Innovative Treatments of Anxiety, Part 2 (Other Standard and Novel Therapeutic Approaches)
Mark H. Pollack, MD, Rush University Medical Center
Antipsychotics are used off-label as monotherapy and as an adjunct to selective serotonin reuptake inhibitors for anxiety, although the evidence of efficacy is mixed and these agents are associated with weight gain. Anticonvulsants have shown some efficacy for anxiety, especially posttraumatic stress disorder (PTSD). Gabapentin has been used for social anxiety; lamotrigine for PTSD. Prazosin, an antihypertensive, can improve sleep and decrease nightmares in PTSD. Using hypnotics to treat sleep disturbances after a traumatic event could reduce the likelihood of developing PTSD. Propranolol has been studied, but is not considered effective for preventing PTSD. Cognitive-behavioral therapy (CBT) is effective for anxiety, may have a lower relapse rate than pharmacotherapy, and has few adverse effects; however, it is more difficult to administer than medication and may not be widely available or affordable. Dr. Pollack recommends integrating CBT with pharmacotherapy. Researchers are examining augmenting CBT or exposure therapy with d-cycloserine.
