There is no clear evidence as to whether therapy or medication is most effective; the specific medication decision can be made by a doctor and patient with consideration to the patients specific circumstances and symptoms. If while on treatment with a chosen medication, the persons anxiety does not improve, another medication may be offered. Specific treatments will vary by subtype of anxiety disorder, a persons other medical conditions, and medications. Lifestyle and diet
Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking. Stopping smoking has benefits in anxiety as large as or larger than those of medications. Omega-3 polyunsaturated fatty acids, such as fish oil, may reduce anxiety, particularly in those with more significant symptoms. Psychotherapy
Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first-line treatment. CBT appears to be equally effective when carried out via the internet compared to sessions completed face to face.Mindfulness-based programs also appear to be effective for managing anxiety disorders. It is unclear if meditation has an effect on anxiety and transcendental meditation appears to be no different than other types of meditation.A 2015 Cochrane review of Morita therapy for anxiety disorder in adults found not enough evidence to draw a conclusion.Adventure-based counseling can be an effective way to anxiety. Using rock-climbing as an example, climbing can often bring on fear or frustration, and tackling these negative feelings in a nurturing environment can help people develop coping mechanisms necessary to deal with these negative feelings.
Medications
First-line choices for medications include SSRIs or SNRIs to treat generalized anxiety disorder. For adults there is no good evidence supporting which specific medication in the SSRI or SNRI class is best for treating anxiety, so cost often drives drug choice. Fluvoxamine is effective in treating a range of anxiety disorders in children and adolescents. Fluoxetine, sertraline and paroxetine can also help with some forms of anxiety in children and adolescents. If the chosen medicine is effective, it is recommended that it is continued for at least a year. Stopping medication results in a greater risk of relapse.Buspirone and pregabalin are second-line treatments for people who do not respond to SSRIs or SNRIs; there is also evidence that benzodiazepines, including diazepam and clonazepam, are effective. Pregabalin and gabapentin are effective in treating some anxiety disorders but there is concern regarding their off-label use due to the lack of strong scientific evidence for their efficacy in multiple conditions and their proven side effects.Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.In general, medications are not seen as helpful in specific phobia, but a benzodiazepine is sometimes used to help resolve acute episodes. In 2007, data were sparse for efficacy of any drug. Cannabis
As of 2019, there is little evidence for cannabis in treating anxiety disorders.