Medication and Anxiety
Medication can be an effective approach for managing various types of anxiety such as panic, hyperarousal, and constant worry. However, contrary to popular belief and subtle messages from pharmaceutical companies, medication is far from a cure. In fact, when it comes to “cures” for most psychiatric conditions, the data tends to support psychotherapy.
For example, post-traumatic stress disorder (PTSD) responds very well to psychotherapy, whereas the positive effects of medication are somewhat limited. The same is true for panic disorder. Although certain types of medication are very good at relieving panic symptoms in the short term, once the person stops taking the medication, the anxiety returns.
The same has not been found for cognitive and behavioral therapies. Still, medication is helpful in many cases. It is often most effective when used in combination with psychotherapy, often referred to as combined or integrated treatment. Some of the more commonly used anxiety medications are listed below.
Antidepressants are most commonly used to treat anxiety, specifically selective serotonin reuptake inhibitors (SSRIs). These medications influence the brain chemical serotonin, a naturally occurring substance responsible for myriad emotional and behavioral processes. Anxiety is one of them.
Although it may seem strange that a person with anxiety would be prescribed an antidepressant, serotonin is related to both depression and anxiety. Initially these medications were studied for their antidepressant effects. In addition to improving mood, it became clear that they improved social anxiety, panic, obsessive worry and compulsions, and trauma-related symptoms. But, since depression was the initial focus in clinical research trials, the label of “antidepressants” stuck.
The more common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). SSRIs are considered safe, but are not free from side effects. The most commonly reported side effects include insomnia, sexual dysfunction, and stomach discomfort.
It’s also important to note that antidepressants in general carry a federally issued warning of increased suicide behavior for people in their mid-20s and younger. This warning is based on a relatively recent discovery that young people who take antidepressants may have a slightly higher risk of suicidal thoughts and behaviors compared to those who don’t take medication.
Benzodiazepines frequently are used for the short-term management of anxiety. The most commonly prescribed are alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). These medications work similarly to alcohol, and like alcohol, are great at generating relaxation, reducing muscle tension and providing an overall feeling of calmness. The effects are felt almost immediately.
However, the safety risks for benzodiazepines are greater than with the SSRIs. These medications do not mix well with alcohol or sedatives and should be avoided in recovering alcoholics and those suffering from some physical issues such as obstructive sleep apnea.
The research also shows that these medications can worsen depression and render ineffective psychotherapy for post-traumatic stress disorder and panic disorder. A small number of people will develop psychological or physical dependence on these drugs. It can be difficult to wean people off them if they have been used for a long time. Stop taking benzodiazepines only under the supervision of a health care provider.
Buspirone (Buspar) is another anti-anxiety medication that manipulates serotonin. Similar to SSRIs, it can take several weeks before the person notices any improvement. The main benefit of buspirone is that there are no abuse or dependency issues associated with the drug. It can be taken for long periods of time and it is relatively easy to wean off of when the person no longer needs it. The most common side effect is a feeling of lightheadedness shortly after taking it. Other less common side effects include headaches, nausea, insomnia, and nervousness.
Mental health professionals use a variety of other medications to treat anxiety, although they are not necessarily called anxiety medications. One example is known as serotonin-norepinephrine reuptake inhibitors, or SNRIs. Similar to SSRIs, SNRIs increase the level of serotonin in the brain. They also increase the neurotransmitter norepinephrine, which also has been implicated in anxiety. Common examples of SNRIs are venlafaxine (Effexor) and duloxetine (Cymbalta). The generic antihistamine hydroxyzine is occasionally used for the short-term treatment of anxiety. Chemically similar to over-the-counter diphenhydramine (Benadryl), its most troubling side effect is sleepiness. It also can lead to weight gain and exacerbate a condition called restless leg syndrome.
The use of medications in the treatment of anxiety can be confusing and worrisome for the average person. However, with a little information and a trusting relationship with your health care provider, medication can be a viable and effective option.
The article is based in part on Dr. Moore’s book Taking Control of Anxiety: Small Steps for Getting the Best of Worry, Stress, and Fear.
Moore, B. (2018). Medication and Anxiety. Psych Central. Retrieved on April 1, 2020, from https://psychcentral.com/lib/medication-and-anxiety/