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Many people have questions about anxiety treatments. What works best? Are there specific treatments for different types of anxiety disorders? Do you need to see a healthcare professional, or could you just wing it?
These are all great questions! Here’s the scoop: Anxiety doesn’t usually get better on its own. It’s important to treat anxiety, especially if you’ve had symptoms for more than six months. Keep reading to get all the information you need about anxiety treatment.
What is anxiety?
Anxiety is a feeling of intense fear, nervousness, or worry about a situation. Many people feel anxious before going to school, work, or speaking in front of an audience. This type of anxiety is normal. It’s usually short-term, and the feelings disappear once the situation is over.
Some people keep having feelings of anxiety even after the stressful event is over, though. When you feel anxiety symptoms for more than six months, you may want to visit your primary care or mental health professional (Chand, 2020).
Living with anxiety can be exhausting. Anxiety disorders are one of the most common psychiatric and mental health conditions. Some people start treating themselves with self-care stress management and relaxation techniques and get support from loved ones or family members. However, for some people, this may not be enough.
Meditation for anxiety: does it work?
Even if you’ve already been diagnosed with one anxiety disorder, there can be several causes and underlying medical conditions that increase your anxiety symptoms. Treatments are available to help you manage your anxiety disorder. Your healthcare provider should customize treatments to you; what works for someone else may not work for you.
Types of anxiety disorders
There is no single cause for anxiety. Your genetics, environment, personality, and health all play a role in how you respond to stress.
Our bodies react to potentially dangerous situations with a “fight-or-flight” reaction. This reaction floods your body with hormones to help you manage the frightening situation. Anxiety disorders happen when you can’t switch off negative thoughts and your stress reaction. Treatments for symptoms of anxiety and anxiety disorders work in different ways to address all these aspects.
There are several different types of anxiety disorders—they all share this fight-or-flight hormonal response, but each has its own characteristics.
People with phobias are frightened by particular objects, activities, or situations. Claustrophobia (fear of small spaces) and agoraphobia (scared to leave the house) are two common examples of phobias. Phobias are among the most common anxiety disorders, and treatment usually involves exposure therapy (Samra, 2020).
Social anxiety disorder
Social anxiety disorder or social phobia is when people have anxiety or fear about social situations. They may feel they will be judged harshly or be humiliated when they’re around people. Treatments include medications and therapy (Rose, 2021).
Separation anxiety disorder
Separation anxiety disorder (SAD) is typical for children up to age three. Older children and adults often have separation anxiety disorder with other anxiety disorders, particularly panic disorder in adults. Psychotherapy is the treatment of choice (Feriante, 2021).
Generalized anxiety disorder
Generalized anxiety disorder (GAD) happens when extreme worry impacts a person’s daily activities. GAD is linked with depression—many people are diagnosed with both. Treatment includes both psychotherapy and medications (Munir, 2021).
Generalized anxiety disorder (GAD): symptoms and diagnosis
Panic disorder is when a person keeps having unpredictable panic attacks, usually with no warning. Panic disorder and panic attacks are both anxiety disorders but considered separate mental illnesses (Cackovic, 2020).
Panic attacks can have frightening physical symptoms like shortness of breath, chest pain, muscle tension, and nausea. People can also have emotional symptoms where they may feel they are dying (Cackovic, 2020).
Treatments for panic disorder include having a complete exam to rule out any underlying health condition that can cause these physical symptoms. If the health condition is treated and symptoms remain, treatment protocols include psychotherapy and medications (Cackovic, 2020).
Obsessive-compulsive disorder (OCD) is when a person obsesses or constantly thinks about an action or an object that leads to compulsive or repetitive behaviors. For example, some people with OCD are frightened of germs and may wash their hands repeatedly, even to the point where it damages their skin. These obsessions can interfere with daily life activities, including work or social situations. Treatments for OCD include medications, talk therapy, and brain/nerve stimulation devices (Brock, 2020).
How can I treat my anxiety?
The mainstays of treatment for anxiety are therapy and medication. There are some outside-the-box therapies as well, if your anxiety is resistant to the standard treatments.
Psychotherapy for anxiety
There are several treatment options for anxiety disorders. You will need a licensed mental health professional—a psychologist or psychiatrist—to help you develop a treatment plan that works for you. Most therapists see their clients in one-on-one sessions or group therapy (Health Quality Ontario, 2017).
You can benefit from psychotherapy by seeing your therapist in person or online (Eilert, 2021).
