U.S. doctors should regularly screen all adults under 65 for anxiety, an influential health guidelines group proposed Tuesday.

It’s the first time the U.S. Preventive Services Task Force has recommended anxiety screening in primary care for adults without symptoms. The proposal is open for public comment until Oct. 17, but the group usually affirms its draft guidance.

The recommendations are based on a review that began before the COVID-19 pandemic, evaluating studies showing potential benefits and risks from screening. Given reports of a surge in mental health problems linked with pandemic isolation and stress, the guidance is “very timely," said Lori Pbert, a task force member and co-author. Pbert is a psychologist-researcher at the University of Massachusetts’ Chan Medical School.

The task force said evidence for benefits, including effective treatments, outweighs any risks, which include inaccurate screening results that could lead to unnecessary follow-up care.

Anxiety disorders are among the most common mental health complaints, affecting about 40% of U.S. women at some point in their lives and more than 1 in 4 men, Pbert noted.

Black people, those living in poverty, people who have lost partners and those who have other mental health issues are among adults who face higher risks for developing anxiety, which can manifest as panic attacks, phobias or feeling always on edge. Also, about 1 in 10 pregnant and postpartum women experience anxiety.

Common screening tools include brief questionnaires about symptoms such as fears and worries that interfere with usual activities. These can easily be given in a primary care setting, the task force said, although it didn’t specify how often patients should be screened.

“The most important thing to recognize is that a screening test alone is not sufficient to diagnose anxiety," Pbert said. The next step is a more thorough evaluation by a mental health professional, though Pbert acknowledged that finding mental health care can be difficult given shortages of specialists.

Megan Whalen, a 31-year-old marketing specialist who was diagnosed with anxiety in 2013, says regular doctors should screen for mental health issues as commonly as they do for physical problems.

“Health is health, whether the problem is visible or not," said Whalen, of Hoboken, New Jersey.

She has gotten help from medicine and talk therapy, but her symptoms worsened during the pandemic and she temporarily moved back home.

“The pandemic made me afraid to leave home, my anxiety telling me anywhere outside of my childhood house was unsafe," Whelan said. “I absolutely still struggle with feelings of dread and fear sometimes. It’s just a part of my life at this point, and I try to manage it as best as I can."

The task force said there isn’t enough solid research in older adults to recommend for or against anxiety screening in those aged 65 and up.

The group continues to recommend depression screening for adults and children, but said there isn’t enough evidence to evaluate potential benefits and harms of suicide screening in adults who show no worrisome symptoms.

In April, the group issued similar draft guidance for children and teens, recommending anxiety screening but stating that more research is needed on potential benefits and harms of suicide screening kids with no obvious signs.

Guidelines from the task force often determine insurance coverage, but anxiety is already on the radar of many primary care doctors. In 2020, a group affiliated with the American College of Obstetricians and Gynecologists recommended routine primary care anxiety screening for women and girls starting at age 13.

Melissa Lewis-Duarte, a wellness coach in Scottsdale, Arizona, says rhythmic breathing, meditation and making a daily list of three things for which she is grateful have all helped with her anxiety.

“Doctors say, ‘Make sure you’re sleeping, control your stress.’ Yeah, I get that," but not everyone knows how, said the 42-year-old mother of three. “It’s difficult to prioritize self-care, but that’s what’s necessary.”

Over half of people with chronic depression who attempted to stop their antidepressant medication relapsed into depression by the end of a year, compared to those who did not stop medicating, according to a randomized, double-blinded clinical trial released Wednesday.

The research, published in the New England Journal of Medicine, found that "quality-of-life measures and symptoms of depression, anxiety, and medication withdrawal were generally worse in patients who discontinued their antidepressant therapy."

Interestingly, the study did find a small percentage of people were able to successfully stop their antidepressant without having another depressive episode.

"Some people can stop their medication without relapse, although at present, we cannot identify who those people are," said coauthor Gemma Lewis, a professor of psychiatric epidemiology at University College London.

"I think we can be very cheered by the findings," said coauthor Dr. Tony Kendrick, a professor of primary care at the University of Southampton in the United Kingdom.

"This is really good evidence to support a patient's own decisions — in discussion with their doctor or other prescriber — about whether they should continue antidepressants or not," Kendrick said. "Both courses of action are reasonable."

