Current therapeutic options in the management of typical anxiety.

Anxiety is a frequent symptom seen in a variety of clinical settings. Recognizing that therapeutic interventions (including drugs) can be costly and may involve potential risks, treatment of anxiety should proceed with some care. As outlined in Table 3, the first step is to establish a diagnosis, determining whether the anxiety is secondary to primary medical or psychiatric disorders. The remaining significant anxiety states fall into acute situational disturbances (best treated with benzodiazepines on a short-term basis) and the primary anxiety disorders. In each case, counseling or psychotherapy may be appropriate. Treatment of primary anxiety disorders is probably best accomplished by a combination of behavior interventions and, when necessary, temporary use of psychotropic drugs. The specific behavior intervention varies with the disorder (Table 6) and ranges from systematic desensitization or immersion techniques (for phobias) to thought stopping or aversion relief (for obsessive-compulsive behavior) to paradoxical intention (for panic disorders). Temporary use of tricyclic antidepressants or MAO inhibitors (probably equally effective) should be considered in the major anxiety disorders when panic attacks become frequent or subjective anxiety levels become intolerably high. Treatment of situational anxiety usually rests with counseling. When functioning is impaired, benzodiazepines can be most helpful as antianxiety agents or as hypnotics (e.g., flurazepam) for periods not to exceed 2-3 weeks.