Long term treatment of anxiety disorders

Abstract

Anxiety disorders, including panic disorder (PD), generalized anxiety disorder, and social anxiety disorder (SAD), generally have a chronic course.

Based on clinical experience, experts recommend that effective treatment be continued for at least 12 months. Only in the recent years, randomized long-term and relapse prevention studies with a duration of 24-52 weeks have been conducted to establish sustained efficacy of drug treatment, triggered by the requirements of the regulatory authorities. Now, an expanding body of evidence from controlled trials demonstrates the long-term efficacy and tolerability of the serotonin selective reuptake inhibitors (SSRIs) such as escitalopram, fluvoxamine, paroxetine, or sertraline, the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine, the calcium channel modulator pregabalin, the reversible inhibitor of MAO-A moclobemide and other drugs for the long-treatment of anxiety disorders.

All these studies confirm the necessity of continuous treatment over at least several months, as differences to placebo were still observable after treatment over half a year. Generally, the drugs were tolerated well during maintenance therapy. In the long-term treatment of anxiety disorders the same doses are usually prescribed as in the acute treatment phase.

There is also evidence for the effectiveness of cognitive-behavioral therapy (CBT). CBT and drug treatment can be combined, and at least for panic disorder, synergistic effects have been observed.