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The Definitive Guide to Anxiety Medications



Your heart is racing, you break out into a sweat, and you feel crippled by fear. If these sensations sound familiar, then you have—at one time or another—experienced anxiety.

Anxiety, in and of itself, is not bad. In fact, it is considered both normal and healthy when experienced during an anxiety-inducing situation, such as speaking in front of a large crowd or attending an interview.

However, in these scenarios, the feeling quickly dissipates once the event or situation has ended. The same cannot be said for those that suffer from generalized anxiety disorder or panic disorder.

For these individuals, feelings of worry and anxiety are near constants, and it can even occur under circumstances that most people consider benign or even pleasant in nature, such as visiting a friend or going to work.

For these individuals, the fear is crippling. Racing or unwanted thoughts are persistent and pervasive to the point that they hinder everyday life.

They may find it difficult to focus or concentrate, and every situation may seem like a life or death situation. Anxiety can also worsen with time, making it next to impossible for a person to function at even the most basic of levels.

If the latter sounds more like what you are dealing with, you could be suffering from generalized anxiety disorder or panic disorder.

Thankfully, there are solutions to help you deal with the condition. We will discuss the most common treatments (and their efficacy and potential side effects) in this guide.

What is Generalized Anxiety Disorder?

Generalized anxiety disorder is characterized as persistent and excessive anxiety or worry that occurs on most days and interferes with the person’s daily activities or routines for at least six months, consistently. [1]

The impact is generally significant, and it often leads to missed days at work or school, difficulty in achieving peak performance, and even stunted interactions with classmates or colleagues. So what, exactly, does persistent and excessive worry and fear look like in a person?

The National Institute of Mental Health indicates that symptoms of anxiety can include:

  • Restlessness or hyper-vigilance
  • Irritability or difficulty controlling one’s emotions
  • Muscle tension
  • Insomnia and other sleep problems
  • Excessive or persistent fatigue
  • Difficulty concentrating or mind going “blank”
  • Racing or unwanted thoughts

These symptoms can occur with or in the absence of panic attacks, which are severe and often crippling periods of intense fear. They often come on quickly and peak within minutes of starting.

Symptoms of panic attacks may include:

  • Feelings of impending doom,
  • Shaking or trembling,
  • Feeling short of breath or smothered,
  • Heart palpations or a racing heartbeat,
  • Sweating, and
  • Feeling out of control.

Anxiety and panic disorder sufferers often worry that they’ll never feel “normal” again. For those that experience panic attacks, fears over when the next one will occur may increase anxiety levels even further.

As a result, they may become trapped in a perpetual cycle of panic and fear, which may ultimately worsen the condition over time. In some cases, medication can help to manage the condition, making it easier for the person to function and enjoy their life.

Most Commonly Prescribed Medications for Anxiety Disorders and Panic Attacks

Medication options for anxiety may include benzodiazepines, antidepressants, or both. It is important to note that medication is not a cure for anxiety.

In fact, the American Academy of Family Physicians indicates that benzodiazepines may lose their therapeutic benefit over time, [2] and a recent study published in the Journal of American Medical Association (JAMA) Psychiatry suggests that SSRIs (a type of antidepressant) may be less effective at managing anxiety than previously thought. [3]

Still, medication can provide temporary relief from the symptoms of anxiety and allow the sufferer a way to take back control over their life. Just be sure to discuss the possible benefits and side effects of any medication with your physician or psychiatrist, as they are the most qualified to help in you developing a long-term treatment plan for your condition. For now, let’s take a closer look at the types of medications that are used to treat anxiety.

Using Benzodiazepines to Treat Anxiety and Panic Disorders

Benzodiazepines, more commonly known as “tranquilizers,” slow down the nervous system to produce a relaxing effect. This helps to reduce muscle tension and other, common anxiety-related symptoms.

They work quickly—typically within just 30 minutes—and are capable of curbing even the most crippling of panic attacks. Benzodiazepines can become addictive, however, so they are not recommended as a long-term solution for anxiety or panic disorders. Instead, they should only be used “as needed.”

Your doctor can help you better understand how to use them responsibly to decrease your risk of addiction.