Antidepressants for life?

When people slip into depression for the first time, current practice is to continue antidepressants between four to nine months after remission of their depression, said Dr. Jonathan Alpert, chair of the American Psychiatric Association's Council on Research, who was not involved in the study.

Remission is defined as a two-month period with no signs of major depression such as sadness and a reduced interest or pleasure in life.

"In my own practice, if the patient has a first episode of depression, and particularly if it was triggered by a life event — death of a loved one, failed business — then I try my best to get patients into remission (and) then I treat for a minimum of six months after they achieve remission," said Dr. Jeffrey Jackson, a professor at the Medical College of Wisconsin, who studies depression.

"If they stay in remission for those six months, then we can consider slowly tapering off the antidepressants — with the person carefully monitoring their own depressive symptoms," Jackson added. Jackson, who was not involved in the study, wrote an accompanying editorial published in NEJM.

Unfortunately, the danger of another bout of depression later in life is high, said Alpert, who is also the chair of psychiatry at Montefiore Health System in the Bronx.

"If one has had one episode of depression, the chances of a second episode sometime during one's lifetime is 50%," he said. "If somebody has already had two depressions, the chances of a third are even higher — over 75% of people who have had two or more depressions will have another."

Science has long known that people with recurrent depression have the most difficulty coming off antidepressants and the most likelihood of relapse when they do, Alpert added.

"For patients who have had three or more depressive episodes, I generally plan to treat them for life," Jackson said.

Addressing out-of-date research

Much of the research done on long-term effectiveness of antidepressants is old and limited, so the study was designed to fill that gap in knowledge, the study authors said.

"Many people are taking long-term antidepressants, and the evidence to advise them whether to continue maintenance or discontinue is poor," Lewis said.

The study recruited 478 people from 150 primary care practices in the U.K. Each person had experienced at least two depressive episodes or had been on antidepressant medication for two years or more. All felt well enough to stop taking their medication.

"This is the largest study that's been done in a real-world primary care setting," said Alpert.

"That's important because most patients with depression are managed by their primary care provider," Jackson said. "Most primary care providers only refer to psychiatrists if the patients are suicidal, homicidal, psychotic, bipolar or not responding to therapy."

Only people taking maintenance dosages of four antidepressants were included in the study: citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), and mirtazapine (Remeron). Other popular antidepressants, such as escitalopram (Lexapro), were not included due to the greater likelihood of severe withdrawal symptoms, the authors said.

All medications and the lactose placebo in the study were packaged identically in unmarked bottles so that both patients and researchers were blinded to the contents.

Half of the group was given reduced dosages of their antidepressant over a two-month period; by the beginning of the third month, all were taking placebo. The other half of the group continued to take their normal dose of antidepressant.

At the end of 52 weeks of follow-up, 56% of the people who had been weaned off their antidepressant had relapsed into depression, compared to 39% of the people who continued their medications.

"The patients who stopped their antidepressants experienced a relapse sooner than the patients who stayed on their antidepressants," Lewis said.

Symptoms of depression and anxiety were higher in the group who discontinued their medications as well, she added. But could those have been withdrawal symptoms instead?

"It's not always that easy to tell," Kendrick said. "If somebody's starting to get anxious, if they're starting to have sleep disturbances or are starting to feel low. Is that depression coming back? Or is it withdrawal symptoms?"

Regardless of the source of the symptoms, a number of people exited the trial even though they did not know if they were on medication or placebo.

"It was clear that they voted with their feet," Alpert said. "When they weren't doing as well, they were more likely to drop out of the trial and more likely to resume medications."

Long-term use

The study results did provide some insight into the benefits of long-term use of antidepressants, Kendrick said.

"It's reassuring to know that antidepressants people are taking long term do seem to be benefiting them, and this is not something that they're taking unnecessarily," he said.

There are side effects to many medications, such as weight gain and sexual dysfunction, "so we try to choose antidepressants and adjust the dose for a given person that they tolerate the best and have the fewest side effects," Alpert said.

"However, to the very best we know, there are no long-term consequences, such as increased risk of cancer, stroke, heart disease or liver problems by virtue of being on antidepressants," he added.

