Professional Care: Conventional Approaches

The focus of this document is primarily to emphasize approaches that can be used as adjuncts to conventional care (e.g., prescribing medications for anxiety). (Note that psychotherapy could also be considered a conventional approach by most, but it was featured in the previous section.) Conventional care is reviewed extensively elsewhere.^1,2

Antidepressants benefit 50%-65% of people with anxiety disorders, and medications are considered a first-line treatment. A 2019 review of 89 trials (n=25,441 people) looking at treatments for generalized anxiety disorder found that duloxetine, pregabalin, venlafaxine, and escitalopram were more efficacious than placebo and relatively well tolerated.³ Smaller sample sizes also indicated potential benefit from mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine. Quetiapine had the largest effect but was not well tolerated. The same was true for paroxetine and benzodiazepines.

In working with people with anxiety, keep in mind that anxiety tends to be linked to a number of other medical and mental health conditions as well, especially for women and those with poorer health-related quality of life.⁴ Keep comorbidities in mind. For instance, anxiety has a bidirectional relationship (it both causes and is caused by) with arthritis, and having it is a strong predictor of future gastrointestinal disease. Panic disorder is linked with up to a 45% rate of comorbidities, with 1½ to 2 times the risk of conditions like diabetes, IBS, respiratory diseases (asthma and COPD), and cardiovascular disease.⁵ Before diagnosing anxiety, clinicians should rule out other health issues that can mimic it, such as thyroid problems, adrenal tumors, insomnia, and substance use.