Medications for Anxiety, Panic and Phobias

By National Institute of Mental Health

Everyone experiences anxiety at one time or another: “butterflies in the stomach” before giving a speech or sweaty palms during a job interview are common symptoms. Other symptoms of anxiety include irritability, uneasiness, jumpiness, feelings of apprehension, rapid or irregular heartbeat, stomachache, nausea, faintness and breathing problems.

Anxiety is often manageable and mild. But sometimes it can present serious problems. A high level or prolonged state of anxiety can be very incapacitating, making the activities of daily life difficult or impossible. Besides generalized anxiety, other anxiety disorders are panic, phobia, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder.

Phobias, which are persistent, irrational fears and are characterized by avoidance of certain objects, places and things, sometimes accompany anxiety. A panic attack is a severe form of anxiety that may occur suddenly and is marked with symptoms of nervousness, breathlessness, pounding heart and sweating. Sometimes the fear that one may die is present.

Anti-anxiety medications help to calm and relax the anxious person and remove the troubling symptoms. There are a number of anti-anxiety medications currently available. The preferred medications for most anxiety disorders are the benzodiazepines.

In addition to the benzodiazepines, a non-benzodiazepine, buspirone (BuSpar), is used for generalized anxiety disorders. Antidepressants are also effective for panic attacks and some phobias and are often prescribed for these conditions. They are also sometimes used for more generalized forms of anxiety, especially when it is accompanied by depression. The medications approved by the FDA for use in OCD are all anti-depressants — clomipramine, fluoxetine and fluvoxamine.

The most commonly used benzodiazepines are alprazolam (Xanax) and diazepam (Valium), followed by chlordiazepoxide (Librium, Librax, Libritabs). Benzodiazepines are relatively fast-acting medications; in contrast, buspirone must be taken daily for two or three weeks before its antianxiety effect is felt.

Most benzodiazepines will begin to take effect within hours, some in even less time. Benzodiazepines differ in duration of action in different individuals; they may be taken two or three times a day, or sometimes only once a day. Dosage is generally started at a low level and gradually raised until symptoms are diminished or removed. The dosage will vary a great deal depending on the symptoms and the individual’s body chemistry.

Benzodiazepines have few side effects. Drowsiness and loss of coordination are most common; fatigue and mental slowing or confusion can also occur. These effects make it dangerous to drive or operate some machinery when taking benzodiazepines, especially when the patient is just beginning treatment. Other side effects are rare.

Benzodiazepines combined with other medications can present a problem, notably when taken together with commonly used substances such as alcohol. It is wise to abstain from alcohol when taking benzodiazepines, as the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications.

Following the doctor’s instructions is important. The doctor should be informed of all other medications the patient is taking, including over-the-counter preparations. Benzodiazepines increase central nervous system depression when combined with alcohol, anesthetics, antihistamines, sedatives, muscle relaxants, and some prescription pain medications.

Particular benzodiazepines may influence the action of some anticonvulsant and cardiac medications. Benzodiazepines have also been associated with abnormalities in babies born to mothers who were taking these medications during pregnancy.

With benzodiazepines, there is a potential for the development of tolerance and dependence as well as the possibility of abuse and withdrawal reactions. For these reasons, the medications generally are prescribed for brief periods of time days or weeks and sometimes intermittently, for stressful situations or anxiety attacks. For the same reason, ongoing or continuous treatment with benzodiazepines is not recommended for most people. Some patients may, however, need long-term treatment.

Consult with the doctor before discontinuing a benzodiazepine. A withdrawal reaction may occur if the treatment is abruptly stopped. Symptoms may include anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, and, in more severe cases, fever, seizures and psychosis.

A withdrawal reaction may be mistaken for a return of the anxiety, since many of the symptoms are similar. Thus, after benzodiazepines are taken for an extended period, the dosage is gradually tapered off before being completely stopped.

Although benzodiazepines, buspirone, tricyclic antidepressants, or SSRIs are the preferred medications for most anxiety disorders, occasionally, for specific reasons, one of the following medications may be prescribed: antipsychotic medications; antihistamines (such as Atarax, Vistaril, and others); barbiturates such as phenobarbital; and beta-blockers such as propranolol (Inderal, Inderide). Propanediols such as meprobamate (Equanil) were commonly prescribed prior to the introduction of the benzodiazepines, but today rarely are used.

 

APA Reference
Mental Health, N. (2006). Medications for Anxiety, Panic and Phobias. Psych Central. Retrieved on October 21, 2014, from http://psychcentral.com/lib/medications-for-anxiety-panic-and-phobias/000424
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
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