Medication for Anxiety
If you have severe anxiety or panic disorder, your doctor may suggest taking medication.
Medication for anxiety falls into several different categories.
The information below will help you identify issues to discuss with your doctor, and the questions you might want to ask.
There are different types of medication commonly prescribed for anxiety, and it is important that you understand the pros and cons of medication, and the differences between the various types of medication.
Keep in mind that medication does not truly treat anxiety – it only relieves the symptoms and so may help in the short term if you are suffering intense distress, perhaps to the point where you can't sleep or can't function in some other way. When this happens, it is easy to get into a vicious cycle, where you become less and less able to do the things you need to do to stop your anxiety and get back into emotional balance. Medication can help to break this cycle.
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The main types of medication for anxiety are:
Benzodiazepines
Benzodiazepines are very fast acting, and so are useful mostly for acute anxiety problems, such as panic attacks. If you use them regularly over long periods, you will build up tolerance and dependence – meaning you will need more and more to get the same effect, and if you stop taking the medication, you will experience a rebound effect where your anxiety comes back worse than before the medication. So follow your doctor's advice and only use these medications very sparingly!
Benzodiazepines used to treat anxiety include:
- Clonazepam (Klonopin) – used to treat Generalised Anxiety Disorder (GAD) and Social Phobia.
- Alprazolam (Xanax) – used to treat Generalised Anxiety Disorder (GAD) and Panic Disorder.
- Lorazepam (Ativan) – used to treat Panic Disorder
Benzodiazepines are thought to increase levels of a brain chemical called GABA (gamma-aminobutyric acid), which has a calming, stabilizing effect on your brain. Unfortunately, benzodiazepines also have some other less pleasant effects: problems with memory and concentration, and drowsiness.
It's possible to take GABA (gamma-aminobutyric acid) as a supplement, and many people with anxiety, especially Generalized Anxiety Disorder (GAD), find this helpful.
Buspirone (Buspar)
Buspirone (Buspar) is a different type of anti-anxiety medication that is thought to work by increasing serotonin levels in the brain. It has been found useful for GAD. Like the anti-depressant medications, it takes a few weeks to start working, and so needs to be taken regularly once you start – and is recommended for no longer than 4 weeks. Busar doesn't have the dependency or tolerance problems of the benzodiazepines, and seems to have relatively few side-effects – though it does have a nasty interaction with grapefruit and grapefruit products.
Anti-depressant medication for anxiety
Anti-depressants were developed to treat depression, but they have been found to be just as useful in controlling anxiety symptoms. Today doctors often prescribe these medications for anxiety disorders, as the best medications for anxiety for long-term use.
SSRIs (Selective Serotonin Re-uptake Inhibitors)
The most commonly used anti-depressants for anxiety are the SSRIs (Selective Serotonin Re-uptake Inhibitors).
Serotonin is a brain chemical that tends to be abnormally low in people with clinical depression – but it also seems to be low in people with anxiety.
SSRIs include:
- fluoxetine (Prozac)
- sertraline (Zoloft)
- citalopram (Celexa; Cipramil)
- escitalopram (Lexapro)
- paroxetine (Paxil)
SNRIs (Serotonin-Noradrenaline Re-uptake Inhibitors)
The SNRIs (Serotonin-Noradrenaline Re-uptake Inhibitors) boost levels of noradrenalin in the brain, as well as serotonin. For some people, and some conditions, this is the extra boost that is needed to help them function properly.
The SNRIs include venlafaxine (Effexor) and desvenlafaxine (Pristiq). These are used to treat OCD and also GAD – they appear to help by relieving the obsessive worrying of GAD sufferers, which is similar to that of OCD sufferers, though less severe.
The SSRIs and SNRIs are safer and have fewer side-effects than the older anti-depressants and so they are easier to tolerate. However, they do still have some side-effects, which vary depending on the medication. Although these medications are not addictive in the normal sense, many people do experience unpleasant effects when they stop taking them.
With any of the anti-depressant medications, you need to be aware that they will take a few weeks to have any effect. If you start taking one of these medications, you should be prepared to give it a proper try before deciding whether or not it is not going to help you. It's no use waiting until you feel you really need something, and then take these meds for a few days in the hope of some relief!
Tricyclic Anti-depressants (TCAs)
These include
- imipramine (Tofranil) – used for GAD and Panic Disorder
- clomiprimine (Anafranil) – used for OCD
TCAs are older anti-depressants, and tend to be used less these days because they can have some unpleasant side-effects such as: dry mouth, stomach upsets, drop in blood pressure when you stand up, blurred vision, weight gain.
TCAs can be very effective in treating the symptoms of an anxiety disorder, but because of the side-effects they will often not be used until other medications have been tried.
MAO Inhibitors
These are another class of anti-depressant medication used to treat anxiety.
MAOIs include
- tranylcypromine (Parnate)
- phenelzine (Nardil)
- isocarboxazid (Marplan).
The MAOIs can be effective when other medication does not work, both for anxiety and depression, and especially where both occur together. There is a serious downside to using MAOIs though – they can interact dangerously with some other medications and common foods like cheese and red wine, causing potentially fatal spikes in blood pressure. If you are prescribed MAOIs you must be willing to take note of the dietary restrictions and comply strictly.
Beta-blockers for anxiety
This is yet another type of medication used for anxiety.
Beta-blockers, eg Propranolol (Inderal), will relieve some of the physical symptoms of anxiety such as muscle shaking, and sweating. Beta-blockers are used primarily to treat heart conditions and high blood pressure, and they work by reducing some of these “fight or flight” stress responses. The downside – and it can be a serious concern – is that they can reduce blood pressure to dangerously low levels in a person who does not have hypertension. This means you might be prone to blackouts when you stand up – not a very pleasant side-effect.
A beta-blocker will not help your anxious thoughts, but can be useful for someone with severe social anxiety or performance anxiety who has to give a speech or play a musical instrument, for example. It is usually only prescribed as a very short-term medication for anxiety, on specific occasions where it is needed.
Reference: NIMH - What medications are used to treat anxiety?
Vanessa is a healer and practitioner of natural medicine with a background in clinical psychology.
She has a special interest in natural remedies for anxiety, depression, and other dysfunctions that keep us from living a full and joyful life.