It is also important to note that these drugs may also worsen pre-existing depression and they can increase one’s chances of experiencing suicidal thoughts and feelings. [4]

Benzodiazepines have also been known to cause emotional blunting and numbness, and recent studies suggest that they may even lead to treatment-resistant depression. [5]

Other common side effects of these drugs may include:

  • Memory impairment
  • Difficulty concentrating
  • Drowsiness or grogginess
  • Poor muscle coordination
  • Mental confusion
  • Decreased reaction time
  • Vertigo (feeling off-balance)
  • Slurred or slowed speech
  • Abnormalities in eye movement
  • Dry mouth
  • Constipation
  • Fatigue
  • Changes in appetite
  • Nausea and/or vomiting
  • Decreased libido
  • Diplopia (“seeing double”), and
  • Impaired driving skills.

Because of their ability to cause psychomotor retardation, users should not drive after taking benzodiazepines. Also, be aware that these drugs can produce a hangover effect the next day.

Users are also encouraged to avoid alcohol use, and they should never take cough or cold medicine unless otherwise directed by their physician, as these substances can lead to serious and fatal complications when mixed with benzodiazepines.

Other potentially serious and life-threatening side effects associated with benzodiazepine use include:

  • Withdrawal symptoms
  • Seizures
  • Respiratory depression
  • Jaundice
  • Extremely low blood pressure
  • Decreased heart rate
  • Increased heart rate
  • Fainting, and
  • Akathisia (a movement disorder)

Users are advised to seek immediate medical assistance if they experience any of these symptoms when actively using benzodiazepines in their anxiety treatment plan.

It is also important to note that certain individuals are at an increased risk for developing serious side effects, including those over the age of 65, women who are either pregnant or breastfeeding, and those with a history of drug or alcohol abuse.

Anxiety and panic sufferers that fall into one of these categories are encouraged to speak with their doctor about developing a treatment plan that either limits or completely avoids the use of benzodiazepines.

Most Commonly Prescribed Benzodiazepines

Though there are many different types of benzodiazepines, only a select few are recommended for treating anxiety and panic disorders. The most commonly used include Alprazolam (Xanax), Clorazepate (Tanxene), Diazepam (Valium), Estazolam, Flurazepam (Dalmane), and Oxazepam.

Anxiety and panic disorder sufferers should discuss each drug, its potential benefits, and side effects with their physician or psychiatrist before settling on any one type. It is also recommended that patients start with the least impairing and addictive drug possible before moving to those with a higher effect and potency.

Using Antidepressants to Treat Anxiety and Panic Disorders

Certain antidepressants may also be used to alleviate the symptoms associated with anxiety and panic disorders.

The most commonly prescribed for anxiety are SSRIs, or selective serotonin reuptake inhibitors, which include popular drugs like fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and fluvoxamine (Luvox). They work by affecting the serotonin receptors in the brain. [6]

Many doctor and psychiatrists prefer antidepressants over benzodiazepines for anxiety due to their decreased propensity for addiction and decreased risk of serious side effects. Results with antidepressants are not instantaneous like they are with benzodiazepines, however.

Instead, users may not feel the full effect until four to six weeks into their treatment. As such, antidepressants are taken continuously, rather than “as needed.”

Users should also be aware that, although antidepressants do not cause physical dependence, they can create a withdrawal effect—especially when their use is suddenly discontinued.

Symptoms involved with SSRI withdrawal can include:

  • Extreme fatigue
  • Extreme depression
  • Increased anxiety levels
  • Extreme agitation or irritability
  • Flu-like symptoms
  • Insomnia
  • Suicidal thoughts or feelings

Antidepressants also come with a myriad of potential side effects, even if when taken as directed. The most notable and concerning is that they can make symptoms worse, causing extreme irritability and anxiety.

They can also lead to suicidal or homicidal thoughts, particularly in teens and young children. Changes to medication may also create these symptoms.

Other common side effects of SSRI use may include:

  • Changes in bowels (constipation or diarrhea)
  • Nausea
  • Headaches
  • Drowsiness and fatigue
  • Agitation or irritability
  • Weight gain
  • Dry mouth
  • Sweating
  • Nervousness or restlessness
  • Sexual dysfunction
  • Dizziness
  • Blurred vision,
  • Insomnia, and
  • Headaches.

Taking the medication with food can help to alleviate some of these symptoms, particularly in terms of nausea.

Individuals should also note that a rare condition known as serotonin syndrome may occur when taking SSRIs. Generally, this condition only occurs when two or more serotonin-containing medications or supplements are combined, but it can occur when taking SSRIs alone.

