[Treatment strategies in anxiety disorders--an update]

Ther Umsch. 2009 Jun;66(6):425-31. doi: 10.1024/0040-5930.66.6.425.
[Article in German]

Abstract

Anxiety disorders are persistent impairing diseases, with often chronic course and suffering from symptoms throughout a life-span. The medication with the most evidence of efficacy is the benzodiazepines having a low incidence of side effects but may cause physical dependence, withdrawal and sedation. The use of these drugs should be limited to the acute treatments during the first several weeks in combination with an SSRI or and SNRI for the treatment of the acute phase. After three to four weeks, when antidepressants become effective, benzodiazepine dose should be tapered over a one week period. Among the antidepressants, the SSRI and the SNRI are considered a first-line therapy because of their favourable side effect spectrum compared to tricyclic antidepressants. However, the association with side effects such as nausea, sweating, sexual dysfunction and gastrointestinal problems and insomnia may be intolerable for a number of patients. Combining antidepressants and benzodiazepine therapy or medication treatment and psychotherapy may lead to an increase in improvement in patients not responding to one treatment approach alone. The most effective treatment for managing the recurrent symptoms of this chronic disorder are still unknown and other studies and approaches are in need as remission rates are still only about 40%.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Acute Disease
  • Anti-Anxiety Agents / adverse effects
  • Anti-Anxiety Agents / classification
  • Anti-Anxiety Agents / therapeutic use*
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use
  • Anxiety Disorders / classification
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / psychology
  • Arousal / drug effects
  • Benzodiazepines / adverse effects
  • Benzodiazepines / classification
  • Benzodiazepines / therapeutic use
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Humans
  • Substance-Related Disorders / etiology
  • Substance-Related Disorders / prevention & control

Substances

  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Benzodiazepines