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Anxiety disorders require professional treatment; simply trying to talk yourself out of anxiety is as futile as trying to talk yourself out of a heart or stomach problem. Fortunately, the vast majority of people with an anxiety disorder can be helped with the right professional care. While obsessive-compulsive disorder and post-traumatic stress disorder can be difficult to treat, most anxiety disorders, especially the phobias, respond well to treatment. There are no guarantees, however, and success rates vary with circumstances.

Treatment periods also vary, with some requiring only a few months of treatment and others needing a year or more. People with anxiety disorders often have more than one disorder or suffer from substance abuse or clinical depression. When more than one mental health-related condition is present, each must be accurately diagnosed and treated.

Treatments for anxiety disorders vary, with both therapy, particularly cognitive behavioral therapy (CBT), and medication, used. Often, the most effective approach for most anxiety disorders is a combination of the two. In OCD, however, it is pretty clear that cognitive behavioral therapy should be tried first, before medication.

Medications used to treat anxiety disorders include:

• Selective serotonin reuptake inhibitors (SSRIs) are first-line medicines used to treat anxiety disorders. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), fluvoxamine (Luvox) and escitalopram oxalate ( Lexapro). They work by affecting the concentration of serotonin, a chemical in the brain thought to be linked to anxiety disorders and have traditionally been used to treat depression. When used to treat panic disorder, agoraphobia and obsessive-compulsive disorder, they have been shown to reduce symptoms in more than half of all patients.

  Paxil is the first and only controlled-release selective SSRI approved for social anxiety disorder, but your health care professional can prescribe other SSRIs "off label" for anxiety disorders.

The most common side effects are nausea and gastrointestinal problems, drowsiness, sweating, headache, difficulty sleeping and mild tremor, all of which usually wear off after a period of time as your body adjusts to the medication.

• Tricyclic antidepressants (TCA), which were first used for treating depression, are also effective in blocking panic attacks and PTSD because they regulate serotonin and/or noradrenaline in the brain. The most common TCA used for the treatment of panic disorder is imipramine (Tofranil, Janimine); it is also effective in treating agoraphobia.

  Clomipramine (Anafranil), which is the only TCA approved for obsessive-compulsive disorder (OCD), significantly reduces symptoms for patients who can tolerate it. Clomipramine has more adverse side effects than the SSRIs, but both appear to be equally effective over time. Tricyclics take two or three weeks to take effect; side effects include dry mouth, blurred vision, sexual dysfunction, weight gain, difficulty urinating, disturbances in heart rhythm, drowsiness and dizziness. Blood pressure may drop slightly when sitting up or standing, causing dizziness. Tricyclics also can have serious, although rare, side effects and can be potentially fatal in overdose. Elderly patients and those with a history of seizures, cardiac problems, closed-angle glaucoma and urinary retention or obstruction should be closely supervised when taking tricyclics.

• Other antidepressants target specific neurotransmitters in the brain that regulate depression, like the SSRIs do. Most act on mechanisms that elevate both serotonin and noradrenaline and some may be more effective for severely depressed patients than are the SSRIs.

  These drugs include bupropion (Wellbutrin, Wellbutrin SR, Zyban), venlafaxine (Effexor), trazodone (Desyrel,), maprotiline (Ludiomil), duloxetine (Cymbalta) and mirtazapine (Remeron).

  Note: All antidepressants carry a black box warning concerning the increased suicide risk in adolescents and children. Anyone taking antidepressants should be carefully watched for any signs of suicidal behavior.

  These drugs (with the exception of Effexor) tend to have fewer adverse effects on sexual function than SSRIs, and some may even enhance sexuality. Common side effects may include: drowsiness, agitation, nervousness, insomnia, nausea, headache, dizziness and dry mouth.

  Venlafaxine (Effexor) is approved for social anxiety disorder and generalized anxiety disorder. Mirtazapine (Remeron) may be an effective treatment for panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and even post-traumatic stress disorder.

• Monoamine oxidase inhibitors (MAOI), typically phenelzine (Nardil) or tranylcypromine (Parnate), are antidepressants used for panic disorder, social anxiety disorder, or PTSD that does not respond to other treatments. They work by blocking the effect of a brain chemical that breaks down serotonin and noradrenaline. Common side effects include a sudden drop in blood pressure upon standing, drowsiness, dizziness, sexual dysfunction and insomnia. The most serious side effect is severe hypertension, which can be brought on by eating certain foods with a high tyramine content, such as aged cheeses, red wines, sauerkraut, vermouth, chicken livers, dried meats and fish, canned figs, fava beans and concentrated yeast products. They can also interact with other medications, such as over-the-counter decongestants and prescription stimulants. You shouldn't take MAOIs if you're pregnant or taking other SSRIs, and should have at least a two-week break between ending one antidepressant and starting on MAOIs.

• Benzodiazepines like alprazolam (Xanax) and clonazepam (Klonopin) have been the treatment of choice for anxiety disorders for years. Although the exact mechanism of these drugs is unknown, some research suggests they enhance the function of gamma aminobutyric acid (GABA), the chief neurotransmitter in the brain that controls inhibition.

