Therapy v medication? How to choose the best treatment for anxiety

There has been a surge in demand for mental health services, with an estimated 1.6 million people in England waiting for specialized support, and another 8 million who would benefit but whose mental health is not considered serious enough to even get on the waiting list. The financial crash of 2008 has been recorded as the year of the rise in anxiety rates, with increases in all age groups under 55.

The number of prescriptions for anti-anxiety medication has gone up. The use of drugs to treat anxiety was steady between 2003 and 2008 but rose significantly by the year 2018, according to research published earlier this year. New anti-anxiety prescriptions increased from 25 to 26 per 1,000 person years at risk during that earlier period. Men are being prescribed more medication than women.

Charlotte Archer, senior research associate in primary care mental health at the University of Bristol, who led the study, says that it could be due to a number of things. She says that before there were concerns that it would go undetected. I think that is starting to change. She thinks that patients are more aware of how to treat anxiety and how to get a prescription. I don't think that's been the case.

Dr Trudi Seneviratne, Consultant Psychiatrist of the Royal College of Psychiatrists, says that when people see their GP, treatment is based on what they want. Would you like to talk therapies if it is more moderate? Would you like a combination of therapies? What are the other lifestyle changes you can make?

Sertraline and depression are some of the most commonly used anti-depressants. Side-effects can range from headaches and nausea to a reduced sex drive and even increased anxiety, depending on the drug. Seneviratne says that the latest thinking on medication suggests that it is not generally considered life long and should be monitored and reviewed about every three months.

With milder forms of anxiety, people should initially be offered psychological therapy such as counselling or CBT

Seneviratne says that medication tends to be prescribed when anxiety is getting so bad that it is affecting quality of life.

She says that people with milder forms of anxiety should be offered psychological therapy. The Nice guidelines for depression recommend other treatments such as therapy, and exercise for patients before they start their medication.

Some people can simply make their own lifestyle changes. Talking therapy should always be offered if that doesn't work. There are huge waiting times depending on where you are and access to talking therapies is patchy. There are long waiting lists for talking therapies so it's not clear if medication is being prescribed there. Private therapy can cost upwards of 40 per hour for people who don't want to take medication.

There is a lot of therapies, which can be confusing for the sufferers. Therapies on the other side of the spectrum tend to be more focused on relief of symptoms. It's not exclusive with a psychodynamic approach, which would be to try and explore what it means.

For many people, medications cover up symptoms for the time that the person is in a state of anxiety, and can undermine natural coping mechanisms

He doesn't want it to be seen as a quick fix for anxiety. Our mental health service is extremely action-orientated. He believes that 40% of people with mental health problems are anti- GPs. He says that strategies need to be supported with psychological therapies.

In July of last year, Hannah began to experience more depression and anxiety. She referred herself to the Improving Access to Psychological Therapies service in England, but didn't hear anything. She got a call from a local talking therapies the day after she went off sick. The rearranged date was the reason for the cancellation of that appointment. She says she hasn't been offered treatment nine months later. The majority of IAPT referrals for talking therapies in England were seen within six weeks, but it varies by area and people have reported long waits.

Paying for private therapy isn't possible, but she did access counseling through the mental health charity Mind. Things got worse and worse until I reached breaking point.

Talking therapy can work for some people but not others. A combination of both has been effective. The medication has not been effective for some. After her mental health rapidly declined last January, Freya was recently hospitalized for a week. She has been taking venlafaxine for the last two months. She needs longer-term and specialized treatment, under the care of a psychologist, and now faces a wait, even though she is clearly struggling. There isn't enough funding and it needs an update.