Users should seek immediate medical assistance if they notice the symptoms, which include tremors, confusion, agitation, lack of coordination, sweating, rapid heart rate, and restlessness. [7]

Using Buspirone (BuSpar) to Treat Anxiety and Panic Disorders

Buspirone (otherwise known as BuSpar) is a fairly new medication used to treat anxiety. These mild tranquilizers are somewhat of a cross between SSRIs and benzodiazepines. They combat the symptoms of anxiety over time, reaching full effect about two weeks after starting the medication, which is faster than an SSRI but slower than a benzodiazepine.

Dependency risk is lower with BuSpar than benzodiazepines because the calming effect is less sedating. Withdrawal effects are also limited, especially in comparison to benzodiazepines.

However, there are still side effects for those taking the drug, including:

  • Dizziness
  • Weight gain
  • Drowsiness
  • Nausea
  • Headaches

Because there are fewer risks involved with taking Buspirone, it may be a plausible treatment solution for individuals who would generally be considered at too high of a risk for benzodiazepines. However, the effect and benefits are quite limited, especially when compared to other, more effective anxiety treatment medications.

Using Beta-Blockers to Treat Anxiety and Panic Disorders

Though generally used to treat high blood pressure conditions, beta-blockers like atenolol (Tenormin) and propranolol (Inderal) are sometimes used as off-label treatments for anxiety. They work by blocking the stress hormone caused by the “fight or flight” response, which can minimize or even eliminate the physical sensations associated with anxiety, such as sweating, dizziness, and trembling.

Beta-blockers do not alleviate the emotional symptoms associated with anxiety and panic disorders, however. This makes them ineffective as a long-term treatment medication. Instead, its preferred application is generally limited to treating intermittent anxiety, social anxieties, and phobias.

Users should also be aware that that are still side effects involved. The most common include:

  • Sleepiness and fatigue
  • Dizziness
  • Changes in bowel habits (constipation or diarrhea)
  • Headaches,
  • Nausea, and
  • Generalized weakness

Individuals who are considering using beta-blockers as a part of their anxiety or panic disorder treatment plan should discuss its uses and limitations with their doctor or psychiatrist to determine if it may be a viable and effective option for their situation.

Non-Medication Treatment Options for Anxiety and Panic Disorders

Medications are not the only option for treating anxiety or panic disorders. In fact, the process of obtaining medication and its associated costs may further increase one’s level of anxiety.

Alternative methods may offer a viable solution, especially for those who suffer from mild anxiety or have experienced fewer than six months of persistent symptoms. These alternative treatment options can include:

1. Cognitive Behavioural Therapy

Cognitive Behavioural Therapy, or CBT, is a therapy process in which one learns how to recognize the thoughts, triggers, and causes of their anxiety. The individual then works to “re-train” the brain to reduce the impact that these thoughts and feelings have on their lives. [8]

There are some self-help books that can be purchased and used at home, but in cases of extreme or severe anxiety, the aid of a therapist may be necessary. CBT can be used in conjunction with medication to help the individual manage the condition while working through the CBT process and exercises, which may be more effective than medication alone. [9]

2. Diet and Exercise

Poor diet and physical condition are the root cause of many health issues. While this may not necessarily be the case with anxiety, studies have shown that exercise and diet can be used to help minimize the physical and emotional symptoms of anxiety. [10], [11]

More specifically, studies have found that aerobic exercise can decrease overall tension levels, improve self-esteem, and elevate and stabilize mood. Anti-anxiety effects can occur in as little as just five minutes. Studies also indicate that regular exercise decreases the likelihood of developing anxiety or depression.

In respect to food and anxiety, most experts simply recommend a well-balanced diet that is high in nutrients and low in artificial sugars and preservatives.

However, some studies suggest that there may be anxiety-combatting foods that can help to naturally boost your serotonin levels. These include foods rich in magnesium, zinc, and omega-3 fatty acids. Antioxidants are also thought to help alleviate anxiety.

3. Mindfulness and Meditation

Mindfulness activities and meditation encourage people to observe their thoughts, feelings, and behaviours in a non-judgmental way, which ultimately allows the thoughts to leave the mind, rather than continuously cycle or race.

The idea is to promote a sense of calmness and relaxation. Recent studies have found this practice to be even more effective than medication. [12]

Unfortunately, it can be difficult to develop a new routine when dealing with extreme anxiety, so those who struggle to maintain basic, daily functions may still need medication when first starting mindfulness or mediation exercises to aid them in the process.

