Anxiety disorders – Treatment principles

The British Association for Psychopharmacology updated its guidelines for the management of anxiety disorders in 2014.¹ These recommend that in patients meeting the diagnostic criteria for an anxiety disorder they are likely to benefit from pharmacological or psychologica…

There are a number of different approaches to psychotherapy for the treatment of anxiety disorders, including CBT,¹ third-wave CBT,² mindfulness-based therapy,³ psychodynamic psychotherapy,⁴ and yoga.¹

References:
1. Hofmann SG. An Introduction to Modern CBT. New York: Wi…

CBT has been widely-studied for the treatment of anxiety disorders, which includes cognitive restructuring and exposure.^1,2 A meta-analysis has shown that effect sizes for diagnosis-specific symptoms, anxiety, depression, and quality of life differed across different type…

The cognitive‒behavioural model describes the maladaptive processes that can occur during mental disorders.¹ Maladaptive beliefs can lead to maladaptive cognitions following exposure to certain triggers (e.g., situations, events, sensations, other thoughts).¹ The triggers…

A meta-analysis included 41 randomized controlled trials that compared CBT with placebo.¹ In 34 of these studies, the intervention was delivered on an individual basis, whereas in the remaining 7 studies CBT was delivered to groups.¹ There was a mean of 11 CBT sessions ac…

In this meta-analysis, effect size estimates suggested that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’s g  0.63) and depressive symptoms (Hedges’s g  0.59) from pre- to posttreatment in the overall sample.¹ In patients with anxiety d…

There are several SSRIs, including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.¹  Although their primary mechanism of action is the inhibition of serotonin reuptake by SERT they typically have some minor effects on other neurotransmitter …

The SNRI class comprises venlafaxine and duloxetine.¹ The action of venlafaxine is dose-dependent: at lower doses, it acts as an SSRI, with NA reuptake inhibition occurring at doses higher than 150 mg/day.¹ However, the relative affinity of duloxetine for serotonin and NA…

Phenelzine is an irreversible inhibitor of both MAO-A and MAO-B, whereas moclobemide is a reversible inhibitor of only MAO-A.^1,2  Moclobemide therefore has less potential for tyramine interactions.^1,2 The combination of MAOIs with other serotonergic agents such as SSRIs, …

Benzodiazepines modulate the actions of GABA via effects on GABA-A receptors, with their binding site within the ion channel complex, with a mainly synaptic location.³ It has been suggested that generalized anxiety disorder may be associated with impaired benzodiazepine r…

In an analysis of pooled data from 6 controlled trials evaluating pregabalin in patients with GAD, there was a significant reduction in depressive symptoms versus placebo, and these effects were apparent in patients with more prominent depressive symptoms at baseline.⁴ In…

In a recent meta-analysis of 4 randomized controlled trials (2 in patients with social phobia, 1 in panic disorder/agoraphobia, and 1 with a range of anxiety disorders), when compared with placebo, there was no significant benefit of either atenolol or propranolol on HAM-…

Multiple studies have assessed the effects of antipsychotics in anxiety disorders.¹ In patients with GAD, 2 studies showed that olanzapine, ziprasidone, and quetiapine achieved higher response rates (as measured using the Hamilton Anxiety rating scale [HAM-A]) vs placebo.…