How long is anxiety medication needed?

by Michael Kahn, M.D., Harvard Medical School

When I prescribe medication for a patient with a mental health problem, I'm frequently asked, "How long will I have to take this medication?" It's a good question. But for someone with an anxiety disorder, the answer is particularly complex.

Here's some information from Harvard Medical School's special health report, Coping with Anxiety and Phobias.

It's true that some anxiety disorders can be controlled with sporadic or short-term therapy. Sometimes a person does feel much better after just a few weeks or even days on an anti-anxiety medication. A specific phobia can be treated as needed, for example, just before getting on an airplane or giving a speech.

But other anxiety disorders — for example, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder — commonly require ongoing treatment. Experience shows that when drug therapy is stopped, symptoms often recur. Only 25% of patients who stop taking antidepressants for anxiety have relief for two years or longer. Two studies found that one in four people with generalized anxiety disorder relapse within a month of going off medications. Similarly, most people with obsessive-compulsive disorder relapse within a month unless they either continue drug treatment indefinitely or undergo behavior therapy.

There are no controlled studies showing how long drug therapy should last. But experience has led to this general guideline: For most anxiety disorders, medication should be taken initially for six to 12 months. If the symptoms vanish or diminish to the point that the individual is satisfied, he or she can take a "holiday" during which the drugs are stopped. If anxiety symptoms return, the individual should take the medication again. For people with two or more anxiety disorders, it's likely that treatment will carry on for more than a year. The more complex the condition, the more difficult it is to treat.

Even if symptoms don't recur, anyone who has had an anxiety disorder should have regular checkups with a mental health professional, preferably every three to four months. Those who are still taking medication should check in with a psychiatrist every three to four months to evaluate its effectiveness. Regular checkups can ensure prompt treatment should the symptoms recur or new ones develop.

It's also important to talk with your doctor before stopping any medication. Discontinuing medication too early or abruptly can trigger side effects. For example, stopping benzodiazepines too quickly increases the risk for withdrawal symptoms and can even result in a flare-up of anxiety, panic, or depression.

Many patients stop taking their medicine because they develop side effects. If you're having trouble tolerating a drug, talk to your doctor. Side effects are more common with some medications than others. Your doctor may be able to suggest a different drug or offer advice on how to prevent side effects.

Have you, or someone you know, ever decided to stop taking a medication for an anxiety disorder? What happened? How would you advise someone else in a similar situation?

Dr. Michael W. Kahn is an Assistant Professor in the Department of Psychiatry at Harvard Medical School, and is medical Director of Ambulatory Psychiatry at the Beth Israel Deaconess Medical Center in Boston.