ANTIANXIETY MEDICATIONS
Psychiatrists, family doctors or other doctors can prescribe medications for anxiety disorders. These doctors often work closely with psychologists, social workers or counselors who provide psychotherapy. Although medications won’t cure an anxiety disorder, they can keep the symptoms under control and help you lead a normal, fulfilling life.
Often, anxiety disorders can occur with depression. Sometimes, anxiety disorders may appear with eating disorders or substance abuse problems. All these disorders must be treated.
Antidepressants
A number of medications that were originally approved for treating depression have been found effective for anxiety disorders. If your doctor prescribes an antidepressant, you will need to take it for several weeks before symptoms start to fade. So don’t get discouraged and stop taking these medications before they’ve had a chance to work.
Some of the newest antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These medications act in the brain on a chemical messenger called serotonin.
SSRIs tend to have fewer side effects than older antidepressants. People sometimes report feeling slightly nauseated or jittery when they first start taking SSRIs, but that side effect usually disappears. Some people also experience sexual dysfunction when taking some SSRIs, which might not go away. Discuss side effects with your doctor to see if you need to change medications or adjust the dose.
Fluoxetine (Prozac®), sertraline (Zoloft®), fluvoxamine (Luvox®), paroxetine (Paxil®) and citalopram (Celexa®) are among the SSRIs commonly prescribed for panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress syndrome (PTSD) and social phobia. SSRIs are often used to treat people who have panic disorder in combination with OCD, social phobia or depression.
Venlafaxine (Effexor®), a drug closely related to the SSRIs, is good for treating generalized anxiety disorder (GAD). Other newer antidepressants are being studied for anxiety disorders, although one, bupropion (Wellbutrin®), does not seem to work for anxiety. These medications are started at a low dose and gradually increased until they reach an effective level.
Similarly, antidepressants called tricyclics are started at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied for treating anxiety disorders. For anxiety disorders other than OCD, they are just as effective as the SSRIs, but many doctors and patients prefer the newer drugs because the tricyclics sometimes cause dizziness, drowsiness, dry mouth and weight gain. When these problems persist or are bothersome, a change in dosage or a switch in medications may be needed.
Tricyclics can treat people with co-occurring anxiety disorders and depression. Clomipramine (Anafranil®), the only antidepressant in its class prescribed for OCD, and imipramine (Tofranil®), prescribed for panic disorder and GAD, are tricyclics.
Monoamine oxidase inhibitors, or MAOIs, are the oldest class of antidepressant medications. The most commonly prescribed MAOI is phenelzine (Nardil®), which helps people with panic disorder and social phobia. Tranylcypromine (Parnate®) is another MAOIs to treat anxiety disorders. People who take MAOIs are put on a restrictive diet because these medications can interact with some foods and beverages, including cheese and red wine, which contain a chemical called tyramine. MAOIs also interact with some medications, including SSRIs. Interactions between MAOIs and other substances can cause dangerous elevations in blood pressure or other potentially life-threatening reactions.
Antianxiety medications
High-potency benzodiazepines relieve symptoms quickly and have few side effects, although drowsiness can be a problem. Because people can develop a tolerance to them and would have to continue increasing the dosage to get the same effect, benzodiazepines are generally prescribed only for short periods of time. One exception is panic disorder, for which they may be used for six months to a year. People who have had problems with drug or alcohol abuse are not usually good candidates for these medications because they may become dependent on them.
Some people experience withdrawal symptoms when they stop taking benzodiazepines, although reducing the dosage gradually can diminish bothersome symptoms. In certain instances, the symptoms of anxiety can rebound after these medications are stopped. Potential problems with benzodiazepines have led some doctors to shy away from using them, or to use them in inadequate doses, even when they can potentially benefit the patient. Benzodiazepines include clonazepam (Klonapin®), which is used for social phobia and GAD; alprazolam (Alprazolam Intensol®, Xanax®, which is helpful for panic disorder and GAD; and lorazepam (Ativan®), which is also useful for panic disorder.
Buspirone (Buspar®), a member of a class of drugs called azipirones, is a newer antianxiety medication that is used to treat GAD. Possible side effects include dizziness, headaches and nausea. Unlike the benzodiazepines, buspirone must be taken consistently for at least two weeks to work.
Other medications
Beta-blockers, such as propranolol, which are often used to treat heart conditions, also help in certain anxiety disorders, particularly social phobia. If you have been diagnosed with an anxiety disorder, your doctor may prescribe a beta-blocker to take in anticipation of an impending attack if you are going into a situation where an attack may happen. The beta-blocker can keep your heart from pounding, your hands from shaking and other physical symptoms from developing.
Before taking medication for an anxiety disorder:
•Ask your doctor to tell you about the effects and side effects of the drug you are getting.
•Tell your doctor about any alternative therapies or over-the-counter medications you are using.
•Ask your doctor when and how the medication will be stopped. Some drugs can’t safely be stopped abruptly; they have to be tapered slowly under a doctor’s supervision.
•Be aware some medications are effective in anxiety disorders only as long as they are taken regularly, and symptoms may occur again if you stop the medication.
•Work together with your doctor to determine the right dosage needed to effectively treat your anxiety disorder.
Strategies to make treatment more effective
Many people with anxiety disorders benefit from joining a self-help group and sharing their problems and achievements with others. Talking with trusted friends or a trusted member of your religious or spiritual community also can help, although not a substitute for mental health care. Participating in an Internet chat room also may be of value in sharing concerns and decreasing a sense of isolation, but any advice received should be viewed with caution.
The family is very important in the recovery of an anxiety disorder. Ideally, the family should be supportive without helping to perpetuate the person’s symptoms. If the family tends to trivialize the disorder or demand improvement without treatment, the affected person will suffer.
Stress management techniques and meditation may help calm you and enhance the effects of treatment, although no scientific evidence supports the value of these approaches to recovery from anxiety disorders. Preliminary evidence says aerobic exercise may help. Caffeine, illegal drugs and even some over-the-counter cold medications can worsen symptoms of an anxiety disorder. Check with your doctor or pharmacist before taking additional medications.
For more information: Please consult your physician on your next visit.