If you, or someone you know, has symptoms of anxiety, a visit to the family physician is usually the best place to start. A physician can help you determine if the symptoms are due to an anxiety disorder, some other medical condition, or both. Most often, the next step to getting treatment for an anxiety disorder is referral to a mental health professional.

Among the professionals who can help are psychiatrists, psychologists, social workers, and counselors. However, it's best to look for a professional who has specialized training in cognitive-behavioral or behavioral therapy and who is open to the use of medications, should they be needed.

Psychologists, social workers, and counselors sometimes work closely with a psychiatrist or other physician who will prescribe medications when they are required. For some people, group therapy or self-help groups are a helpful part of treatment. Many people do best with a combination of these therapies.

When you're looking for a health care professional, it's important to inquire about what kinds of therapy he or she generally uses or whether medications are available. It's important that you feel comfortable with the therapy. If this is not the case, seek help elsewhere. However, if you've been taking medication, it's important not to quit certain drugs abruptly, but to taper them off under the supervision of your physician. Be sure to ask your physician about how to stop a medication.

Remember, though, that when you find a health care professional you're satisfied with, the two of you are working as a team. Together you will be able to develop a plan to treat your anxiety disorder that may involve medications, behavioral therapy, or cognitive-behavioral therapy, as appropriate. Treatments for anxiety disorders, however, may not start working instantly. Your doctor or therapist may ask you to follow a specific treatment plan for several weeks to determine whether it's working.

Many people with anxiety disorders can be helped with treatment. Therapy for anxiety disorders often involves medication or specific forms of psychotherapy.

Medications, although not cures, can be very effective at relieving anxiety symptoms. Today, thanks to research by scientists at NIMH and other research institutions, there are more medications available than ever before to treat anxiety disorders. So if one drug is not successful, there are usually others to try. In addition, new medications to treat anxiety symptoms are under development.

For most of the medications that are prescribed to treat aniety disorders, the doctor usually starts the patient on a low dose and gradually increases it to the full dose. Every medication has side effects, but they usually become tolerated or diminish with time. If side effects become a problem, the doctor may advise the patient to stop taking the medication and to wait a week – or longer for certain drugs – before trying another one. When treatment is near an end, the doctor will taper the dosage gradually.

Research has also shown that behavioral therapy and cognitive-behavioral therapy can be effective for treating several of the anxiety disorders.

Behavioral therapy focuses on changing specific actions and uses several techniques to decrease or stop unwanted behavior. For example, one technique trains patients in diaphragmatic breathing, a special breathing exercise involving slow, deep breaths to reduce anxiety. This is necessary because people who are anxious often hyperventilate, taking rapid shallow breaths that can trigger rapid heartbeat, lightheadedness, and other symptoms. Another technique – exposure therapy – gradually exposes patients to what frightens them and helps them cope with their fears.

Like behavioral therapy, cognitive-behavioral therapy teaches patients to react differently to the situations and bodily sensations that trigger panic attacks and other anxiety symptoms. However, patients also learn to understand how their thinking patterns contribute to their symptoms and how to change their thoughts so that symptoms are less likely to occur. This awareness of thinking patterns is combined with exposure and other behavioral techniques to help people confront their feared situations. For example, someone who becomes lightheaded during a panic attack and fears he is going to die can be helped with the following approach used in cognitive-behavioral therapy. The therapist asks him to spin in a circle until he becomes dizzy. When he becomes alarmed and starts thinking, "I'm going to die," he learns to replace that thought with a more appropriate one, such as "It's just a little dizziness – I can handle it."

Source: The National Institute of Mental Health

The cost for treatment of depression and anxiety is insignificant compared to the enormous economic costs when left untreated, says a professor of psychiatry.

David Sheehan of the University of Florida College of Medicine said this when giving a lecture on depression and anxiety at the Lobatse Institute of Health Sciences this week.

He said if left untreated, depressions and anxiety could lead to economic costs like absenteeism, decreased productivity and suicides.

The costs from these are much higher than the pharmaceutical costs, he said. Sheehan told the audience that the past 10 years had seen major advances in the treatment of depression and anxiety.

He said it was important to always critically diagnose patients in order to avoid mistaking a depression for anxiety or vice-versa.

It is important to first make a correct diagnosis, he said. Sheehan said it had since been realised that most of the treatment problems were associated with diagnosis problems.

To help in a diagnosis, he said, a standardised MINI International Neuro-Psychiatric Interview manual had been translated into 45 languages worldwide.

He said currently the manual was still being translated into Setswana and upon completion it would also be deposited on the website.

The audience heard that studies in Europe and the United States had shown that depressed people had a highest risk of committing suicide.

On other issues, Sheehan said in future depression and anxiety would probably require blood tests just like it had happened with other diseases.

Sheehan also said the new anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRI) or second generation medication for sexual side-effects was only for delayed ejaculation and never causes any erection failures.

He urged the health professionals to always explain to their patients such side effects as failure might lead patients to mistake them for something else.

(HealthDay News) - When provided by experienced psychotherapists, cognitive therapy may be as effective as antidepressant drugs in initial treatment of moderate to severe depression, a new study suggests.

The study, published in the April issue of the journal Archives of General Psychiatry, included 240 people with moderate to severe depression. One group of 60 people received cognitive therapy, another group of 120 received antidepressant medication (usually Paxil), and a third group of 60 received a placebo pill.

 According to University of Pennsylvania researchers, patients in the cognitive therapy group attended two 50-minute sessions a week for the first four weeks of the study. They went to one or two sessions a week for the middle eight weeks and to one session a week for the final four weeks of the study. After eight weeks of treatment, response rates were 50 percent in the medication group, 43 percent in the cognitive therapy group and 25 percent in the placebo group.

After 16 weeks of treatment, response rates were 58 percent for patients receiving either medication or cognitive therapy. Remission rates were 46 percent for patients receiving medication and 40 percent for those in the cognitive therapy groups. 

Warnings

Do not stop taking Alprazolam (Xanax) abruptly. Do not give this drug to anyone who is psychotic. Narcotics may increase the sedative effects of this drug. Do not take other sedative, benzodiazepine's, or sleeping pills with this drug. The combinations could be fatal. Do not drink alcohol when taking benzodiazepine's. Alcohol can lower blood pressure and decrease your breathing rate to the point of unconsciousness. The habit-forming potential is high. It is possible to become dependent in the first few days. Do not stop taking this drug abruptly, this could cause psychological and physical withdrawal symptoms. Do not take Xanax if you have narrow-angle glaucoma. Alprazolam may worsen this condition.

Before taking this medication, tell your doctor if you have:

Kidney disease.
Have liver disease.
Have a history of alcohol or drug abuse.
Have asthma or bronchitis.
Emphysema.
Any respiratory disease.
Depressed or have suicidal thoughts.
Mania.
Bipolar disorder.
Any psychiatric condition.

How it works

Xanax affects chemicals in the brain that may become unbalanced and cause anxiety.

CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereo specific  receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis.

Following oral administration, Xanax is readily absorbed. Peak concentrations in the plasma occur in 1-2 hours following administration. Plasma levels are proportionate to the dose given; over the dose range of 0.5 to 3.0 mg, peak levels of 8.0 to 37 ng/ml were observed. Using a specific assay methodology, the mean plasma elimination half-life of Xanax has been found to be about 11.2 hours (range: 6.3-26.9 hours) in healthy adults.