How can you help with anxiety?

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By Samir Vohra

Clinical quiz A heart attack has left a customer anxious about exerting himself and going out. What could help him?

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Mr Patel had a heart attack several months ago. He is now afraid to exert himself, has stopped going out and does not want to go back to work due to work-related stress.

QUESTIONS

1. Symptoms of anxiety include feelings of dread and irritability, increased muscle tension, dry mouth, shortness of breath, dizziness and trembling. True or false?

2. The aim of treatment is to reduce symptoms of anxiety to an acceptable level so that the anxiety no longer interferes with day-to-day living. True or false?

3. First-line recommended drug treatment for anxiety is with the SSRI sertraline due to cost-effectiveness. But sertraline is unlicensed for this. True or false?

4. Intense review of effectiveness of treatment is required initially. True or false?

5. Drug treatment can be simply stopped as and when required. True or false?

DISCUSSION

1. True. In anxiety there is an increased activity of the nervous system, which results in sufferers experiencing these symptoms.

2. True. Anyone can feel anxiety. Day-to-day situations can increase anxiety levels, such as a near miss when driving. These feelings are therefore normal. It is only when these feelings become more intense or long-lasting and they begin to interfere in someone's ability to concentrate and complete day-to-day tasks that anxiety becomes an issue.

3. True. Clinical trials have shown SSRIs to be clinically effective when compared with placebo in treating general anxiety disorder (GAD). There is no clinically significant difference in outcome when SSRIs are compared. Studies have shown that sertraline is the most cost-effective choice and associated with the lowest total costs among all treatments assessed, including no treatment. Sertraline is not licensed for the treatment of GAD; if it is prescribed, informed consent should be obtained from the patient and documented.

4. True. At the start of drug treatment, the effect on symptoms develops gradually and takes a week or more to become apparent. Therefore patients should be reviewed for effectiveness of treatment and side effects every two to four weeks during the first three months of treatment and every three months thereafter. Because of an increased risk of suicidal thinking and self-harm associated with SSRIs, patients under 30 years of age should be seen within one week of first prescribing an SSRI, and every week in the first month thereafter.

5. False. If drug treatment is effective then the person should continue taking it for at least a year, as the likelihood of relapse is high. Stopping SSRIs abruptly may lead to discontinuation symptoms.