The Course of Anxiety Management: A Psychiatric Nurse Practitioner's Outlook
Written By: Integrative Mind
In my capacity as a psychiatric nurse practitioner, my primary goal is to navigate and deliver the most fitting and effective treatment solutions for those dealing with mental health issues, including anxiety disorders. The anxiety management field has experienced considerable growth recently, with several pharmacological and non-pharmacological treatment options demonstrating optimistic results in research studies.
In this piece, I will explore both established and emergent pharmacological interventions for anxiety and shed light on non-medication-based methods that can bolster pharmacotherapy, all of which are supported by evidence-based research.
Conventional Pharmacological Treatments
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), are frequently prescribed for anxiety disorders, encompassing generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. These medicines increase the serotonin level in the brain, which aids in mood stabilization and anxiety control. A meta-analysis concluded that SSRIs were more effective than a placebo in managing anxiety disorders (Bandelow et al., 2015).
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs, which include venlafaxine (Effexor) and duloxetine (Cymbalta), inhibit the reuptake of both serotonin and norepinephrine. These medicines can be particularly beneficial for individuals with concurrent depression and anxiety or those suffering from chronic pain symptoms.
Benzodiazepines
Medicines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax) are often administered for short-term anxiety symptom management due to their swift action onset. Nonetheless, they are associated with a risk of dependence and are usually not recommended for prolonged use. A systematic review confirmed that while benzodiazepines were successful in treating anxiety disorders, they presented a higher risk of side effects compared to SSRIs and SNRIs (Baldwin et al., 2011).
Emerging Pharmacological Treatments
Pregabalin (Lyrica)
Originally designed to treat epilepsy and neuropathic pain, Pregabalin has shown promise in managing anxiety disorders, particularly GAD. Pregabalin operates by binding to voltage-gated calcium channels, thus reducing the release of excitatory neurotransmitters. This study confirmed that Pregabalin was more potent than a placebo in managing GAD, with rapid action onset and good tolerability (Boschin, 2011).
Oxytocin
This neuropeptide hormone is being explored for its potential anti-anxiety effects. Preliminary research suggests that oxytocin may alleviate anxiety symptoms in social anxiety disorder and other anxiety disorders. A review found that intranasal oxytocin administration reduced anxiety and improved social cognition in individuals with social anxiety disorder (De Cagna et al., 2019).
Cannabidiol (CBD)
CBD, a non-intoxicating compound in cannabis, has sparked interest as a potential treatment for anxiety disorders. Research suggests that CBD might have anti-anxiety effects via its modulation of the endocannabinoid system and serotonin receptors. A systematic review confirmed that CBD was effective in reducing anxiety symptoms across a range of anxiety disorders, including GAD, social anxiety disorder, and panic disorder (Blessing et al., 2015). However, further research is needed to determine optimal dosages and long-term safety.
Non-Medication-Based Treatment Options
Psychotherapy
Evidence-based psychotherapies, such as cognitive behavioral therapy (CBT), exposure therapy, and acceptance and commitment therapy (ACT), have proven effective in managing anxiety disorders. These therapies can be utilized independently or in tandem with medication to help individuals cultivate coping mechanisms and address the root causes of their anxiety. Meta-analyses have found that these therapeutic interventions significantly reduce anxiety symptoms (Hofmann & Smits, 2008; Swain et al., 2013).
Lifestyle Changes
Regular physical exercise, a balanced diet, and appropriate sleep hygiene have demonstrated their capacity to improve anxiety symptoms and should be considered as an integral part of a holistic treatment plan (Stonerock et al., 2015; Kalmbach et al., 2018). Limiting time online and with social media has been shown to have beneficial effects on the treatment of anxiety and depression as well (Vannucci et al., 2017).
Mindfulness and Meditation
Techniques such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have proven effective in managing anxiety symptoms. These practices foster self-awareness, emotional regulation, and stress reduction, beneficial attributes for managing anxiety. A meta-analysis of 39 studies found that MBSR and MBCT significantly reduced anxiety symptoms (Hofmann et al., 2010).
Biofeedback and Relaxation Techniques
Techniques such as biofeedback, progressive muscle relaxation, and deep breathing exercises can help individuals control their physiological responses to anxiety, ultimately reducing anxiety symptoms (Goessl et al., 2017). A systematic review found that these techniques significantly reduced anxiety symptoms (Manzoni et al., 2008).
Conclusion
With an increasing number of traditional and emerging pharmacological treatments available, along with evidence-based non-medication-based strategies, it is paramount to personalize treatment plans to the individual's unique needs and circumstances.
A comprehensive approach to anxiety management, incorporating both pharmacological and non-pharmacological strategies, often ensures the best possible outcomes for patients. It is vital for patients to collaborate closely with their healthcare providers to monitor progress, adapt treatment plans as necessary, and ensure the safe and effective control of their anxiety.
By keeping up-to-date with the latest advancements in anxiety treatment and incorporating evidence-based practices, healthcare providers like myself can play a crucial role in assisting patients in managing their mental health complexities. Together, patients and healthcare providers can cooperatively identify the most suitable treatment options, cultivating hope and healing in the process.
Integrative mind is a psychiatry practice in New York City that offers virtual in-network psychiatry and psychotherapy sessions for adolescents and adults. Our team is comprised of psychiatric clinicians and psychotherapists that specialize in treating a wide range of mental health conditions. Get started today!