What's the standard of care for treating anxiety today? What's on the horizon?
Posted Oct 15, 2014
How best to treat anxiety? And is there new hope on the horizon? To address those questions, I turned to Dr. Daniel Pine. He has written over 200 papers on anxiety, mood, and behavior disorders and is Chief of the National Institute of Mental Health (NIMH) section of development and affective neuroscience. I spoke with him yesterday.
Marty Nemko: Anxiety takes different forms, for example, phobias, panic attacks, social anxiety, PTSD, and, most common, generalized anxiety. Is the current thinking that they generally have different etiology?
Daniel Pine: There’s more evidence they’re similar. For example, people with one form of anxiety often have another, if not on the same day, over time. The strongest evidence that forms of anxiety have different causes is that average age of onset is different. For example, phobia and social anxiety typically begin before puberty, generalized anxiety and panic disorder after.
DP: All mental health problems are caused by a mix. Well over half the variance in bipolar and Attention Deficit Hyperactivity Disorder (ADHD) is genetic, slightly less than half in anxiety.
MN: Is there a definable level of severity of anxiety at which one should seek treatment?
DP: If the person avoids doing important things because of undue anxiety or even simply feels quite anxious doing them, the person should seek an evaluation.
MN: Should different forms of anxiety be treated differently?
DP: In general, all forms of anxiety respond well to cognitive-behavioral therapy (CBT) and/or Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram (Celexa), Fluoxetine (Prozac), Paroxetine (Paxil), and Sertraline (Zoloft). While CBT and SSRIs are also standard treatments for depression, both tend to be more effective for anxiety than for depression, especially in adolescents.
MN: Are those drugs equal in effectiveness?
DP: A discussion with your physician and a trial can help you make the optimal choice.
MN: Are there any differences in SSRIs’ effectiveness across the types of anxiety?
DP: Obsessive-compulsive disorder (OCD) tends to respond somewhat less well and tends to be more persistent than some other anxiety disorders.
MN: If SSRIs and cognitive-behavioral therapy don’t work well enough, what should a person do?
DP: There are many other possible treatments, including other non-pharmacological treatments and medications such as seizure medications or benzodiazopines such as: Alprazolam (Xanax), Clonazepam (Klonopin), and Diazepam (Valium).
MN: Benzodiazepines can create physical as well as psychological addiction within months. In light of that, what’s best advice about their use?
DP: As long as you follow your physician’s advice, they can be used safely, especially for short-term treatment.
MN: What does the data say about alternative treatments: exercise, herbs, meditation, etc.?
DP: The data doesn’t support the use of herbs. Regarding exercise, mindfulness, and computer training, the quality of research is improving and worthy of continued study. We’re seeing promising results with computer apps: games that teach people how to distract themselves from their irrational fears.
MN: Are you optimistic that we’ll have even better treatments in the future?
DP: Yes. We’ll likely make more progress in developing new treatments for anxiety than for other mental diseases because what works with animals usually works with humans.
MN: Anything else you’d like to share with my readers?
DP: I think we’ve covered it.
Marty Nemko's bio is in Wikipedia.