One of the most effective therapies for treating the symptoms of anxiety disorders is cognitive-behavioral therapy (CBT). CBT helps you identify what triggers your anxiety and teaches you tools and skills to change your reaction to fearful or anxiety-provoking situations.
CBT therapists can modify standard cognitive-behavioral therapy by adding other types of therapy for other anxiety disorders. Cognitive-behavioral therapy is appropriate for all anxiety disorders (Health Quality Ontario, 2017; Eilert, 2021).
If you suffer from phobias, your CBT therapist may recommend exposure therapy. Exposure therapy is where the therapist gradually exposes you to the anxiety-provoking object or activity in a safe and controlled way. This process often starts with imagery and progresses to the actual feared activity or object.
An example is where a person is afraid to leave the house (agoraphobia). At first, the CBT therapist might have them imagine opening the front door. With every session, the person gets more exposure to all of the potential aspects of finally leaving the house. The overall goal is to eliminate the fear and anxiety related to the phobia. Exposure therapy is appropriate for phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
Prescription medications to treat the symptoms of anxiety
The U.S. Food and Drug Administration (FDA) regulates the medications used to treat anxiety disorders. Your primary care healthcare provider can prescribe these medications if you need them. But suppose your symptoms of anxiety are severe or aren’t responsive to your current treatment plan. In that case, your primary care provider may refer you to a psychiatrist to help manage your care with medication (Bandelow, 2017, Carl, 2020).
Buspar for anxiety: warnings and side effects
The medications used to treat anxiety work on hormones, neurotransmitters, and chemical messengers in your body. These include serotonin, norepinephrine, GABA, and epinephrine (Sartori, 2019).
The most common medications prescribed for anxiety disorders are antidepressants. While their original purpose was to help relieve depression, they help ease anxiety as well. There are several types of antidepressants, so if one doesn’t work for you, your healthcare provider may prescribe another.
Antidepressants for anxiety
Serotonin is a neurotransmitter that helps regulate your mood. People with anxiety disorder often have trouble with mood symptoms like feeling worried, frightened, irritable, or unable to sleep. These medications help increase serotonin levels in your brain so you can start feeling better (Bandelow, 2017; Sartori, 2019; Carl, 2020).
SSRIs: everything you need to know
SSRIs usually prescribed for anxiety disorders include fluoxetine (Prozac; see Important Safety Information), paroxetine (Paxil), and sertraline (Zoloft; see Important Safety Information). Other common SSRIs are citalopram (Celexa) and escitalopram (Lexapro; see Important Safety Information). SSRIs treat generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD) (Bandelow, 2017; Sartori, 2019; Carl, 2020).
SNRIs work similarly to SSRIs by increasing serotonin and limiting the effects of norepinephrine, a stress chemical, on the brain. SNRIs usually prescribed for anxiety disorders include duloxetine (Cymbalta; see Important Safety Information) and venlafaxine (Effexor; see Important Safety Information). SNRIs treat panic disorder, generalized anxiety disorder, and social anxiety disorder (Bandelow, 2017; Sartori, 2019; Carl, 2020).
Researchers are looking into how newer antidepressants, like mirtazapine (Remeron; see Important Safety Information) and vilazodone (Viibryd), may impact GAD. There are also some promising results from an older antihistamine called hydroxyzine. While results are encouraging, more extensive studies are needed (Strawn, 2018).
Benzodiazepines help increase the effect of GABA in your brain. GABA is an amino acid that helps you relax and sleep by lowering anxiety. Benzodiazepines are often prescribed as an anti-anxiety medication. Since they are highly addictive, many healthcare professionals try to limit these to short-term management of anxiety disorders.
Common benzodiazepines prescribed for symptoms of anxiety include lorazepam (Ativan), clonazepam (Klonipin), and alprazolam (Xanax). These treat generalized anxiety disorder, panic disorder, and social anxiety disorder (Bandelow, 2017; Sartori, 2019; Carl, 2020).
Beta-blockers are typically used to treat heart problems like high blood pressure. They work by blocking epinephrine—better known as adrenaline. Epinephrine is a hormone that increases your heart rate and blood pressure, and beta-blockers decrease those effects.
Beta-blockers are best for people with physical symptoms of anxiety, like a pounding or racing heart. Low doses of propranolol (Inderal) and atenolol (Tenormin) are prescribed for people with performance anxiety (Bandelow, 2017; Sartori, 2019; Carl, 2020).
