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In addition to ED treatment, patients in an acute anxious state of such severity that they pose a danger to themselves or to others should have a psychiatric consultation.In the best of circumstances, a calm environment and social support from family, friends, and the emergency staff are ideal.For patients with more severe anxiety, a short course of a fast-acting anxiolytic agent is recommended.

However, these patients can be discharged on a short course of benzodiazepines until they see a psychiatrist.

Americans' use of anti-anxiety medications has increased dramatically over the past decade, and while medications can play an important role in the treatment of anxiety disorders, they are not risk free and in some cases, may exacerbate the problem.

Nonetheless, because anti-anxiety medications work quickly and involve less effort than psychotherapy, they are a popular choice of treatment among both doctors and patients.

Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly the newer agents, which have a safer adverse effect profile and higher ease of use than the older tricyclic antidepressants (TCAs), such as selective serotonin reuptake inhibitors (SSRIs).

Behavioral therapy and CBT have demonstrated efficacy through controlled studies.

Psychodynamic therapy (or insight-oriented therapy) is rarely indicated as an exclusive treatment for phobias and is now mostly used for cases of phobic disorders that overlap personality disorders.Interpersonal psychotherapy (IPT) has also shown some efficacy.Eight trials examined the use of IPT for anxiety disorders and found large effects in comparison with control groups.There was no evidence suggesting that IPT is less effective than CBT for anxiety.Deciding which treatment or combination of treatments to prescribe depends on a careful interview and assessment of the patient's goals and level of pathology.The outcome of treatment is determined by several factors, including the following: Patients with significant discomfort from their anxiety can benefit from emergency anxiolytic treatment, primarily with a benzodiazepine.


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