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Anxiety is usually presented as an uneasiness about some impending or anticipated event, either real or imagined. Symptoms associated with anxiety include: rapid heartbeat, tremors, gastrointestinal problems, perspiration, dry mouth, dizziness, increased blood pressure, impatience, irritability, insomnia. There are many different types of anxiety disorders including panic disorders and social phobias.

Causes of Anxiety

Some anxiety disorders can be traced back to childhood events or fears. This can include traumatic events either witnessed or experienced. Also, anxiety disorders can be learned or can result from abuse. In addition, some anxiety disorders are physiological in causation. This means that they result from physical factors that may be beyond the persons control. There are effective tests available through a patient's doctor that can help identify and determine the cause of an anxiety disorder.

How Common is Anxiety?

According to the Southwestern Research Institute, 12.6% of adults in America each year suffer from an anxiety problem. According to the National Institute of Mental Health (NIMH), anxiety disorders are the most common mental illness in the United States. It is also known that anxiety disorders are often accompanied by other anxiety problems which makes their prevalence even greater.

How Does Anxiety Affect Quality of Life?

Anxiety disorders left untreated can make people avoid certain situations (called avoidance behavior) that normally bring on anxiety attacks. This can make the anxiety sufferer withdrawn, lonely, or depressed. Avoidance behavior can also affect a persons job or family life. In addition, people who suffer from an untreated anxiety disorder have a much greater potential for drug abuse. Drug abuse usually results from the desire to relieve the symptoms of anxiety, it is an easy but ineffective alternative to treating an anxiety disorder. As it will be explained, non-prescription methods of treatment are much safer, and are more effective long-term treatments than prescription drug use.

The management of anxiety with prescription drugs can cause a number of problems that can contribute to a diminished quality of life. A survey conducted by the National Institute of Drug Abuse indicates that two thirds of all people over the age of 65 are on prescribed medications. The second most commonly prescribed medication for those over 65 are sedatives and/or tranquilizers, which includes antianxiety medications (anxiolytics). More than half of these users report that they are unable to perform their daily tasks without these drugs, indicating that a great deal of anxiety sufferers over the age of 65 develop a dependence on the drug. Widespread dependence can be largely attributed to benzodiazepines. Benzodiazepines are a class of drugs with strong sedating effects and great addictive potential. Quite often they are prescribed as an initial treatment of anxiety, which may be appropriate, but are then used for an inappropriate amount of time. Long term use of benzodiazepines can lead to dependence and tolerance. It is also important to note that long acting benzodiazepines have been shown to increase the risk of falls in the elderly, which can lead to fracture or death.

Non-Drug Therapies

The National Institute of Mental Health has endorsed both 'behavioral therapy' and 'cognitive therapy' as highly effective forms of treatment for people with anxiety disorders. Behavioral therapy involves training in relaxation techniques and deep breathing which counteract the physical symptoms associated with most anxiety disorders. Cognitive therapy helps people learn how to control the thoughts that contribute to anxiety attacks. Usually, both of these therapy techniques are combined to provide a holistic approach to managing an anxiety disorder. In addition, family and group psychotherapy offer additional approaches to anxiety management. These forms of therapy are effective in giving anxiety sufferers support and confidence along the road to anxiety management. In cases where drug use is needed, medication is an adjunct to psychotherapy, in which case it has been proven to be extremely useful.

Drug Therapies

The most effective form of therapy for anxiety management has been shown to be a combination of cognitave behavior therapy and prescription drug use. Benzodiazepines are a very common form of drug therapy in the management of anxiety. About thirty years ago, benzodiazepines replaced barbiturates (a highly addictive and toxic class of drugs) because they were thought to be less toxic and less addictive. However, benzodiazepines were later found to be very addictive, and it was concluded that they should NEVER be used as a long-term therapy. Xanax is a benzodiazepine that is widely prescribed for anxiety, depression, and insomnia, yet is highly addictive.

A recent email to AgeNet's Ask a Pharmacist stated that, "My mom, age 87, has been on Xanax for a long time, and is trying to get off it. . . none of her doctors. . . will help her get off this dangerous, addictive drug. She didn't need it then. She doesn't need it now. How can we find a medical pro who will get her off this stuff? Side effects for her have included insomnia, anxiety, hypertension, nightmares/hallucination, depression, headaches, etc."

It is imperative to understand that some practitioners may not realize the impact that benzodiazepines may have on a person's quality of life. In addition, people cannot expect their doctors to have an easy solution to benzodiazepine addiction.

As a short-term treatment option, the best benzodiazepines are Ativan (Lorazepam) and Serax (Oxazepam). This judgement is based upon comparing the relative toxicities of the benzodiazepine class. In any case, all benzodiazepines can cause dependence, hence their use should be closely monitored.

BuSpar is an excellent alternative to benzodiazepines, and is the AgeNet preferred drug for the treatment of anxiety disorders. It has been shown to have much less potential for addiction. One disadvantage is that BuSpar is not effective at relieving acute panic attacks associated with some types of anxiety disorders.

Other alternatives such as herbal supplements exist. For the management of anxiety, people sometimes use Kava Kava, even though it is only proven effective as a muscle relaxant. It is always best to seek medical advice when considering treatment methods for these disorders. Please read AgeNet's herbal supplement review before considering treatment with herbal supplements.

We hope this review has provided you with information to help you become informed about the management of anxiety.

Preferred Anxiolytics

Preferred Anxiolytics	Cost	Manufacturer	Generic	Cost
BuSpar (Buspirone)	$$$$	brand	no	na

Acceptable Anxiolytics

Acceptable Anxiolytics	Cost	Manufacturer	Generic	Cost
Ativan	$$	brand	Lorazepam	$
Serax	$$	brand	Oxazapam	$

Non-preferred Anxiolytics

Non-preferred Anxiolytics	Cost	Manufacturer	Generic	Cost
Tranxene	$$$	brand	Clorazepate Dipotassium	$
Xanax	$$$	brand	Alprazolam	$$
Klonopin	$$$$	brand	Clonazepam	$

Excluded Benzodiazepines

Excluded Agents	Cost	Manufacturer	Generic	Cost
Librium	$$$	brand	Chlordiazepoxide	$
Valium	$$$	brand	Diazepam	$

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