Current Treatments for Anxiety and Obsessive-Compulsive Disorders

Abstract

Anxiety disorders are prevalent and represent an important focus of treatment within the field of psychiatry as well as within medicine more broadly. First-line pharmacotherapy treatment for anxiety disorders is serotonin selective reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). For patients who do not responsd to an initial first-line treatment, clinicians should ensure that there has been adequate exposure to the medication by assessing compliance and optimizing the prescribed dose. Non-response to a treatment trial should also prompt a re-evaluation of the diagnosis and a search for occult psychiatric, substance, or general medical disorders. Laboratory tests and other components of a diagnostic work-up should be considered if they have not already been completed. Following confirmation of the diagnosis, the clinician should consider a switch to an agent from a different class, for example a tricyclic antidepressant or monoamine oxidase inhibitor. Combination treatments with an antidepressant plus a benzodiazepine, second-generation antipsychotic, anticonvulsant, β-blocker, or other medication may be considered but data is limited. Psychotherapy is an important treatment component for anxiety disorders and should be implemented whenever feasible. Variants of cognitive behavioral therapy (CBT) in particular are effective in reducing anxiety symptoms, and data suggest that the combination for CBT plus medication may be particularly beneficial for patients. Obsessive-compulsive disorder (OCD), while sharing many clinical features with anxiety disorders, represents its own unique clinical challenge and has been removed from the category of anxiety disorders in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). SSRIs are first-line therapy for OCD and higher doses are often required compared with anxiety disorders or major depressive disorder. Exposure and response prevention may be a particularly helpful form of psychotherapy for this patient population. For severe, intractable OCD, deep brain stimulation may be an appropriate therapeutic option.