Chronic anxiety: deciding the length of treatment

Anxiety disorders are chronic illnesses requiring long-term treatment. Relapse is typical and should not be considered treatment failure. Although the general guiding principle of pharmacotherapy for anxiety disorders--the lowest effective dose for the shortest possible time--remains, this rule should not interfere with the judicious use of medications as long as the benefits justify it. Although most antianxiety drugs are safe and have no long-term side effects, periodic drug discontinuation should be attempted. Establishing a secure and specific diagnosis and ruling out concomitant psychiatric and medical illnesses will augment the success of pharmacotherapy. The efficacy of nonpharmacologic treatments alone is, with very few exceptions, unsubstantiated at present; however, nonpharmacologic techniques may well supplement medication trials. Based on these principles and on the available data, specific recommendations are given for treating patients with generalized anxiety disorder, panic disorder, social phobia, and obsessive compulsive disorder.