If you do decide to taper, do it slowly and add psychological therapy, which studies have shown "can help prevent the risk of relapse," Kendrick added.

"The latest guidelines are suggesting that you should take some weeks to come off antidepressants," he said. "If you're getting withdrawal symptoms and finding it difficult, you might need to take months to come off them."

What else can be done?

Antidepressants are, of course, not the only treatment for depression. There are many things people can do to improve their depressive symptoms while on medication or reduce the likelihood of a relapse once weaned off an antidepressant, Alpert said.

Physical activity is key. "It looks like even relatively moderate amounts of activity, like a brisk walk several times a week, can help in the treatment of depression and also help in relapse prevention," he said.

Social connections are important, too. Making an effort not to be isolated, by reaching out to others for social support, makes a difference, as do activities that are meaningful and rewarding, Alpert said.

"Community activities, volunteer activities, seem to be important in helping with depression," he said. "When people are pursuing goals that are meaningful to them, that's also helpful."

Evidence-based psychotherapy works. "People who opt to taper off their medications have a greater chance at staying well if they're pursuing certain forms of psychotherapy that have been shown in studies to be effective," Alpert said.

Cognitive behavioral therapy, or CBT, has been widely studied and considered to be comparable in effectiveness to antidepressants for depression. It's often used in conjunction with medication for people whose symptoms do not improve on antidepressants alone.

The therapy focuses on a person's thought process, attempting to interrupt false or negative thoughts about oneself and others that can lead to a depressive mood. Instead, people are encouraged to substitute healthier, more positive thoughts, which can improve self-image and behavior.

"It's not quite like lying on the couch and free associating," Alpert said. "There's specifics like homework assignments and skills that people acquire."

Acceptance and commitment therapy, or ACT, uses a similar approach, Alpert said, with more of a focus on accepting negative thoughts and discarding them.

"Rather than changing your thoughts, you accept the idea that they're just thoughts, they're not the same as reality, and they are not who I am," Alpert explained. "Realizing that thoughts like 'I'm not good enough' and so on are just thoughts, and learning how to push those thoughts away."

Interpersonal psychotherapy or IPT, focuses on changes in one's life that has to do with interpersonal relationships, Alpert said.

"Interpersonal therapy has to do a lot with relationships like losses or transitions in one's role with others ... and then working on those, like how can you go ahead with a life worth living and adapt to or will make the best of those transitions," he said.

Therapists will often tell patients about the different approaches, as one may be a "better match to where they are in their lives and the things that they're dealing with," he added. "There are many things that people can do in addition to medications."

Advocates say there's a huge need for expanded access to medication as the number of victims affected by opioid use disorder continues to rise.

Looking at pictures of Adam Black in a bodybuilding competition, you'd never know that he's 7 years in recovery from opioid addiction.

“I hit a spiritual bottom and everything around me was falling apart. I couldn’t keep anything together in my life, the drugs become everything to you,” said Black.

When those drugs truly become everything to you, Black says, you "lose yourself."

He describes running out of money and says, "I couldn’t feed my addiction anymore, so I started breaking into unlocked cars, stealing change, trying to feed my addiction and, being an addict, I couldn’t do anything right, couldn’t even be a criminal right.”

He went to prison for three years, and then he ended up in the hospital.

“(I) Got heart surgery. I was like 150 pounds at the time, that was one of my rock bottoms, right there, that changed my life, that I can’t keep going this way.”

It was then that he was able to change. It wasn't overnight, but eventually he found Groups Recover Together, and received medication-assisted treatment.

He says, “I don’t have cravings anymore. I’m able to maintain a job, a family, everything I was working so hard to get, I’m able to have that now, and I owe it all to Groups.”

Dr. Gus Crothers is an addiction medicine specialist. He treats people with substance abuse disorders.

“The treatment is a combination of medication, counseling, and lifestyle changes. And those are the same core treatments we use for managing any chronic disease," said Crothers.

He says one of the treatments has tight, and some say, outdated restrictions. It's known as the "X-Waiver" and it requires doctors to get extra training before they can prescribe buprenorphine.

It's a legal hurdle that dates back to the early 2000s.

“When we have such an access gap to medications, people are thinking we should get rid of the data waiver and get rid of those restrictions that limit access to treatment,” Crothers said.