Zoloft for anxiety: how is it used?
Other treatments for anxiety
If you are diagnosed with generalized anxiety disorder only, your primary care provider or psychiatrist may prescribe buspirone (Buspar). This medication works best for this type of anxiety disorder (Bandelow, 2017, Sartori, 2019).
Some mental health providers may use older medications like tricyclic antidepressants or monoamine oxidase inhibitors. These medications are generally used to treat depression but may also help treat the symptoms of anxiety disorders (Bandelow, 2017; Sartori, 2019).
The FDA approved ketamine, an anesthetic drug usually used for surgical procedures, for depression. This drug is generally given via muscular injection or IV, though it’s now also available in a nasal spray, called esketamine. Some healthcare providers provide ketamine to people with severe anxiety disorders, especially OCD, PTSD, and SAD (Ballard, 2020).
There are very few evidence-based studies on medical cannabis (marijuana). However, there are anecdotal reports on its effects on anxiety. A small amount of research shows that medical cannabis may be effective for social anxiety disorder (Sarris, 2020).
Brain and nerve therapies
People who suffer from severe anxiety disorders that do not respond to psychotherapy or prescription medication may try brain stimulation therapy. These therapies work on the parts of the brain that impact fear, mood, and stress responses. Most of these therapies are helpful for OCD, but there is some evidence that they can help treat panic disorders, too (Cirillo, 2019).
The most invasive of brain stimulation therapies is deep brain stimulation. The process of deep brain stimulation is similar to a heart pacemaker, in that an electrode is placed in the brain to control a person’s mood. Because this procedure is so invasive, it is currently reserved for extremely severe OCD (Cirillo, 2019).
Another form of brain stimulation is called repetitive transcranial magnetic stimulation (rTMS). It consists of electrodes being placed on the scalp rather than inside the head. This type of stimulation sends magnetic pulses to the brain to help with difficult-to-treat OCD. There are promising results of rTMS research for panic disorder, social anxiety disorder, and post-traumatic stress disorder (Guo, 2017).
Other transcranial (or scalp electrode) therapies currently being researched for anxiety disorders include transcranial direct current stimulation (tDCS) and transcranial electrical stimulation (tES) (Guo, 2017).
An older therapy best known for treating mania and depression since the 1930s, electroconvulsive therapy (ECT), is also being researched for generalized anxiety disorder, social anxiety disorder, OCD, and PTSD (Guo, 2017).
Another type of stimulation is vagus nerve stimulation. The vagus nerve starts from the head, travels down to the abdomen, and is connected to many areas in the brain. The FDA has approved vagus nerve stimulation to treat depression and epilepsy.
With vagus nerve stimulation, a small device is implanted on the left side of the chest. A thin wire is then attached to the vagus nerve, a major nerve in the body. A non-invasive vagus nerve stimulation device recently received approval from the FDA for cluster headaches only. Several studies are in progress to see if these work for all anxiety disorders (Carreno, 2017).
Some people want to try a more natural approach to treating their anxiety. Complementary or alternative providers typically don’t use prescription medications. Instead, they often suggest supplements or herbal remedies.
The FDA does not regulate herbal remedies and supplements, and there is little scientific research on their safety and effectiveness. Just because they’re “natural,” that doesn’t mean they’re automatically safe. It’s important to let your mental health professional or primary care provider know if you are taking anything besides your prescribed medications. Some herbal supplements may interact poorly with your prescriptions.
Essential oils for reducing anxiety
The only supplements that show some positive results in reputable studies are lavender and kava. More research is needed to determine if other herbs and supplements work for anxiety (Strawn, 2019).
Can my anxiety be cured forever?
Treating anxiety takes time—no matter which approaches you use. In some cases, it may take 6–8 weeks to see some results. If you have adverse side effects from your treatment plan, let your mental health provider know as soon as possible. Do not stop taking your medication without speaking to your healthcare provider first. Stopping therapy or medicine suddenly can cause other health problems.
Several factors cause anxiety; some you can control, like lowering your stress levels, and others you can’t, like your genetics. If your anxiety disorder has a genetic component, it may not be possible to cure your anxiety forever. However, psychotherapy, medications, and self-help strategies can help you manage the intense fear, worry, and other anxiety symptoms.
When you work with your healthcare provider to find the best treatment plan for you—and you follow that treatment plan—you will be able to get back to enjoying your life.
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