Substance abuse, which is very common in anxiety disorders, makes anxiety worse and harder to treat. Lack of social support is another important factor. “A big part of cognitive-behavioral therapy for anxiety is learning how to confront anxiety and cope with it. Supportive friends and family are an important part of treatment,” says Salcedo.
Studies show that using the Mood Disorders Questionnaire to diagnose mood disorders correctly is tricky. In one study, only one in five doctors was able to diagnose bipolar disorder correctly. DSM-5 categories are imperfect with lots of overlap.4
There are also different types of anxiety disorders to sort out. “Generalized anxiety disorder is probably the most resistant to treatment because it is always there. The other types of anxiety are more situational,” says Salcedo.
Front-line Treatments for Anxiety Disorder in Primary Care
Front-line treatments may include antidepressants (SSRIs or SNRIs), benzodiazepines, and cognitive-behavioral therapy (CBT). “Everyone should get CBT. If four to six sessions are not helping, an SSRI or SNRI should be added. Both medications are equally effective, but SSRIs are better tolerated and SNRIs have a more difficult withdrawal,” says Salcedo.
Antidepressants should show some effects in a few weeks but will not have full effects for six to eight weeks. The dosage needs to be increased until a plateau is reached. Benzodiazepines may be used as needed while other treatments are given time to work. However, they are not effective as long-term treatment.
“Giving benzodiazepines almost always suppresses anxiety. But anxiety will eventually escape, and escape with force,” says Bystritsky. These medications are dangerous in patients with a substance abuse history given they have dangerous withdrawal and significant cognitive side effects.
Learning the ABCs of Anxiety Can Improve Treatment
“The ABCs of anxiety are alarm, belief, and coping. Understanding the interconnections of these components is essential for people treating anxiety and for people being treated for anxiety,” adds Bystritsky. “This educational component is key to better treatment and compliance.”
Alarm is a deeply embedded, evolutionary, and protective function. Recognizing what triggers alarm signals helps to understand what triggers anxiety. Belief is how you assess anxiety-producing threats. False beliefs may contribute to anxiety disorders. Coping strategies are the mechanisms we all use to deal with anxiety. Bystritsky recommends the following website for anyone treating or suffering from anxiety disorder: https://www.anxiety.org/about-anxiety/abcs-of-anxiety.5