Treatment options include lifestyle changes, therapy, and medications. 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 patient's specific circumstances and symptoms. If while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered. Specific treatments will vary by subtype of anxiety<unk> , a person's 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<unk> s 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<unk> s. 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<unk>  in adults found not enough evidence to draw a conclusion. Medications First-line choices for medications include SSRIs or SNRIs to treat generalized anxiety<unk> . 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. If they are effective, it is recommended that they are continued for at least a year. Stopping these medications 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. Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical<unk> s. 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. Alternative medicine Other remedies have been used or are under research for treating anxiety<unk> s. As of 2019, there is little evidence for cannabis in anxiety<unk> s. Kava is under preliminary research for its potential in short-term use by people with mild to moderate anxiety. The American Academy of Family Physicians recommends use of kava for mild to moderate anxiety<unk> s in people not using alcohol or taking other medicines metabolized by the liver, while preferring remedies thought to be natural. Inositol has been found to have modest effects in people with panic<unk>  or obsessive-compulsive<unk> . There is insufficient evidence to support the use of St. John's wort, valerian or passionflower. Neurofeedback training (NFT) is another form of alternative medicine, where practitioners use monitoring devices to see moment to moment information in relation to the nervous system and the brain. Sensors are placed along the scalp, and the brain responses are recorded and amplified in association with specific brain activity. The practitioners then discuss the responses associated with the client, in an attempt to determine different principles of learning, and practitioner guidance to create changes in brain patterns. Children Both therapy and a number of medications have been found to be useful for treating childhood anxiety<unk> s. Therapy is generally preferred to medication. Cognitive behavioral therapy (CBT) is a good first therapy approach. Studies have gathered substantial evidence for treatments that are not CBT-based as being effective forms of treatment, expanding treatment options for those who do not respond to CBT. Although studies have demonstrated the effectiveness of CBT for anxiety<unk> s in children and adolescents, evidence that it is more effective than treatment as usual, medication, or wait list controls is inconclusive. Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. Family therapy is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings. Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and play therapy are also used. Art therapy is most commonly used when the child will not or cannot verbally communicate, due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others. In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment. If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective. Minor side effects with medications, however, are common.
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