We asked the Department of Health and Human Services about the waiver, which has become confusing for some.

The Trump administration removed the X-Waiver shortly before President Joe Biden's inauguration. Recently, the current administration reversed that decision. A spokesperson for HHS says the previous announcement was made prematurely, but they are committed to "examine ways to increase access to buprenorphine."

Which means, doctors still need extra training to prescribe the treatment, which people like Black say, is life-changing and lifesaving.

“I still take the medication. I’m weaning down as we speak. I sponsor a couple of other guys, I check in with 3 or 4 other people at our group. You can’t do this alone, you need to be there for the people who are going through this," Black said.

You can't go it alone, and Black says, you can get help.

Nearly 1 in 5 adults in the U.S. live with mental illness, and there are a number of ways to seek treatment -- from psychiatrists, who have the ability to prescribe medication, to psychologists, therapists, and counselors.  

"There's a varying spectrum of ways that you can approach dealing with things like anxiety, depression, substance use disorders," explained Dr. Eric French, Medical Director of Adult Psychiatry at the Medical Center of Aurora. "Sometimes that involves medications if it's warranted. Some people are able to get by with just some therapy. There's cognitive behavioral therapy. There’s dialectical behavioral therapy, there’s motivational therapy, interpersonal, there are so many different types. And the reason that's encouraging for our patients out there is is that we will tailor-fit what you need to you."

Dr. Flavia DeSouza a Board-Certified Psychiatrist and Assistant Professor at Howard University explained that psychotherapy can do any number of things, including helping us regulate our emotions.

"Particular skills that are taught, it may help us to slow down our thoughts to understand what is actually going on in our minds, and how it is affecting our behavior and our feelings," Dr. DeSouza said. "It may help us to name our feelings. Many of us just go through life, without actually knowing what's going on inside of us. It may help us to learn how to change our behavior, or thinking or feeling — so that we can function in a healthier way."

Regardless of the method you start with, remember that it may take time to find the right fit or the right mental health professional. 

"You don't have to stick with this, the first therapist that you find, sometimes there's not that match," said Nii Addy, a Neuroscientist, and Host of the Yale University Podcast, Addy Hour. "So there's no there's no shame in saying, Okay, this person is not quite working for me, I'm gonna move on to the next."

A good place to start that search is findtreatment.gov or to learn more about the various types of treatment, check out the National Alliance on Mental Illness at nami.org.

Amber Strong at Newsy first reported this.

Seeking out mental health treatment is a major first step, often followed by that all-too-familiar question, "How am I going to pay for this?"

The cost of a therapy session ranges, depending on your access to health care coverage and even where you live in the country. But experts say, don’t let it be a hindrance. 

The Affordable Care Act requires some insurers to offer coverage for mental health services. But just like any other treatment, there could be stipulations like using in-network providers for full coverage. So it’s best to get familiar with your plan. 

And if you don’t have insurance, there are still options for affordable help.

"There are clinics out there who will try to work with you. And will do scaled pay. And for patients who really have zero resources at all, there are clinics within the county that will care for you for free, provide medications for free, they typically tend to work more closely with the homeless. But those are still options," said Dr. Eric French, medical director of adult psychiatry at the Medical Center of Aurora.

"Group support is often very useful, especially for individuals who don't have a lot of support already built in. And it can, in the case of some illnesses, it can take the place of psychotherapy," said Dr. Flavia Desouza, a board certified psychiatrist and assistant professor at Howard University. 

"There is an emergence of mental health services that are also offered in church settings as well. Sometimes colleges or universities will have therapists in training, who have much cheaper rates and who are being supervised by someone. So that can also be another option," suggested Nii Addy, a neuroscientist and host of the Yale University Podcast Addy Hour. 

There’s also findtreatment.gov, a search engine run by the federal government that can direct you to affordable options near you. When it comes to medication, you have to shop around. Experts recommend price comparison sites like GoodRX. And groups like the National Alliance on Mental Illness which can serve as a road map to affordable options.

"NAMI and other places can actually facilitate some of that conversation, to make sure that people do get plugged into those resources," said Addy. 

While it may take some homework and research, experts agree the payoff could be worth it in the long run.

This story originally reported by Amber Strong on Newsy.com.