There are two main types of treatment options for anxiety: medications and psychological counseling (psychotherapy). Depending on the severity of symptoms, psychotherapy can be used alone or combination with medication. NPF recommends a personalized, holistic and comprehensive strategy for the treatment of mental health problems, meaning that care should be tailored to each person’s individual health needs and preferences.
The following are treatment options for anxiety disorders:
A newer class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are typically the first-line treatment for depression and anxiety disorders. All of these medications have been shown to be helpful for one or more anxiety disorder. They include:
- fluoxetine (Prozac®)
- sertraline (Zoloft®)
- paroxetine (Paxil®)
- citalopram (Celexa®)
- escitalopram (Lexapro®)
For patients with anxiety attacks, very low dosages should be used at first, as there is evidence that these medications can actually increase attacks when first started at higher dosages. An added benefit of using SSRIs is that they also work for depression, which often occurs simultaneously.
Benzodiazepines (anti-anxiety medications)
An older class of medications called benzodiazepines is used to treat anxiety disorders and target the brain chemical GABA. Most of these medications have been around for many years. They include:
- diazepam (Valium®)
- lorazepam (Ativan®)
- clonazepam (Klonopin®)
- alprazolam (Xanax®)
These medications can be very effective for anxiety, sometimes working better than antidepressants. They take effect very quickly, often providing some relief after a single dose, though they have to be taken regularly for a lasting effect. Also, they can help with other symptoms of Parkinson’s, including certain types of tremor, muscle cramping and sleep changes. Major drawbacks of using benzodiazepines include memory difficulties, confusion, increase in balance problems and tiredness. These medications should not be stopped suddenly, as patients can have serious withdrawal symptoms such as seizures and severe stiffness called spasticity.
NOTE: Benzodiazepines should be used with caution in older patients with Parkinson’s or in those with dementia. If used regularly, they should never be stopped suddenly to avoid serious withdrawal symptoms.
Psychotherapy or “talk therapy” is a term used to refer to the many varieties of counseling available today. This type of treatment can help people diagnosed with an anxiety disorder understand their illness and better manage their symptoms. Mental health professionals who provide therapy include psychologists, social workers, psychiatrists, licensed professional counselors, and specially-trained nurses. Importantly, the first step is to find a compatible therapist. Here are ways that quality therapy can be beneficial.
- Cognitive behavioral therapy (CBT) is a popular technique that has been shown to be very effective at helping people change negative thinking patterns and behaviors in order to solve their problems and engage in life.
- CBT encourages patients to develop more positive thoughts about themselves, the environment around them and their future: in this case the outcome related to their illness.
- Counseling sessions can provide vital support, understanding and education. Patients may be seen alone, as a couple or family, or in a group.
- For those who do not want to take medication, psychotherapy offers two advantages: no drug side effects and coping skills that can be used over the long term.
Page reviewed by Dr. Joash Lazarus, NPF Movement Disorders Fellow, Department of Neurology at Emory University School of Medicine.