In most cases, anxiety disorders are treated with medication, specific types of psychotherapy, or both, depending on each individuals problem and preference. If you are diagnosed with an anxiety disorder, the type of disorder or the combination of disorders that are present have to be identified, in addition to possible parallel conditions, like depression or drug abuse.
Sometimes coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought into control.
Anxiety disorders can not be “cured” by medications, but it can keep them in check while the person undergoes psychotherapy. Medication must be prescribed by a physician, generally a psychiatrist. The main types of medications used to treat anxiety disorders are antidepressants, and anti-anxiety drugs.
Beta-blockers are also used to manage some of the physical symptoms. With correct treatment, many people suffering from anxiety disorders can lead normal, satisfying lives.
Obviously, antidepressants were designed to treat depression; nevertheless, are also successful against anxiety disorders. The medications start altering brain chemistry immediately after the very first dose, however, their full effect on symptoms usually takes about 4 to 6 weeks to build up. You must continue taking these medications long enough to allow them to work.
The newest generation of antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac®), sertraline (Zolof®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), and social phobia.
SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a drug closely related to the SSRIs, is used to treat Generalized Anxiety Disorder (GAD). These medications are started at low doses and gradually increased until they have a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but occasionally bring about minor nausea or jitters when people first start to take them, symptoms which fade with time. Some people also encounter sexual dysfunction while taking SSRIs; this may be helped by adjusting the dosage or switching to another SSRI.
The second generation of antidepressants, tricyclics are older than SSRIs. They work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They sometimes cause drowsiness, dry mouth, dizziness, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic.
Tricyclics include imipramine (Tofranil), prescribed for panic disorder and GAD, and clomipramine (Anafranil®), the only tricyclic antidepressant useful for treating OCD.
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are helpful in treating panic disorder and social phobia.
People taking MAOIs are restricted from eating a variety of foods and beverages (including cheese and red wine) containing the amino acid tyramine or taking certain medications, including some types of birth control pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help lessen these risks.
MAOIs can also react with SSRIs to produce a serious condition called “serotonin syndrome,” which may cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.
High-potency benzodiazepines fight anxiety and have few side effects other than drowsiness. Sice people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are usually prescribed for shorter periods of time, particularly for people who have abused drugs or alcohol and who tend to become dependent on medication easily.
An exception to this is people with panic disorder, who can take benzodiazepines for up to a year without harm.
Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD. Some people experience withdrawal symptoms if they stop taking benzodiazepines suddenly rather than tapering off, and anxiety may come back once the medication is stopped. These possible problems have led some physicians to avoid using these drugs or to use them in insufficient doses.
Buspirone (Buspar®), is a newer anti-anxiety medication used to treat GAD. Potential side effects include headaches, dizziness, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can also prevent physical symptoms accompanying certain anxiety disorders, particularly social phobia. When a phobic situation can be foreseen (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.
Before taking any medication for treating anxiety disorders:
- Ask your doctor to tell you about the effects and side effects of the drug.
- Tell your doctor about any alternative therapies or over-the-counter medications you are using.
- Ask your doctor when and how the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s supervision.
- Work with your doctor to determine which medication is right for you and what dosage is best.
Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
Image: Annie Cavanagh, Wellcome Images