Anxiety medications & treatments
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Anxiety is something we have all felt in our lives. You may feel it for many different reasons. You may be worried about your finances, your health, or the health of a loved one. It may be that you’re starting a new job, moving home, or you’ve recently had a relationship breakdown. Whatever the reason may be, feeling anxious is perfectly normal.
If, however, your worry or fears affect your everyday life you may be suffering from an anxiety disorder. According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental health disorders in America, affecting as many as 40 million adults in the United States each year. Here we will talk about what anxiety is, what treatment options are available, and try to answer some questions you may have.
What is anxiety?
The different types of anxiety disorders include:
- Generalized anxiety disorder
- Panic disorder
- Phobia-related disorders
- Obsessive-compulsive disorder (OCD)
What causes anxiety?
Anxiety can be caused by a wide range of factors. Often it is because of a combination of these factors occurring at the same time. Factors include:
- Stress caused by events in your life, such as a death in the family, moving home, losing your job, or having financial problems
- Health issues such as diabetes, hypertension, and asthma are all linked to anxiety
- Conditions such as depression can have symptoms similar to those of anxiety
- You may have a genetic tendency towards anxiety. This does not mean however that if a family member has it, you are more likely to get it too
- Drug and alcohol abuse. Also, withdrawal from drugs and alcohol can lead to irritability and anxiety
How is anxiety diagnosed?
Anxiety will be diagnosed by your doctor from the symptoms you show. You may not have all of these symptoms listed below. Symptoms include:
- Increased heart rate
- Having a tight feeling around the chest area
- Difficulty breathing
- Feeling restless, or excessively nervous
- Problems concentrating and racing thoughts
- Avoiding things that trigger your anxiety
What are the treatment options for anxiety?
The two main treatment options for anxiety disorders are psychotherapy and medications. Psychotherapy is often used in combination with medication to treat mental health conditions. Sometimes medication may be more useful and in others, psychotherapy may be the best option. For most people, a combined medication and psychotherapy treatment is better than either alone. Your doctor may also recommend lifestyle changes, such as reducing alcohol consumption, dietary changes, physical exercise, and meditation.
Psychotherapy treatments for anxiety
The choice of therapy type depends on your particular needs and preference. Therapists may combine elements from different approaches to best meet your needs.
- Cognitive-behavioral therapy (CBT) – gives you skills to change negative thoughts and behavioral patterns and to focus on current problems and how to solve them. This technique will also help to treat and prevent panic attacks
- Supportive therapy – uses guidance and encouragement to help you develop your own resources. It helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy will help you deal with issues related to your mental health condition which in turn affect the rest of your life
- Animal-assisted therapy – working with dogs, horses, or other animals to bring comfort, help with communication and help cope with trauma
- Creative arts therapy – use of art, dance, drama, music, and poetry therapies
Your doctor will recommend which type of medication is best for you based on your medical history, any medications you are already taking, and the specific type of anxiety disorder you’re experiencing. These medications can include antidepressants, anti-anxiety medications, and beta-blockers. Beta-blockers give rapid relief from the physical symptoms of panic attacks, such as a rapid heartbeat. Some of the most common classes of drugs you may be prescribed include:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressant medications used. They work by increasing levels of a neurotransmitter called serotonin in your brain. This helps to regulate your mood, sleep, and energy levels. SSRIs can take four to six weeks to work properly.
Brands of SSRIs are Lexapro (escitalopram), Zoloft (sertraline), Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram). Side effects of SSRIs can include drowsiness, nausea, insomnia, erectile dysfunction, and dizziness.
Serotonin-norepinephrine reuptake inhibitors (SNRI)
SNRIs are antidepressants that increase serotonin and norepinephrine levels in the brain by blocking their reabsorption to treat symptoms of both depression and anxiety.
Brands of SNRIs are Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine). Side effects include dizziness, headache, dry mouth, insomnia, constipation, and erectile dysfunction.
Tricyclic antidepressants, another class of antidepressants used to treat the symptoms of anxiety disorders also work by balancing the levels of neurotransmitters in the brain. Brand names include Tofranil (imipramine), and Vivactil (protriptyline).
Tricyclic antidepressants can take up to 12 weeks to have an effect. Side effects can include dizziness, dry mouth, constipation, insomnia, and rapid weight gain.
Benzodiazepines affect the gamma-aminobutyric acid (GABA) receptors of the brain, causing the central nervous system to slow down. Benzodiazepines are prescribed for insomnia and muscle spasm, as well as panic attacks and anxiety due to their sedative effects.
Common brands of benzodiazepines include Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam).
The most common side effect of benzodiazepines is drowsiness and impaired coordination. They are best used as short-term treatments for anxiety as they can be addictive. Speak with your doctor before stopping benzodiazepines as there can be a risk of withdrawal symptoms.
Antihistamines normally used to treat allergic reactions also work to decrease activity in the brain. Brands include Atarax (hydroxyzine) which also has sedative effects.
