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Treatment of anxiety

The options available for the management of anxiety and phobias.

The anxiety disorders are a group of disorders that include generalized anxiety, phobias and panic disorder. In addition to varying levels of fear and apprehension, physical symptoms that include palpitations, sweating, tremors, a dry throat, dizziness and headaches often accompany anxiety states. . The mechanisms behind anxiety are complex and are an interplay between biological, psychological and social factors.. Thus, management of anxiety usually utilizes a multi pronged approach wherein all possible causative factors are  identified and corrected.                                    

 

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1) Most patients will be evaluated for medical illnesses that could present as anxiety. Examples include cardiovascular illness, thyroid dysfunction and hormonal imbalance.


2) Based on the specific type of anxiety (read here) an appropriate psychotherapeutic modality with or without pharmacological agents (medication) will be chosen.


Choices in psychotherapy - Behavoral therapy and cognitive behavioral therapy including exposure therapy are widely accepted as effective therapeutic modalitites.Exposure therapy involves the slow graded exopsure to an anxiety provoking situation . CBT involves challenging and restructuring thoughts and beleifs thereby changing consequent behavior.


Abberant strategies developed to deal with anxiety such as avoidance and escape will be dealt with. Psychodynamic psychotherapy  (wherein unoptimal early life events are seen as the basis of abberant behavior) may be effective in some. Hypnotherapy can also be effective in managing anxiety in trained hands.


Alternative practices such as yoga, meditation and mindfulness have also been scientifically proven to be effective in the management of anxiety.

However, administration of effective psychotherapy requires time and effort on both sides. So what are the medications available ?


1) Antidepressants - Drugs that increase serotonin levels are considered by some to be the first line in managament of anxiety. 


2)Benzodiazepines and sedative hypnotics - Highly effective in the short term especially in social anxiety and panic, however risks of long term use far outweigh benefits.


3) Beta blockers - These are medications that help reduce the autonomic hyperactivity that accompanies anxiety ( they can help reduce tremors, palpitations and high blood pressure) thereby reducing the subjective sense of anxiety.


4) Supplements - L-theanine  (green tea extract) has recently been approved for the management of generalized anxiety disorder. 


Your psychiatrist may choose  psychotherapy or pharmacotherapy either alone or in combination to effectively tide over anxiety. 

Despite the availabilty of a number of treatment modalities, people are still reluctant to see a psychatrist. Even in the presence of debilitating anxiety people would rather waste their efforts in  temples,  quacks and in running from hospital to hospital hoping to find cure. rather than seek help from a qualified professsional. Sigma has got to go !  

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Psychiatry is a medical speciality, like surgery, general medicine and paediatrics. It involves the study, diagnosis and management of mental illnesses and distressing conditons, pertaining to both the mind and body. Misconceptions about psychiatric illness and treatment have some how prevented help seeking behaviour in those who need it the most. This Wall has to go, wherin visiting a psychiatrist should no longer be taboo, and people should be able to openly and freely discuss mental health issues. 


Dr Vikas Prabhav is a psychiatrist in chennai, he runs The Vivid Mind  mental wellness clinic in Anna Nagar. We aim at providing holistic, multimodal care for those suffering from mental illnesses and adjustment issues. We offer effective management strategies for depression, anxiety, unexplained physical symptoms, addictions, child/adolescent problems and other behavioural issues.The information provided in this website does not substitute for a medical consult.