Medications for Anxiety, Panic and Phobias
Forty million people in the United States (U.S.) are affected by anxiety disorders, which are the most common group of mental illnesses in the country. However, only 36.9 percent of people with the condition receive treatment. Besides generalized anxiety, other anxiety disorders include phobia, panic disorder, separation anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder (OCD).
We’ve all experienced “butterflies in the stomach” before giving a speech or sweaty palms during a job interview. It is a normal part of life to experience some anxiety. Additionally, some people may experience jumpiness, nausea, feelings of apprehension, irritability, uneasiness, rapid / irregular heartbeat, stomachache, faintness, and breathing problems.
There are situations where anxiety can present serious problems, even though, oftentimes, it is a mild and manageable condition. Depending on the duration and severity, anxiety can make daily life activities the activities difficult or impossible.
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.
According to the American Academy of Family Physicians, antidepressants are often used as the first line of treatment. SSRIs, or selective serotonin reuptake inhibitors, specifically, are the most-often prescribed antidepressants. They help make serotonin, a neurotransmitter that helps maintain mood, become more available to the brain.
Some SSRIs used to treat chronic anxiety include paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft).
The antidepressants duloxetine (Cymbalta) and venlafaxine (Effexor), SNRIs (serotonin and norepinephrine reuptake inhibitors), which act on the brain chemicals serotonin and norephinephrine, may also help. Some tricyclic antidepressants like imipramine (Tofranil) can work for some people, too. Antihistamines (such as hydroxyzine) and beta-blockers (such as propranolol) can help mild cases of anxiety. SSRIs, SNRIs, and tricyclics each need to be taken daily, even if anxiety is not experienced all the time. It is important to follow your doctor’s dosage instructions. Antihistamines or beta-blockers are usually taken only when needed for anxiety, or immediately before an anxiety-provoking event (for example, taking propranolol shortly before giving a speech). Finally, certain anticonvulsant medicines, such as gabapentin (Neurontin) and pregabalin (Lyrica), are also beginning to show value in treating some forms of anxiety in early-stage research studies.
For acute anxiety, benzodiazepines are the most prominent of the anti-anxiety medications, as their effects are felt immediately. Benzodiazepines include chlordiazepoxide (Librium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium). These medications can sometimes cause drowsiness, memory issues, irritability, dizziness, attention problems, and can be addictive. Despite these drawbacks, they have largely replaced barbiturates in recent years, because they tend to be safer if taken in large doses.
In contrast to the fast-acting nature of benzodiazepines, buspirone must be taken daily for two or three weeks before it fully takes effect. Buspirone (Buspar) is another anti-anxiety medication that has fewer side effects than benzodiazepines and is not associated with dependence. Buspar, however, can have its own side effects and may not always be as effective when a person has taken benzodiazepines in the past.
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.
The doctor should be informed of all other medications the patient is taking, including over-the-counter medications. Benzodiazepines increase central nervous system depression when combined with alcohol, anesthetics, antihistamines, sedatives, muscle relaxants, and some prescription pain medications.
Some benzodiazepines may influence the action of some anticonvulsant and cardiac medications, and they 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, dizziness, shakiness, headache, insomnia, 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.
Web MD. (2017). Understanding Generalized Anxiety Disorder — Diagnosis and Treatment. Retrieved from https://www.webmd.com/anxiety-panic/guide/understanding-anxiety-treatment#2 on April 23, 2018.
Medical News Today. (2017). Anxiety: Causes, symptoms, and treatments. Retrieved from https://www.medicalnewstoday.com/info/anxiety on April 23, 2018.
Everyday Health. (2018). Which Medications Are Best for Anxiety Disorders? Retrieved from https://www.everydayhealth.com/anxiety/guide/medications/ on April 23, 2018.
Carmosino, A. (2020). Medications for Anxiety, Panic and Phobias. Psych Central. Retrieved on May 30, 2020, from https://psychcentral.com/lib/medications-for-anxiety-panic-and-phobias/