Anxiety disorder and its treatment

In today’s stressful world, the issue of diagnosing such a neurotic disorder as anxiety disorder and its treatment is becoming increasingly relevant.

And there are quite understandable reasons for this. People are constantly in a hurry somewhere, solve urgent tasks, report on the work done and listen to dissatisfaction, reproaches and claims from the authorities for the unfulfilled. Those tasks and actions for which enough time was allocated a hundred years ago now need to be done in a couple of hours. At the beginning of the 20th century, a professor gave one lecture a week, having at least six days to prepare, while modern teachers often have three, four, or even five lectures every day. According to analysts, the amount of information on the Internet doubles every year and a half. Such a sudden acceleration of life and an information explosion cannot but affect a person ‘s mental health.

Therefore, the number of people with anxiety disorders is on the rise. At the same time, the number of registered cases, which, of course, is less than it actually is, is due to the fact that the population begins to get used to psychiatrists, accept them, cease to be afraid and increasingly seek help. If earlier a person preferred to sit at home and not tell anyone about his problems, then with the growth of the level of culture, we more often come to a consultation with specialists with the prefix psycho-, making, of course, the right decision.

It often happens that people with anxiety disorders turn not to psychiatrists, but to general practitioners (general practitioners, neuropathologists, cardiologists, family doctors, etc.). Often these appeals are not associated with a specific disease from which a person really suffers, although, of course, in this case, anxiety may appear due to the occurrence or presence of somatic diseases. Quite often, people do not turn to a psychiatrist for help due to the fact that anxiety is often manifested by somatic symptoms – nausea, flatulence, redness or blanching of the skin, headaches and other manifestations.

Anxiety Disorder: Symptoms and Treatment

Diagnosing an anxiety disorder and its symptoms is complicated by the fact that having a certain level of anxiety is normal, since anxiety is a natural human emotion, very important and necessary. It leads to the emergence of a certain internal tension, which, among other things, does not allow, so to speak, to postpone our important tasks for the deadline and thus serves as a source of motivation. Elizabeth Zintle called anxiety an emotional temperature that signals that our mental balance is out of whack.

But, if a person constantly has increased anxiety, then it interferes with his normal life, work and relationships and does not fulfill his natural functions, but, on the contrary, increases maladjustment, then this is already a disease that requires treatment . Quite often, people suffering from anxiety disorders go to general practitioners and receive diagnoses that have nothing to do with their real problem.

Have you ever heard the phrase that all diseases are from nerves? If we talk about anxiety disorders, then it fully justifies itself. According to studies, more than half of those who visit general practitioners do not have any somatic diseases. Most often, the reason for their poor health is increased anxiety as a result of having an anxiety disorder. And there is nothing surprising here, because anxiety is a reaction to both external circumstances and the internal state of the body. And it turns out that anxiety causes vegetative symptoms, and on the other hand, vegetative disorders can cause anxiety. Therefore, in the treatment of both anxiety disorders and autonomic disorders, the so-called breaking of this vicious circle, this relationship, plays an important role.

If the patient has complaints of a somatic nature, then this complicates the diagnosis of an anxiety disorder. If a person has a combination of bodily diseases and an anxiety disorder, then their manifestations reinforce not only each other, but also the maladaptation of the patient, of course, too.

anti-anxiety therapy at an earlier stage of treatment , even if the symptom of anxiety is mild.

Very often, somatic doctors do not take into account the complaints of patients about their emotional state. In their opinion, if a person comes with complaints of back pain, then he must be treated precisely for this pathology, even if he simultaneously talks about his emotional experiences, which are caused by problems and difficulties in his life. Therefore, every family doctor, internist, neurologist and other general practitioner would greatly benefit from a basic knowledge of anxiety disorders so that he can understand the patient’s condition and explain what is happening to him. And then it is quite possible to expect a referral of a person with increased anxiety to a specialized specialist (psychiatrist, psychotherapist) so that the person suffering from anxiety disorder receives professional and competent treatment.

Anxiety disorder: treatment with antidepressants

Treatment with antidepressants and drugs of other pharmacological groups is used to relieve the symptoms of an anxiety disorder. But it is very important that the doctor be guided not only by his personal preferences, but also take into account the opinion of the patient. It is often possible to encounter a situation where, in case of severe anxiety, the attending physician prescribes medications and a referral for psychotherapy, practically without explaining to the patient the features of the disorder and its treatment. Everything seems to be fine, he made the correct diagnosis, he knows what to prescribe and where to direct, but all these recommendations will be of no use if the patient himself does not want to apply them. That is why it is necessary to discuss the situation with the patient, because he may be an opponent of drug treatment and in any case will not go to the pharmacy with a prescription, or he is prejudiced against psychotherapy and considers this method charlatan. The task of the doctor is to find out the preferences of the patient and explain to him the need and effectiveness of the prescribed methods. It is necessary to achieve compliance in the relationship and cooperation between the doctor and the patient.

