1. Define treatment refractory anxiety.
Treatments refractory anxiety is anxiety that has been ineffectively treated with standard anxiety
disorder treatments, specifically unresponsive to at least one antidepressant given for an adequate
period of time as an adequate or appropriate dose for the patient (Ansara, 2020).
2. Describe two common comorbidities of treatment refractory anxiety.
One common comorbidity of treatment refractory anxiety is substance use disorder. Similar
symptoms to anxiety disorder may appear when a person is experiencing a substance use
disorder. Because anxiety disorders modify the presenting symptoms and treatment of
substance use disorders and vice versa, individuals may be at increased risk for relapse and poor
outcomes related to poor adherence to treatment or self-medicating through illegal
substances(Campelo et al, 2021).
Similarly, Anxiety and depression often occur together because they overlap so many
symptoms. Those who suffer from anxiety are more vulnerable to the depressing effects of
ruminating on unpleasant ideas. Symptoms of anxiety appear to be worse in patients with major
depressive disorder as a diagnosis and research believes this may be related to pseudo-resistance,
also known as poor medication adherence. One study shows that patients who are considered
medication-resistance have higher levels of baseline anxiety ratings and high occurrence of
comorbidities with MDD(Roy-Byrne, 2022).
3. Discuss two possible approaches to treatment for treatment refractory anxiety.
, One approach to treating treatment-refractory anxiety is to focus on the underlying causes of the
anxiety. This may involve exploring past trauma or current stressors that are triggering the
anxiety. Once the underlying causes are identified, various treatment modalities can be used to
address them. This may include psychotherapy, specifically CBT (cognitive behavioral therapy).
CBT is considered a first-line treatment because of its therapeutic effectiveness shown through
research. Some studies show a higher effectiveness with CBT as an adjunct to pharmacological
agents such as SSRIs, but some CBT may be conducted alone because it enhances effectiveness,
however, combined treatment is best and is best approached by adding one modality (either CBT
or medication) to the other modality that has been deemed as ineffective (Roy-Byrne, 2022).
Another approach that has been demonstrated efficacy in the treatment of treatment refractory
anxiety is the GABA-related agent Gabapentin. Because of medication’s effect on GABA and the
unique mechanism of blocking the alpha delta calcium channel, it has similar effectiveness to
benzodiazepines with fewer adverse effects regarding high abuse risk and dependency. Although
Gabapentin is widely used for treatment of anxiety, it is typically not the first-line treatment
initiated by clinicians and should be recognized more often because of its proven efficacy and
decreased side effect profile, especially in comparison with benzodiazepines( Roy-Byrne, 2022).
4. Identify the most appropriate response to a client who states that they use marijuana
to manage their anxiety. Discuss the education the PMHNP should provide.
The appropriate response to a client who states that they use marijuana to manage their anxiety
would be to provide the client with evidence-based information regarding what marijuana can
actually do for someone experiencing anxiety. Studies show that there is currently no evidence-
based science proving that marijuana is effective or in any way beneficial for treating any
psychiatric disorder including anxiety and in fact, marijuana use has been known to be associated
Treatments refractory anxiety is anxiety that has been ineffectively treated with standard anxiety
disorder treatments, specifically unresponsive to at least one antidepressant given for an adequate
period of time as an adequate or appropriate dose for the patient (Ansara, 2020).
2. Describe two common comorbidities of treatment refractory anxiety.
One common comorbidity of treatment refractory anxiety is substance use disorder. Similar
symptoms to anxiety disorder may appear when a person is experiencing a substance use
disorder. Because anxiety disorders modify the presenting symptoms and treatment of
substance use disorders and vice versa, individuals may be at increased risk for relapse and poor
outcomes related to poor adherence to treatment or self-medicating through illegal
substances(Campelo et al, 2021).
Similarly, Anxiety and depression often occur together because they overlap so many
symptoms. Those who suffer from anxiety are more vulnerable to the depressing effects of
ruminating on unpleasant ideas. Symptoms of anxiety appear to be worse in patients with major
depressive disorder as a diagnosis and research believes this may be related to pseudo-resistance,
also known as poor medication adherence. One study shows that patients who are considered
medication-resistance have higher levels of baseline anxiety ratings and high occurrence of
comorbidities with MDD(Roy-Byrne, 2022).
3. Discuss two possible approaches to treatment for treatment refractory anxiety.
, One approach to treating treatment-refractory anxiety is to focus on the underlying causes of the
anxiety. This may involve exploring past trauma or current stressors that are triggering the
anxiety. Once the underlying causes are identified, various treatment modalities can be used to
address them. This may include psychotherapy, specifically CBT (cognitive behavioral therapy).
CBT is considered a first-line treatment because of its therapeutic effectiveness shown through
research. Some studies show a higher effectiveness with CBT as an adjunct to pharmacological
agents such as SSRIs, but some CBT may be conducted alone because it enhances effectiveness,
however, combined treatment is best and is best approached by adding one modality (either CBT
or medication) to the other modality that has been deemed as ineffective (Roy-Byrne, 2022).
Another approach that has been demonstrated efficacy in the treatment of treatment refractory
anxiety is the GABA-related agent Gabapentin. Because of medication’s effect on GABA and the
unique mechanism of blocking the alpha delta calcium channel, it has similar effectiveness to
benzodiazepines with fewer adverse effects regarding high abuse risk and dependency. Although
Gabapentin is widely used for treatment of anxiety, it is typically not the first-line treatment
initiated by clinicians and should be recognized more often because of its proven efficacy and
decreased side effect profile, especially in comparison with benzodiazepines( Roy-Byrne, 2022).
4. Identify the most appropriate response to a client who states that they use marijuana
to manage their anxiety. Discuss the education the PMHNP should provide.
The appropriate response to a client who states that they use marijuana to manage their anxiety
would be to provide the client with evidence-based information regarding what marijuana can
actually do for someone experiencing anxiety. Studies show that there is currently no evidence-
based science proving that marijuana is effective or in any way beneficial for treating any
psychiatric disorder including anxiety and in fact, marijuana use has been known to be associated
