Psychotherapy and medications are important treatment modalities for anxiety disorders. Both are effective for most anxiety disorders, and the choice depends on many factors including patient preference, practitioner preference, previous treatment, family history, availability, and cost. The efficacy of medication for anxiety disorders is similar to the best psychological therapies. There appears to be a longer-lasting therapeutic benefit with the psychological therapies [18]. For many patients, a combination of pharmacotherapy and psychotherapy is the best approach to treatment.

Cognitive behavior therapy (CBT) has been empirically validated for the treatment of anxiety disorders [18]. There are patients, however, who respond incompletely or not at all to CBT [10]. Psychotherapy alone may be helpful as a first-line form of treatment for patients with mild anxiety such as situational or adjustment problems. A brief course of a rapid-acting anxiolytic such as a benzodiazepine may also be helpful in these patients. Patients who have anxiety disorders and prefer to avoid the use of medications may also benefit from psychotherapy.

The cognitive component of CBT helps patients modify distorted or inaccurate thinking patterns. The behavioral component helps patients change their reactions to situations that induce anxiety symptoms. Behavioral components include exposure (confronting fear), response prevention (kept from performing behaviors), and relaxation, including deep-breathing exercises. The major aim of cognitive-behavioral and behavioral therapy is to eliminate beliefs and behaviors that maintain anxiety symptoms [7]. In particular, CBT attempts to increase cognitive control over the fear response [3]. The primary side effect of these forms of psychotherapy appears to be temporary discomfort due to increased anxiety levels [7].

The pharmacological treatment of most anxiety disorders includes the selective serotonin reuptake inhibitors (SSRIs), serotoninnorepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and the nonbenzodiazepine 5-hydroxytryptamine (5-HT1A) receptor agonist buspirone (BuSpar). It is important to consider comorbidity when a practitioner selects a medication regimen to treat an anxiety disorder [22].

There are several medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of anxiety disorders. The SSRIs approved by the FDA for the treatment of various anxiety disorders, include the following:

• Fluoxetine (Prozac, generics)
• Fluvoxamine (Luvox, generics)
• Paroxetine (Paxil, generics; Paxil CR)
• Sertraline (Zoloft, generics)
• Escitalopram (Lexapro)

The SNRIs approved by the FDA for the treatment of anxiety disorders include the following:

• Venlafaxine extended release (Effexor XR)
• Duloxetine (Cymbalta)

The benzodiazepines approved by the FDA for the treatment of anxiety and various anxiety disorders include the following:

• Alprazolam (Xanax, generics; Xanax XR)
• Clonazepam (Klonopin, generics)
• Lorazepam (Ativan, generics)
• Diazepam (Valium, generics)
• Chlordiazepoxide (Librium, generics)
• Oxazepam (Serax)
• Clorazepate (Tranxene, generics)

The nonbenzodiazepine 5-HT1A receptor agonist medications approved by the FDA for the treatment of anxiety disorders include the following:

• Buspirone (BuSpar, generics)

Other medications useful for the treatment of anxiety disorders include beta-blockers, tricyclic and other antidepressants, anticonvulsant medications, atypical antipsychotics,  antihistamines, and monoamine oxidase (MAO) inhibitors. Many of these medications are used off-label for the treatment of anxiety disorders, especially with difficult cases, and have anecdotal clinical as well as scientific literature to support their use.