Anxiety: How to Decide Which Treatment is Best for You

By Wallace B. Mendelson, M.D. | Published 7/10/2019 0

anxiety treatment

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In this article, we will look at practical steps to take if you are experiencing anxiety. A good place to begin is to realize that anxiety may have many sources. So, an important first step is to see a doctor in order to explore some possible causes for anxiety. Among these are some medical illnesses, medications, and psychiatric conditions. Let’s look at each of these in turn.

Possible causes of anxiety

  • Medical illnesses associated with anxiety  

Many medical conditions are associated with anxiety symptoms, including the following:

        • hormone disorders such as an overactive thyroid
        • nutritional problems such as Vitamin B12 deficiency
        • heart disorders such as angina and abnormal rhythms

There are many other conditions as well. Your doctor can determine if any are a problem for you.

  • Medicines and other substances can cause anxiety

There are quite a few medications that can cause anxiety. Among these are stimulants and medicines for ADHD, thyroid, asthma, and Parkinson’s disease. If it appears that a medication may be involved in anxiety, it’s important to not immediately stop it. Instead, consult a doctor to consider lowering the dose or changing to a different medicine.

Many over-the-counter drugs (OTC) contain caffeine and can potentially contribute to excessive caffeine consumption. Caffeine in excess can make you feel anxious. Some OTC preparations for pain, menstrual discomfort, and migraine may have caffeine in them.

Psychiatric conditions and anxiety

In addition to anxiety disorders, the symptom of anxiety may be a part of a wide range of psychiatric conditions which have specific treatments of their own. Among these are

        • obsessive-compulsive disorder
        • post-traumatic stress disorder (PTSD)
        • eating disorders
        • substance abuse

Is specific treatment for anxiety needed?

After causes such as medical illnesses, medicines, and other psychiatric disorders have been ruled out, it is time to address the anxiety and determine whether treatment is in order.

Anxiety is a part of everyday life, and indeed, in moderation can have useful purposes. It can be a spur to solving problems and learning to be more productive. Every life has its ups and downs, and often these ‘downs’ can be anxiety-producing.

The point at which normal anxiety becomes a disorder such as Generalized Anxiety Disorder (GAD) is when it meets the following criteria:

  • It has become more frequent (occurs on most days for at least six months)
  • It’s difficult to control
  • lt leads to significant distress or it starts to inhibit one’s ability to function.

When anxiety is present but falls short of this mark, if it still feels uncomfortable, one option is to address it in psychotherapy. It may come out in therapy, for instance, that the anxiety stems from conflicts between a person’s desires and their beliefs about what is appropriate. Or from an unhelpful way of thinking about relationships.

The good news is that one can learn ways to better tolerate a certain amount of anxiety. On the other hand, when anxiety crosses the mark into anxiety disorders due to its frequency, an uncontrollable quality and effect on functioning, it is clearly time to seek treatment.

Choosing the type of treatment:

As I write in my new book, “Understanding Medicines for Anxiety,” the basic treatment choice is between medications, psychotherapy or combination treatment.

  • Why choose medication?

Initial factors favoring medication would be if symptoms are moderate-to-severe and the speed of response is important. The onset of the effect of many, but not all, medicines can be very rapid. The price of choosing this treatment modality on the basis of speed, however, is that there can sometimes be medication side effects.

Medication might also be considered if a person does not have the time or wherewithal for psychotherapy. Or, if they have been in therapy but do not feel the desired symptom relief.

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  • Why choose psychotherapy?

Factors that would favor psychotherapy include being pregnant or nursing, having more mild-to-moderate symptoms, and having the available time and resources.

Many psychotherapies for anxiety are relatively brief, often 3-4 months. They are also advantageous if a person is particularly concerned about the possibility of medicine side effects.

Another factor favoring therapy would be that if in addition to anxiety, a person seems to have habitual ways of dealing with others that are not helpful. For instance, typically being dramatic and emotional, being extremely sensitive to rejection, or overly suspicious or manipulative. These kinds of habits can be addressed in psychotherapy, which can often benefit anxiety.

  • Other considerations

The most important incentive for choosing a medicine or non-medicine approach would be the lack of adequate improvement with the other treatment.

Finally, medicines and therapy are also not incompatible and are often combined.

Setting realistic goals

It is valuable to think about what a reasonable outcome would be right from the beginning. It’s natural to want relief from the uncomfortable feeling of excessive anxiety.

However, it is important not to imagine a goal of living in a kind of blissful state completely free of anxieties and worries. The world won’t allow it. Life has too many ups and downs. Also, in moderation, anxiety can help with the difficult parts. Even if it were possible to eliminate all anxiety, upon reflection, it might be a kind of dreary, colorless kind of existence.

The good news is that the kinds of treatments we have described here can greatly decrease levels of excessive anxiety. A reasonable goal is that if it is not completely abolished, it is brought to a point where it is manageable. And, it is not inhibiting how one functions or one’s capacity for experiencing pleasure.

It’s possible that the anxiety might reappear at some point in the future. If so, it’s good to know that it has happened before and was dealt with effectively and can be dealt with again this time.

The important thing to remember is that you are not helpless in the face of anxiety. There are many options available and learning about them can help in making the choices that are best for you.

Additional Article by this Author: Melatonin – Can it Help with Your Insomnia?



Wallace B. Mendelson, M.D.


Wallace Mendelson, MD is Professor of Psychiatry and Clinical Pharmacology (ret) at the University of Chicago. He is a Distinguished Fellow of the American Psychiatric Association and a member of the American Academy of Neuropsychopharmacology. He was the director of the Section on Sleep Studies at the National Institute of Mental Health, the Sleep Disorders Center at the Cleveland Clinic Foundation, and the Sleep Research Laboratory at the University of Chicago.

He is the author of seven books and numerous professional papers. Among his honors have been the Academic Achievement Award from the American Sleep Disorders Association in 1999 and a special award for excellence in sleep and psychiatry from the National Sleep Foundation in 2010

Dr. Mendelson's most recent books, Understanding Medicines for Anxiety
and and Understanding Antidepressants are available on Amazon. For more information on Dr. Mendelson and his work, click here.

See more information on Dr. Mendelson on Wikipedia.

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