Some forms of anxiety disorders such as persistent phobia, PTSD and OCD requires medical treatment. The resistance to psychological forms of treatment usually indicate deficits in extinction mechanism of the fear response.
Medications such as Alpha 1 NA receptor antagonist and Alpha 2 Adrenergic receptor agonists blunt the heightened Noradrenergic surge associated with arousal symptoms of PTSD, including REM sleep disturbances and nightmares. Whereas, beta-Adrenergic blockers such as propranolol can potentially block reconsolidating and recall of traumatic memories. It can also reduce the physiological and psychological symptoms associated with performance or stressful situation and hence can be used in social phobia. NMDA receptor partial agonists such as D-cycloserine on the other hand enhance the fear extinction when used in combination with exposure therapy. It can help in acrophobia and social phobia.
Generally, anti-depressants are considered to be the first line medications for anxiety disorders as it works for anxiety disorders in addition to depression. Selective serotonin reuptake inhibitors (SSRIs) are the most widely used medications to treat anxiety. Examples are fluoxetine and citalopram. If SSRI’s are not suitable, a serotonin and noradrenaline reuptake inhibitor (SNRI) such as venlafaxine and duloxetine. Benzodiazepines are sometimes used to treat anxiety, but they are no longer recommended as an initial treatment because they’re addictive, and their effects don’t last long.
Cognitive behavioral therapy (CBT) is the best type of psychological treatment for anxiety disorders. When you do CBT you will start by learning about healthy anxiety and the way our brains handle anxiety. Then you will learn how to challenge your unhelpful thoughts and control your anxious thoughts and behaviours. You should see an improvement in 4–8 weeks if the treatment works.
Exposure therapy lets you gradually confront a situation that makes you anxious. First, you make a list of all the things that you are avoiding due to anxiety. Then you start by doing the easiest thing, and gradually work your way up to the hardest.
Psychiatrists at Mindoc would evaluate your condition in detail, go through your past blood results and investigations, rule out medical causes for your anxiety and finally discuss a tailored treatment plan for you. This may involve a combination of psychological and medical interventions. Our psychiatrists are qualified to perform CBT and exposure therapy but we are happy to liaise with your psychologist if you are already undergoing psychotherapy.