slowly reducing your dose, as stopping abruptly can cause withdrawal symptoms.

Buspirone is sometimes prescribed to reduce the feelings of anxiety. It is an anxiolytic drug. You will need to take buspirone for at least six weeks before you begin to feel better. You will probably start on a small dose, which will be gradually increased. If you find this drug works to reduce your feelings of anxiety you should discuss how long you should take it with your GP. It is normally only used for a short period.

Self Help: You may be advised to contact a support group, where they are available. Support groups sometimes arrange face-to-face meetings or telephone help. They can also provide information and advice. Ask your GP or practice nurse for details. Exercise can also be beneficial.

Your GP may also suggest books or a computer package that uses CBT or other psychological therapies for you to use at home.

If you have tried at least two treatments and you still feel very anxious. Your GP may refer you to specialist mental health services for further assessment.