Feeling anxious is a normal protective response to challenging situations, and a certain degree of anxiety can be useful, helping to increase performance to some extent. However, if symptoms become severe, anxiety can interfere with a person’s ability to function in work or social situations, and impair quality of life to such an extent that help is required. 

This module outlines the main anxiety disorders and their treatments. It focuses on the most important features of drug therapy for anxiety and summarises ways in which pharmacy can help patients with anxiety. 

Symptoms

Symptoms of anxiety can be both physical (e.g. dry mouth, sweating, over-breathing, palpitations, flatulence) and cognitive/psychological (e.g. fear, worry, sleep disturbance, irritability). Anxiety can also result in behavioural changes (e.g. avoidance of certain situations), which can reinforce the anxiety.

Anxiety disorders are common, but sufferers are often reluctant to seek medical help. Assessment of patients presenting with anxiety symptoms involves excluding a medical cause, identifying features of specific anxiety disorders and other co-existing psychiatric disorders (such as major depression, substance abuse or schizophrenia), and assessing the degree of distress. 

It should be noted that it is possible for patients to have symptoms of multiple anxiety disorders without fulfilling the criteria for any specific disorder.

Facts about anxiety disorders

• Anxiety disorders are usually managed with psychological therapy (e.g. cognitive behavioural therapy) or drug therapy
• Selective serotonin receptor inhibitors (SSRIs) are first-line drug therapy for most anxiety disorders
• The anti-anxiety effect of psychological or drug therapy can take time to develop and symptoms may get worse before they get better
• After anxiety symptoms have been controlled, many months of therapy are needed to prevent relapse
• Discontinuation symptoms may develop if treatment is stopped abruptly, so the dose should be reduced gradually.