The assessment and treatment of refractory anxiety

Most patients with anxiety disorders can be effectively treated with the use of specific pharmacologic and psychological approaches. Nevertheless, some anxiety patients remain refractory to standard treatments. For these patients, reappraisal and a systematic approach can be helpful. A common problem in patients with "treatment-resistant" anxiety is the use of inadequate doses or inadequate duration of medication treatment. Alternatively, the diagnosis may need to be reconsidered, and comorbid diagnoses carefully assessed. Comorbid psychiatric, medical, and neurologic conditions may complicate the treatment of anxiety or require additional specific treatments. Finally, alternative pharmacologic approaches for specific types of anxiety can yield successful outcomes.