A growing number of studies have also found that yoga, tai-chi, and Qigong, which combine mindfulness with exercise, are effective at managing anxiety conditions. [13], [14]

Treating Anxiety and Panic Disorders – Which Option is Right for You?

With so many options for treating anxiety and panic disorders, it can be difficult to decide where to start. Often, the best approach is to first consider how much anxiety affects your life. Is it hindering your ability to have healthy relationships? Are you unable to work or attend school? Is your anxiety only an issue during social situations?

By knowing and understanding your condition, and how it impacts your daily life and routines, you can approach your treatment and set goals from a more objective stance.

This also allows you to determine if a more natural option may be a viable solution, or if medication may be needed to help you manage the condition until a more permanent solution can be found.

If medication does seem necessary, make sure you prepare for the conversation with your doctor. It is critical that your medical history, familial history, and current medications are considered when developing your treatment plan.

Your doctor will also likely ask you a few questions about your anxiety, and how it is impacting your daily life so that they can better understand how to help you in treating it. Be honest during this questioning, as your answers may determine the type of treatment that would be most effective for managing your condition.

Questions to Ask Your Doctor About Medication

  • Is medication the best option for managing my anxiety, or would alternative methods be effective enough?
  • What are the side effects of the medication I would be taking, and are there ways to minimize or prevent them?
  • Could therapy help me manage anxiety while taking medication?
  • How long should I expect to be on mediation?
  • What happens if I miss a dose?
  • What are the chances that my anxiety will re-emerge after treatment?
  • How long will it take for the medication to help me feel better?
  • Are there any additional lifestyle changes I can make to improve the way I feel?
  • How will alcohol and other medications interact with my anxiety medication?
  • Are there any over-the-counter medications that I should avoid?

Once medication has been prescribed, your doctor will likely request that you make a return appointment to see if the treatment plan is helping. Your treatment plan will also be re-evaluated over time to determine if changes should be made.

Lastly, remember to seek immediate help if your condition worsens, you notice serious side effects, or you start to notice suicidal thoughts or feelings while taking your medication.

Feeling better may seem impossible when you’re trapped in the clutches of anxiety, but you can manage the condition. A thought-out, educated treatment plan, along with help from your doctor and/or psychiatrist can pave the way to better mental health.

Just remember to stay optimistic and communicate regularly with those closest to you, as well as your doctor and other clinicians.

References:

[1] National Institute of Mental Health – Anxiety Disorders: https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml(NIMH website)

[2] Addiction: Part I. Benzodiazepines – Side Effects, Abuse Risk, and Alternatives: https://www.aafp.org/afp/2000/0401/p2121.html(American Family Physician medical journal)

[3] Reporting Bias in Clinical Trials – Investigating the Efficacy of Second-Generation Antidepressants in the Treatment of Anxiety Disorders: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2205839(JAMA medical journal of psychiatry)

[4] Hypnotic Medications and Suicide – Risk, Mechanisms, Mitigation, and the FDA: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5205566/(American Journal of Psychiatry)

[5] Is Your Medication Making You Depressed? – Harvard Health Publishing: https://www.health.harvard.edu/drugs-and-medications/is-your-medication-making-you-depressed(Harvard Medical School website)

[6] Web MD – How Different Antidepressants Work: https://www.webmd.com/depression/how-different-antidepressants-work#1(WebMD website)

[7] Mayo Clinic – Selective Serotonin Reuptake Inhibitors (SSRIs): https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825(Mayo Clinic website)

[8] Effective Treatments for Anxiety – The Department of Psychology Community Clinic: https://clinic.unc.edu/anxiety-clinic/for-consumers/effective-treatments-for-anxiety/(The Department of Psychology Community Clinic website)

[9] Treatment of Anxiety Disorders – Dialogues of Clinical Neuroscience: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/(PMC website)

[10] Nutritional Strategies to Ease Anxiety – Harvard Health Publishing: https://www.health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441(Harvard Medical School Website)

[11] Exercise for Stress and Anxiety – Anxiety and Depression Association of America: https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety(ADAA website)

[12] Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity – Journal of Clinical Psychiatry: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/(PMC website)

[13] Yoga for Anxiety and Depression – Harvard Health Publishing: https://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression(Harvard Medical School website)

[14] Tai Chi and Qigong for the Treatment and Prevention of Mental Disorders – Psychiatry Clinics of North America: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917559/(PMC website)

 

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