Treatment of Anxiety

TREATMENT OF ANXIETY

Anxiety is a universal phenomenon, and to experience it in appropriate circumstances is the normal response. It may serve to enhance vigilance and drive. However, if anxiety symptoms are frequent and persist in a severe form, they are a cause of distress/suffering and markedly impair performance. It should be treated with drugs only when excessive and disabling in its own right.

The established drugs are BZDs which should be used in the smallest possible dose. The dose has to be found out for each patient by titration with symptoms of anxiety. Acute anxiety states generally respond better. The drug should be withdrawn as soon as it is no longer required. But when large doses have been used for longer periods—withdrawal should be gradual. Long-term use of BZDs is of questionable value.

The usual practice is to give ½ to 2/3 of the daily dose at bed time to ensure good nightly rest; the remaining is divided in 2–3 doses given at day time. Though the t½ of BZDs used in anxiety are longer, divided day time doses are required to avoid high peaks.

Buspirone is a non-sedating alternative to BZDs for less severe forms of generalized anxiety. The SSRI and some atypical antidepressants are now being increasingly used in many forms of severe anxiety disorders, but are not good for acute anxiety. They produce a delayed but often gratifying response and can be combined with BZDs. The SSRIs are now drugs of choice for social anxiety in which BZDs, though effective, carry abuse potential on long-term use.

Patients with hypertension, peptic ulcer, ulcerative colitis, irritable bowel, gastroesophageal reflux, thyrotoxicosis, angina pectoris are often given low doses of BZD in addition to specific therapy, though anxiety may not be a prominent manifestation.

Fixed dose combination of tranquillizers with vitamins has been banned.