15. Treatmets that workin anxiety disorders

On March 12 this year the Federal Minister for Health released the results of a national survey of mental health and well-being conducted by the Australian Bureau of Statistics.' It showed that 9. 7% of adults in Australia repor ted symptoms in the past year that met cr iteria for one of the six main anxiety disord ers (Box I) . In comparison, 5.8% met criteria for depression and 7.7 % for a substance-use disorder. The prevalence of anxiety disorders was stable across the 18 to 55 age range but reduced progressively thereafter we do seem to get calmer as we get older. People with anxiety disorders reported being unable to carry out their usual roles or tasks one day in 12, almost at the same level as people with chronic physical disorders like heart trou ble, asthma or arthritis, yet only 28% reported using health services, and three quarters of the time this meant seeing a general practitioner . Thus, the first question is why people disabled by an anxiety disorder do not seek help, or are not recognised when they do. The answer is, in part, related to the normality of bein g anxious and, on occasions, too anxious. Anxiety is a normal emotion and a powerful mot ivator. Mild to moderate levels of anxiety improve the ability to cope, reactions become faster, understanding is better and respon ses are more appropriate . This sense of increased mastery is usually pleasurable. It is good to be aroused, tense, and anxious before important events, but care should be taken to see that the anxiety does not become so severe that it impairs performance. Just as moderate levels of anxiety facilitat e coping , high levels reduce th e capacity to plan , to make accurate judgements or to carry out skilled tasks, or even to comprehe nd useful information . Patients who are stressed complain of being disabled by anxiety, yet some level of anxiety is required to make them keen to work on their problems. This facilitating effect of moderate anxiety and th e debilitating effect of high anxiety makes the prescr ibing of anxiolytics difficult. Sufficient medication to produce the calm th at patients seek will usually result in impaired performance. There is now considerable conce rn abou t the dependency-producing potential of the benzodiazepines and many doctors are looking to alternative treatments.a In this article, alt ernative and useful drug therapies will be mentioned because they tend to be the treatments used most often in general practice (details of dru g therapies can be found in other articles in this seriesj.e-t but, like Tyrer,J·4we would encourage do ctors "to introduce pati ents to psychological treatment whenever possible". The result s of the nation al survey reinforce thi s advice. Of peopl e with any mental disorder (and anxi ety disord ers were th e • The anxiety disorders are common and disabling menta l disorders.