Generalized anxiety disorder treatment
The common rules of generalized anxiety disorder treatment
In early stages of the generalized anxiety disorder approximately six months are necessary for establishing the diagnosis and starting the generalized anxiety disorder treatment.
Frequently simple methods of patients’ consulting are effective. Consulting will consist of two components. At the beginning the character of the disorder is explained to the patient and assurance is given that physiological symptoms of disorder are not connected to any somatic illness. As anxious patients frequently concentrate poorly on the new information, it is useful to give them out an information leaflet in which the same items are explained in written form. Then the patient is helped to cope with any social problems associated with uneasiness. Uneasiness is amplified by uncertainty and consequently it is important to elaborate the precise plan of treatment.
Patients with generalized anxiety disorder are more sensitive to anxiogenic effect of caffeine. The majorities of patients find out it themselves and reduce the consumption of caffeine. If they have not made it yet, it is useful to advise them to lower or stop to consume the caffeine.
Patients with short-term uneasiness usually do not require further consulting, but in more serious and long-term cases additional cognitive, behavioral or pharmacological treatment is usually required.
Psychotherapy:
Relaxation training can be effective almost in all cases of generalized anxiety disorder. If the sessions are carried out on a regular basis, the effect of relaxation may become as strong as the effect anxiolytic preparations. However some patients stop prematurely the relaxation training. The patients’ motivation can be increased by means of group training, particularly in the support group. The teaching of anxiety management unites the relaxation with cognitive procedures, which help patients to cope with anxious thoughts.
Pharmacotherapy:
The use of medications in the generalized anxiety disorder treatment should be selective. Medications can be useful for quick elimination of generalized anxiety disorder symptoms until the psychotherapeutic methods produce appreciable result. Pharmaceutical preparations are also useful for those few patients whose condition does not improve with the help of psychotherapeutic approaches. However, today there is a general tendency to prescribe medications too frequently and for too long term.
For a short-term treatment of generalized anxiety disorder the use of one of the long-time acting benzodiazepines is indicated; for example, diazepam in a dose of 5 mg twice a day in mild cases or 10 mg three times a day in serious disorder. It is not recommended to prescribe the anxiolytics for the period more than three weeks as drug dependence may develop in case of their longer use.
Serotonin anxiolytic buspirone is as effective as benzodiazepines in the short-term treatment of generalized anxiety disorder; at the same time, it causes dependence much less often. In the past, barbiturates were used for the treatment of the generalized anxiety disorder, but the risk of dependence development is too great, and therefore they should not be used in the treatment of generalized anxiety disorder.
Beta-adrenergic blockers are of limited use for the generalized anxiety disorder treatment. Doctors prescribe them for elimination of tachycardia in cases when it does not disappear after treatment with anxiolytics. When beta-adrenergic blockers are used, it is necessary to take into account contra-indications to the use of beta-adrenergic blockers.
Tricyclic antidepressants produce both antidepressive, and anxiolytic effect. They operate more slowly, than benzodiazepines, but their effect is the same or even stronger. Besides, they cause dependence much less often in comparison with benzodiazepines. For generalized anxiety disorder treatment it is recommended to use one of the sedative antidepressants of amitriptyline type or imipramine, which does not possess such a sedative action, but produces the comparable effect. However, if imipramine is used, the initial dosage should be low and must be increased gradually.