This is the most prevalent psychiatric problem in the U.S., and it attacks women twice as often as men. Two thirds of all anxiety patients also are experiencing depression, which leads to ¼ of all cases experiencing panic attacks and 1/3 of all cases having alcohol problems.

Because all these issues are so closely tied together, a proper diagnosis must start with an honest and thorough health history evaluation for at least the past 6 months. In most cases, the probable cause can be detected (i.e. a new drug/alcohol problem or a recent withdrawal from that drug/alcohol problem can be found to be the trigger of anxiety). Anxiety disorders are generally found to be a very persistent stress/worrying condition over a fairly long period of time, causing restlessness, concentration loss, and sleeping problems. A panic disorder may come and go during the anxiety issues.


Due to the high association of anxiety with depression, anti-depressants are normally tried first. However, there are many medication options depending on the specific case. In general:

  • Benzodiazepines (Clonopin, Ativan, etc) may work very quickly for anxiety, but they can be highly addictive.
  • Tricyclics (Trofanil, Pamelor, etc) can be effective for anxiety or the combo of anxiety/depression, but the side effects can be a problem in some patients. In most cases, improvements are not noted until 8 weeks of treatment.
  • Serotonin re-uptake inhibitors (Lexapro, Paxil, etc) can also be effective for anxiety or the combo. Fewer side effect problems and minimal addiction issues make these very popular. These treatments also take 8 weeks to show improvements. BuSpar (a serotonin antagonist) is similar regarding side effects and addiction.
Though positive results may be achieved in 8 weeks or less, the normal treatment duration is 6 - 12 months.

In addition to medications, cognitive behavior therapy is helpful. This involves learning how to replace thoughts of stress/anxiety with positive thoughts. Normal therapy is a weekly session for 6 - 12 weeks.

One final note: anxiety disorders (with or without depression) may occur during pregnancy or postpartum. Addictive medications or ones with the potential for strong side effects are not normally used during this time (this includes breast feeding time).

For more info, see the August 12, 2004 issue of NEJM, or go to www.nejm.org

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