Antianxiety therapy: potential value of long-term treatment

Although short-term therapy for patients with anxiety disorders has been the accepted mode of therapy, it has become increasingly evident that certain patients with generalized anxiety disorder, panic disorder, and chronic illness may require longer-term therapy. Therapeutic goals for such patients include reducing anxiety symptoms, returning the patient to normal or near-normal functioning, and improving quality of life. Clinicians must choose the appropriate drug regimen with regard to duration, continuous versus intermittent treatment, and administration on a daily versus as-needed basis. Because of the nature of some anxiety disorders, intermittent therapy very often may be preferred. Benzodiazepines are highly effective and safe anxiolytics, but with continuous use these agents have demonstrated psychologic and physical dependence problems. Other agents, such as tricyclic antidepressants and monoamine oxidase inhibitors, also relieve anxiety, although they have been shown to be unsuited for indiscriminate use. Buspirone, a newer anxiolytic, seems to be both effective and without abuse or dependence potential. In all cases, the prudent clinician should combine good patient management within the context of a good doctor-patient relationship.