Of course, one should not neglect the knowledge and experience of the specialist who prescribes the treatment, as well as the standards of treatment for mental disorders. The doctor already has his own personal experience built over the years and preferences in prescribing certain necessary drugs, as well as recommendations on what treatment and at what stage will be the most effective, of course, taking into account the standards for treating mental disorders. Ideally, if there is no disagreement between the doctor and the patient in this matter, but if this happens, then the doctor should try to adapt his prescriptions to the individual.

When choosing a drug for the treatment of anxiety disorders, it is very important to consider its long-term effect and whether it will maintain remission, as well as whether the patient will tolerate treatment with this drug without side effects . To date, there is a very wide variety of drugs, and when prescribing treatment, it is important not only the effectiveness of the drug and the speed of improvement, but also its long-term drug effect and, of course, the presence of side effects.

Studies have shown that patients with anxiety disorder are very much affected by the placebo effect. But this effect tends to weaken over time, and rather quickly. And the recommended treatment period for anxiety disorders is at least a year, although these terms are very individual.

Antidepressants, which are recommended for the treatment of anxiety disorders, need to be used for a longer period of time than for the treatment of depression.

The drugs should be continued to be taken not only until the complete elimination of painful symptoms – pathological anxiety, but also for a longer time (up to one year) in order to have an anti -relapse effect. After achieving the desired result, it is very important to continue anti-relapse therapy for anxiety disorder, which is recommended to be used, as already mentioned earlier in this article, for about a year.

Sometimes there are cases when the prescribed treatment does not lead to the expected result. This may be due to the wrong treatment algorithm – the choice of the drug, its dose, the timing of treatment.

As for antidepressants, there are some features in their use for the treatment of anxiety disorder:

  • A higher dose of antidepressants is recommended for the treatment of anxiety than for the treatment of depression. If you use low doses of antidepressants, then the effect of the treatment will be insufficient.
  • If, when using antidepressants in a therapeutic dose, there is no weakening of anxiety symptoms for 2 months, then this drug can be called ineffective and another one can be selected that has a different chemical structure and mechanism of action.
  • The drugs of the antidepressant group begin to act only after 3 weeks, and yet they still need to be allowed to work for some time in order to get some positive result. Therefore, we cannot judge the effectiveness of treatment when taking even the optimal dose of an antidepressant in less than one month (three to four weeks) from the start of its administration. And changing an antidepressant to another one earlier than one month does not make sense at all and is simply not reasonable.

If the effectiveness of the prescribed treatment for anxiety disorder is insufficient, the potentiation method is used by adding another drug.

Then a serotonergic antidepressant is prescribed as the main one and combined with anti-anxiety drugs or benzodiazepines. Despite the fact that this combination enhances the effectiveness of treatment, one should also be aware of the presence of such an undesirable effect as addiction when using benzodiazepines for more than 1.5 months.

It also makes sense to combine antidepressants with anxiolytics ( anti-anxiety drugs) and benzodiazepines in the first month of taking antidepressants that do not work yet, and the patient needs to mitigate increased anxiety, improve sleep, etc., that is, in this way help wait for the action of antidepressants.

Treatment of anxiety disorder without antidepressants

It used to be common practice to treat anxiety without antidepressants. But the approach to treating anxiety disorders has changed in recent years. For another 25-30 years, the dominant view was that the only effective treatment for anxiety neurosis was psychotherapy (from psychoanalytic to hypnosis). Now most often use a combination of psychotherapy and drugs. But, of course, drugs should not cause a pronounced sedative effect. After all, if a sleepy and lethargic patient sits at a psychotherapist’s appointment, then the effect of such a session will be very insignificant. With the development of the pharmacological industry and significant progress in it, modern anti-anxiety drugs do not have a pronounced sedative effect and, moreover, have proven effectiveness in combating anxiety disorders. Therefore, now it makes no sense to talk about the opposition of drug treatment and psychotherapy – they work much more effectively together.

If the anxious patient trusts the doctor, is sympathetic to the prescribed treatment, and uses a combination of medications with psychotherapy, the anxiety disorder will have no chance. And a person will be able to return to his former life and feel happy again!

event_note February 6, 2022

account_box Winona Tse MD

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