Treatment of anxiety and panic disorders

Treating anxiety disorders takes a lot of patience!

In the previous articles you could learn a lot about the complex reasons and facets of anxiety and panic disorders. But how do you get rid of them?

Anxiety and panic disorders are usually well treated with psychotherapy, medication or even better with a combination of both. Relaxation techniques, such as autogenic training or progressive muscle relaxation according to Jacobson, are often used to support the therapy.^{1, 2, 3}

What you can do yourself¹

• The most important rule is: Face the anxiety-provoking situations and do not avoid them. This means, for example, taking the elevator even if you are afraid of it.
• It helps if you realize that signs of anxiety such as rapid heartbeat or dizziness are not precursors to fainting or a heart attack.
• It is difficult to face the anxiety-provoking situation that you have avoided for years. But the more often you manage to do it, the sooner you can reduce anxiety. Even small steps are successes!
• Do not hesitate to contact your family doctor's office or a psychotherapy practice. There you can make an appointment for a so-called "consultation hour". You do not need a referral for this. Dare to take this step. Nobody chooses their illness. A mental illness, like a physical one, is not a question of guilt: no one would be ashamed to go to the doctor because of back pain.
• Be prepared for the fact that the treatment of an anxiety disorder takes time.
• Crises are easier to overcome with support. Take advantage of support and counseling services. In self-help groups, you can exchange experiences with other sufferers.1 Psychotherapy.¹

Psychotherapy

The Cognitive behavioral therapy is at the top of the list. It involves the patient examining his or her current behavior and attitudes, learning to identify the reasons for them ("cognitive"), and learning ways to change his or her behavior. In other words, it is about guiding the patient to help himself in the present.⁴

In confrontation therapywhich is often part of behavioral therapy, a patient must then face the fearful situations in imagination, and later in reality, remaining in each situation until the fear has completely or largely receded.⁹

The psychodynamic direction assumes that unresolved conflicts (especially from the past) are responsible for present fears. Therefore, therapy involves working through current conflicts as well as past conflicts from childhood. Outpatient treatment often extends over several years.²

In addition, computers, tablets and smartphones can be used - for example, by recording one's feelings in a digital diary. It is also possible to access a virtual guide to relaxation exercises at home and at a time when they best fit into daily life.⁸ There are also online courses (even available on prescription) or alternative procedures such as hypnotherapy.  

Drug treatment

It should be noted that anxiety usually returns quickly after stopping medication unless psychotherapy is done at the same time. Because only in therapy you learn how to deal with the anxiety differently. That is why medication is usually prescribed in addition to psychotherapy.⁵

Medications that are also prescribed for depression are used, especially so-called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Another medication used for generalized anxiety disorder is pregabalin, a drug from the group of anticonvulsants (antiepileptics). Other effective drugs include so-called tricyclic antidepressants such as amitriptyline or trimipramine; typical anxiety relievers are also moclobemide, opipramol or buspirone.

The benzodiazepines (a typical benzodiazepine is diazepam / Valium), which are well effective in anxiety disorders, have a high risk of dependence. Therefore, they should only be used temporarily for severe anxiety in exceptional cases.

Drug therapy should be continued for at least six to twelve months after improvement has occurred.³

Traditionally, herbal agents such as St. John's wort, valerian, lavender, chamomile, or passionflower are considered to be sedative and thus antianxiety, but their efficacy is inferior to the above-mentioned medications, especially in severe anxiety and panic disorders.⁶

With all medications side effects and are usually most severe during the first few weeks of use and gradually subside thereafter. The most common side effects with SSRIs and SNRIs are gastrointestinal symptoms such as nausea, diarrhea, loss of appetite, and vomiting. Furthermore, sleep disturbances and sexual dysfunction may also occur. With SNRI, headaches, an accelerated heartbeat, and to some extent restlessness may occur at the beginning of use. However, the side effects with SSRIs and SNRIs are usually significantly less than with tricyclic antidepressants. In addition to the side effects mentioned so far, dry mouth, constipation, changes in heartbeat, dizziness, fatigue and also weight gain may occur.⁵

On the other hand, diabetes type 2 was found in more than St. John's wort the main thing to watch out for is sensitization to UV light, so you can easily develop sunburn even when there is no sun at all. In addition, St. John's wort influences the metabolism of other medications and, depending on the preparation, can strengthen or weaken its effectiveness. It is urgently recommended to read the chapterInteractionscarefully in the respective package inserts.⁷ 

And: Please report your side effects!!

Our reporting service offers you a quick and easy way to report side effects without revealing your identity.  

With every report, you actively contribute to improving drug safety by creating a better information basis for the future prescription of drugs.