  They work relatively quickly. Their principal side effects are drowsiness, possible weight gain, impaired concentration and short-term memory, but they have the potential for dependency after as brief a period as a few weeks. Thus, if you stop taking them after taking them for a long period, you may experience rebound symptoms, sleep disturbance and anxiety within a few days. Make sure you discuss these risks with your health care professional, and if you are taking benzodiazepines, talk to your health care provider before you stop taking them.

• Azapirone is a class of drugs that includes buspirone (BuSpar), approved for generalized anxiety disorder, because they enhance the activity of serotonin. It usually takes several days to weeks for the drug to be fully effective, and it is not useful against panic attacks. Unlike the benzodiazepines, buspirone is not addictive, even with long-term use, and it seems to have less pronounced side effects and no withdrawal effects, even when the drug is discontinued quickly. Because the drug does not produce any immediate euphoria or change in sensation, those experienced with benzodiazepines may believe it's not working. Common side effects include dizziness, drowsiness and nausea. BuSpar should not be used with MAOIs.

• Beta-blockers, including propranolol (Inderal) and atenolol (Tenormin), reduce the effects of adrenaline by blocking cellular receptors for adrenaline. They affect only the physical symptoms of anxiety and are most helpful for phobias, particularly performance anxiety, but are less helpful for other forms of anxiety. They work quickly and aren't habit forming, but shouldn't be used with certain pre-existing medical conditions such as asthma, congestive heart failure, diabetes, vascular disease, hyperthyroidism and angina pectoris.

Other drugs being investigated as treatments for anxiety include pagoclone, a gamma amino butyric acid (GABA) receptor modulator, and neurosteroids, hormones produced in the brain.

• Behavioral techniques focus on changing negative thinking and behaviors that can contribute to anxiety disorders. Talking to a mental health therapist can provide relief, lead to new insights, and help replace unhealthy behaviors with more effective ways of coping. Most mental health professionals tailor their approach to the needs, problems and personality of the person seeking help, and may combine different techniques in the course of therapy. The various types of behavioral techniques used to treat anxiety disorders include:

• Cognitive-behavioral therapy focuses on identifying and modifying the faulty thoughts and assumptions that keep a person stuck in the anxiety pattern. There are two parts to this therapy. First, a therapist helps you identify and modify the thoughts and behaviors keeping you stuck in the anxious mode. This is done by challenging false assumptions and negative thinking. The second part of the therapy is to expose you to situations that cause the anxiety to help you desensitize yourself to these thoughts and feelings. Another part of the therapy is to help you understand what's happening to your body: it's misfiring like a false alarm. As you begin to understand the underlying falseness of the assumptions that cause anxiety, you can begin substituting new ways of coping.

• Systematic desensitization requires a woman to gradually confront the object of fear with a goal of breaking the link between the anxiety-provoking stimulus and the anxiety response. First, you undergo relaxation training and compose a list that prioritizes anxiety-inducing situations by the degree of fear they invoke. Next, you undergo the desensitization procedure itself, confronting each item on the list, starting with the least stressful. This treatment is especially effective for simple phobias, social phobias, agoraphobia and post-traumatic stress disorder.

• Breathing retraining helps women with panic disorder practice measured, controlled breathing. Because many people with panic disorder hyperventilate, breathing rapidly and tensely and expelling too much carbon dioxide, they suffer from chest pain, dizziness, tingling of the mouth and fingers, and muscle cramps. One helpful breathing retraining approach is to practice controlling respiration rate and volume with slow deep breaths. By controlling your breathing at the onset of a panic attack, you may be able to prevent full attacks. This technique is frequently used in conjunction with other treatments for anxiety disorders.

• Other forms of psychotherapy, commonly called "talk" therapies, deal more with childhood roots of anxiety and usually, although not always, require longer treatments. They include interpersonal therapy, supportive psychotherapy, attention intervention and psychoanalysis. Some experts believe that such therapies might be more useful for generalized anxiety, which may require more sustained work to process and recover from early traumas and fears.

• Hypnotherapy, which uses the technique of hypnosis, may also be an appropriate treatment option. Hypnosis is a form of intense receptive concentration. Accordingly, hypnosis often is used to modify behavior and overcome phobias and bad habits—it can help you make changes that you've been unable to make otherwise. Often hypnotherapy is combined with other relaxation techniques.

Ongoing Research

Imaging tools are being developed to allow researchers to peer into the living brain and watch the amygdala, the cortex and other areas of the brain at work. They can identify abnormal activity when someone has an anxiety disorder. For example, recent studies of the brain using magnetic resonance imaging (MRI) showed that people with OCD had significantly less white matter than control subjects, suggesting a widely distributed brain abnormality in OCD. Imaging studies are also looking at how brain structure may be related to PTSD. For instance, a part of the brain involved in emotion, called the hippocampus, tends to be smaller in some people with PTSD. Researchers are also trying to decipher whether that is a result of extreme stress responses related to the trauma or whether people who already have a smaller hippocampus are more prone to PTSD.