Off-label medications for the treatment of anxiety
Off-label means the medication prescribed is actually FDA (Food and Drug Administration) approved for a condition other than for the one you are using it for. Your doctor may prescribe a medication for the off-label treatment of anxiety if your regular anti-anxiety medications have not worked. Common off-label medications are:
Beta-blockers such as Inderal (propranolol), normally used for high blood pressure, can be used to treat the physical symptoms of anxiety, such as an increased heart rate and tightness of the chest. Beta-blockers tend to be prescribed for social anxiety disorders, or anxiety triggered by a specific event.
Buspar is an off-label anti-anxiety medication prescribed most commonly for generalized anxiety disorder. Buspirone helps to control serotonin and dopamine receptors in the brain.
Buspirone is commonly used in conjunction with selective serotonin reuptake inhibitors, or when other treatments have not been effective or when too many side effects have occurred.
Monoamine oxidase inhibitors (MAOIs)
If other options have not been effective, MAOIs are a secondary option. MAOIs improve mood by once again balancing brain neurotransmitters. Side effects of MAOIs include high blood pressure.
What is the best medication for Anxiety?
Your doctor will recommend which type of medication is best for you based on your medical history, any medications you are already taking, and the specific type of anxiety disorder you’re experiencing. Speak with your healthcare provider about the best medication for you. Below is a comparison of the most commonly prescribed anxiety medications:
Best medications for anxiety
|Brand name||Active ingredient||Drug class||Dosage form||Dosage||How it works||Common side effects|
|Prozac||fluoxetine||SSRI||Tablet or liquid||20 mg in the morning||Increase serotonin levels in the brain||Drowsiness, nausea, dry mouth, erectile dysfunction|
|Lexapro||escitalopram||SSRI||Tablet or liquid||10 mg in the morning or evening||Increase serotonin levels in the brain||Drowsiness, nausea, dry mouth, erectile dysfunction|
|Cymbalta||duloxetine||SNRI||Capsule||60mg, 1-2 times a day||Increase serotonin and norepinephrine in the brain||Dizziness, headache, constipation|
|Tofranil||imipramine||Tricyclic antidepressant||Oral tablet||25mg, up to 4 times a day||Rebalance neurotransmitters in the brain||Dizziness, dry mouth, constipation|
|Xanax||alprazolam||Benzodiazepines||Oral tablet||0.25 to 0.5mg, 3 times a day||Slow down the central nervous system||Drowsiness, impaired coordination|
|Valium||diazepam||Benzodiazepines||Oral tablet||2-10mg, 2-4 times a day||Slow down the central nervous system||Drowsiness, impaired coordination|
What are the most common side effects of anxiety medications?
The most common side effects of medicines for anxiety are:
- Dry mouth
- Impaired coordination
- Loss of appetite
- Weight gain
This is not a full list of all side effects of all medications that may be prescribed to you. For more information, speak with your doctor.
Other treatment options for anxiety
As mentioned earlier, there are other treatment options other than medication. Your doctor may suggest some alternative options, such as:
- Changes in your diet
- Reducing alcohol intake
- Stopping any misuse of medication
- Taking vitamin and mineral supplements
Frequently asked questions about anxiety
Do anxiety drugs cause weight gain?
Some anxiety medications can cause weight gain, but other medications can cause weight loss. You should discuss any concerns you have with your doctor.
What is the safest anxiety medication?
Only a doctor can decide which medication is safest for you. Based on your particular type of anxiety, symptoms, and any other health concerns you have, as well as your progress and response to treatment.
What questions will I be asked about my anxiety?
Your doctor, psychiatrist, psychologist, or mental health professional will ask you questions. Answering these questions honestly is essential to diagnosing and developing a treatment plan for you. The questions you can expect to be asked are:
- Do you take any medication? This would include over-the-counter, prescription drugs, or herbal supplements
- Do you take drugs or alcohol regularly?
- Describe your symptoms?
- Are your feelings of anxiety constant or does anything in particular trigger your anxiety?
- How long have you had these feelings of anxiety?
- Have you ever had a panic attack?
Are there any over-the-counter medicines for anxiety?
There are no over-the-counter drug treatments available for anxiety disorders, but your doctor may recommend some vitamins or supplements to complement your treatment.
How quickly do anti-anxiety medications work?
This will depend on the individual person being treated, but anti-anxiety medications can work within 30 minutes. Others can take days to build-up to the correct level in your system. Once working you will feel a sense of relief and a decrease in worry.
What side effects are there from anxiety medication?
Side effects may include headaches, nausea, and tiredness in the first few weeks. However, these side effects should eventually stop. Speak with your doctor if you think you are experiencing any side effects.
Related resources for anxiety
- What Are the Best Medications for Anxiety? | Everyday Health
- Treatment of anxiety disorders – PMC (nih.gov)
- Treating anxiety without medication – Harvard Health
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) – Mayo Clinic
- What is Psychotherapy? (psychiatry.org)
- Which Medications Are Best for Anxiety Disorders. Everyday Health
- Treatment of Anxiety Disorders. National Library of Medicine
- Treating Anxiety without medication. Harvard Health
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). Mayo Clinic
- What is Psychotherapy? Psychiatry.org