Anxiety Treatment and Drug Cautions

QUESTION: With all the news cautioning against the use of drugs, is there any
way you can still treat anxiety?
------------------------------------------------------------------------------
ANSWER: Anxiety is one of the most common psychological symptoms dealt with
in clinical practice, and for this reason, alternate forms of treatment should
be explored before drug therapy is used. In cases of mild anxiety, many
patients respond to meditation or exercise which can relieve some of the
edginess they experience. Relaxation techniques can also be quite helpful for
patients who wish to learn them. Anxious patients who suffer from insomnia
can frequently find relief by trying to establish a regular sleeping pattern
and by engaging in exercise early in the day.
It is important to bear in mind, however, that anxiety can vary a great
deal in intensity and treatment decisions must be based on the degree of
stress and disability suffered by the patient. In light of recent research,
it is now believed that anxiety can sometimes be a biologically determined
disorder. Therefore, physicians feel less guilty than they did in the past
about using drugs for its treatment. During the past year, a new drug called
buspirone has been introduced for anxiety treatment, and it offers some
promising advantages over previously prescribed drugs. To begin with, it is
nonsedating and therefore does not interfere with the patient's ability to
maintain normal functions. Use of the drug also poses a very low potential
for dependence or abuse. There is no cross-tolerance or cross-dependence with
alcohol, so it is unlikely to be abused by alcoholic or drug-dependent people,
and even with prolonged use, no withdrawal reactions occur. Therefore, as a
drug option, buspirone seems to be a good choice.
Like all drugs, however, busiprone does have a few minor disadvantages.
The drug has a delayed onset of action, taking two to three weeks before it
become effective. For this reason, it should not be used for patients needing
immediate relief for acute anxiety. In addition, since some patients desire a
sedative effect to help them sleep, buspirone's nonsedative formula seems
lacking. In such cases, benzodiazepines are usually prescribed. They have
been the antianxiety drugs of choice for the past 25 years and are still
considered quite effective.
In any case, when drug therapy is in order, it should always be used with
discretion. It is best to start with the lowest dose possible and increase as
needed. Once symptoms have been relieved to a tolerable degree, the drug
should then be discontinued. As your question implies, nondrug management of
any disorder is usually preferable. It is therefore our hope that as we
continue to gain insight into the mechanisms that produce anxiety, we will
eventually discover new and effective treatments.