Therapy, medication or both for anxiety?

Is therapy or medication better for anxiety?

Neither is better for everyone. Both psychotherapy and medication are established treatments for anxiety, and the National Institute of Mental Health says choosing a treatment plan is based on a person's needs, preferences and medical situation, in consultation with a mental health professional or health care provider. Many people use one, some use both, and some start with one and add the other later.

The research backs up that even-handed answer. A 2013 meta-analysis by Pim Cuijpers and colleagues pooled 67 trials that compared psychotherapy and antidepressant medication head to head, 27 of them in anxiety disorders, and found no significant overall difference between the two after treatment. The UK's National Institute for Health and Care Excellence, in its guideline for generalized anxiety, tells clinicians to base the choice between a high-intensity psychological treatment and medication on the person's preference, because there is no evidence that either is better.

Not every review lands in exactly the same place. A 2015 meta-analysis by Borwin Bandelow and colleagues found larger average before-and-after improvements in medication trials, while its authors still concluded that the choice should be left to the patient because drugs may have side effects, interactions and contraindications.

What medications are used for anxiety?

This section is general information from NIMH, not advice about your own treatment. Medication is prescribed by a medical provider, such as your primary care doctor, a psychiatrist or a psychiatric nurse practitioner. NIMH describes these main groups:

• SSRI and SNRI antidepressants, commonly used for generalized anxiety, panic and social anxiety. NIMH notes they may take several weeks to start working and may cause side effects such as headaches, nausea or trouble sleeping.
• Benzodiazepines, sedative medications that can reduce anxiety quickly. NIMH says some people build up a tolerance or become dependent, so providers usually prescribe them for short periods and taper them slowly. In 2020 the FDA required an updated boxed warning on the whole class about abuse, addiction, physical dependence and withdrawal reactions.
• Buspirone, a non-sedating anti-anxiety medication that NIMH says must be taken daily for 3 to 4 weeks to reach full effect and does not work on an as-needed basis.
• Beta-blockers, sometimes prescribed off-label for the physical symptoms of short-term anxiety, such as a racing heart before a performance. NIMH notes they are generally not recommended for people with asthma or diabetes.

What therapy offers that medication does not

Medication works on symptoms. Therapy works on the patterns around them: the thoughts that feed worry, the avoidance that keeps fear alive, and the life pressures that keep the pot boiling. NIMH puts it this way: even when medication relieves symptoms, psychotherapy can help address specific issues such as self-defeating ways of thinking, irrational fears, problems with other people, or difficulty coping at home or at work.

Combining them is common and often sensible. A 2014 meta-analysis by Cuijpers and colleagues found that adding psychotherapy to antidepressant medication produced better results than medication alone across depressive and anxiety disorders, with the clearest evidence for panic disorder among the anxiety conditions, and the advantage persisted at follow-up. The UK guideline is more cautious about combinations for generalized anxiety, noting that evidence there is lacking. That is one more reason to make this decision with a professional who knows your history.

If you want to know what therapy itself involves, see how counseling helps with anxiety.

Questions to weigh, and to take to your doctor

A primary care visit is a good place to start the medication conversation, and a reasonable place to rule out physical causes; NIMH notes that some symptoms are due to a medical condition. These questions can help:

• How much is anxiety disrupting work, sleep, relationships or ordinary errands right now?
• What have you already tried, and what helped even a little?
• Do you have a strong preference? Some people want to avoid medication; others want relief quickly while they start therapy.
• What other medications, supplements or health conditions does your prescriber need to know about, and what side effects should you watch for?
• How long will it take to know whether a medication is working, and who do you call if you have concerns?
• Can you get to regular therapy appointments? In Polk County that may mean a drive to Columbus, Hendersonville or Spartanburg, so plan for it.

If you already take medication

Keep taking it as prescribed while you consider counseling. NIMH is clear that people should not stop a prescribed medication, even if they feel better, without the help of a health care provider, because stopping too soon may cause unpleasant or harmful effects. If you are unhappy with a medication, that is a conversation for your prescriber.

Starting counseling does not mean changing your medication. Many people do both. If you would like your therapist and your doctor to be able to talk, you can give written permission for that, and you can limit what is shared.

Where Laura Bass fits

Laura Bass is a psychotherapist who works with adults; anxiety is among the concerns she sees. She does not manage medication, so if you are on a prescription, your doctor remains the person to ask about it. When you start, you can bring a list of current medications and the names of any doctors you would like Laura to be able to contact with your permission.

Laura has a part-time office at The Healing Cottage in Columbus. Ask which days she is there when you call 704-706-3264 or write through the contact page. The individual counseling page describes her work, and self-help for anxiety covers what you can do on your own in the meantime.

If anxiety ever turns into a crisis, or you have thoughts of harming yourself, call or text 988 at any hour. In Polk County, Vaya Health's 24-hour crisis line is 1-800-849-6127. If anyone is in immediate danger, call 911.

Common questions