Long-term management of anxiety states

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Abstract
The management of persistent anxiety states often presents problems for the clinician. The long term use of benzodiazepines is no longer recommended because of the risk of physical dependence, sedation and memory impairment. New pharmacological and psychological treatments are being proposed as alternatives but opinions differ as to which patients should receive them. This paper briefly describes the current controversies regarding the classification and aetiology of anxiety states which may underlie this difficulty. It highlights the importance of careful pharmacological and psychological management of acute anxiety states in preventing some of the problems that arise with the more chronic disorders. It reviews the evidence for the effectiveness of the new treatments in generalized anxiety disorder, panic disorder, phobic disorder and obsessive compulsive disorder and suggests a practical approach to their long term management.