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Areas › Worry and anxiety › Treatment and medication
The fast option is a rescue. It works quickly, it is meant for the worst moments, and its usefulness is measured in that hour. The slower option is maintenance, judged over weeks, and it is the one that shifts the pattern. Confusing the two is where a lot of trouble starts, because the fast one feels far more convincing.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Stamp your foot! Here is cool water for you to wash in and drink (Quran 38:42). Job is given immediate relief, and the restoring of everything else comes after it rather than instead of it.
ص
ٱرۡكُضۡ بِرِجۡلِكَۖ هَٰذَا مُغۡتَسَلُۢ بَارِدࣱ وَشَرَابࣱ
‘Stamp your foot! Here is cool water for you to wash in and drink,’
Qur’an 38:42read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A meta-analysis covering 234 randomised studies and more than 37,000 people found that medication, talking therapy and the two combined all produced substantial improvement in panic, generalised anxiety and social phobia. Comparing them against each other is awkward, because the different kinds of trial use different comparison conditions. The safe reading is that several routes work, not that any one has been shown to beat the rest.
Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D. (2015). Efficacy of treatments for anxiety disorders: a meta-analysis.. International clinical psychopharmacology doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Stopping a surge and reducing how often surges happen are separate tasks on separate timescales.
Rescue medication is a prescriber's decision, so this is for understanding a plan rather than adjusting one.
The first week or so on one of these can feel worse rather than better: jittery, restless, sleeping badly. For most people it settles within a fortnight, and it is a known part of starting rather than a sign of harm.
Sleeping tablets, sedatives, antihistamines and alcohol all pull on the same brake. Whoever is prescribing needs the whole list, including the things that do not feel like medicine.
These medicines work on a timescale of four to six weeks, not days. Say the number out loud at the start, because someone expecting relief this week will have decided by Friday that it failed.