Anxiety Medication

In situations where anxiety symptoms are associated with a substance being used or a medical condition it would be hoped the resolution of the condition or removal of the offending substance would resolve the anxiety symptoms.

In anxiety disorders not associated with substance use or medical conditions two types of treatment are available, medication and non-medication treatments. Specific types of psychotherapeutic therapies (talking therapies) appropriate to the specific disorder are often used by psychiatrists, psychologists, social workers or other mental health care workers. Research has found in many cases a combination of medication and non-medication treatment is the best option for a number of these disorders. In some anxiety disorders, for instance in specific phobias, psychotherapy is necessary for effective treatment as medication alone has not been found to be effective.

A number of medication treatments are available for the various anxiety disorders and it is important to realize if one has not worked that there are other possibilities and so you should not give up hope but realize you might have to try different courses of action until you find the course that is most suitable for you and your condition.

Benzodiazepines

These agents are among the best known medications for treating anxiety. Although all benzodiazepines are know to relieve anxiety symptoms some have FDA approval for anxiety treatment while others are approved for use as sleeping agents (sedative-hypnotics) while others are used for both purposes. There are short acting, intermediate and long acting medications in this class. The length of action of the medication is determined by how fast the body breaks down (metabolizes) the active part of the medication and eliminates it from the body.

Anti-Anxiety

• Alprazolam (Xanax) - [Intermediate acting]
• Bromazepam (Lectopam) - [Intermediate acting]
• Lorazepam (Ativan) - [Intermediate acting]
• Oxazepam (Serax) - [Intermediate acting]
• Temazepam (Restoril) - [Intermediate acting]
• Chlordiazepoxide hydrochloride (Librium) - [Long acting]
• Clorazepate (Tranxene) - [Long acting]
• Diazepam (Valium) - [Long acting]

Sedative/Hypnotics

• Midazolam (Versed) - [Short acting]
• Triazolam (Halcion) - [Short acting]
• Alprazolam (Xanax) - [Intermediate acting]
• Bromazepam (Lectopam) - [Intermediate acting]
• Lorazepam (Ativan) - [Intermediate acting]
• Oxazepam (Serax) - [Intermediate acting]
• Temazepam (Restoril) - [Intermediate acting]
• Flurazepam (Dalmane) - [Long acting]
• Nitrazepam (Mogadon) - [Long acting]
• Clorazepate (Tranxene) - [Long acting]
• Diazepam (Valium) - [Long acting]

Side effects - The most common side effects of these medications are drowsiness, fatigue, confusion and disorientation-primarily in the elderly, dizziness, decreased concentration, decrease memory, dry mouth and blurred vision.

Precautions - These medications can impair ability to drive operate machinery or perform dangerous tasks. They lower tolerance to alcohol and increase confusion and impairment due to their own side effects when taken in conjunction with alcohol so alcohol and benzodiazepines should not be taken together. Physical and psychological dependence can occur, with withdrawal symptoms which are in keeping with dosages and length of time taking these medications.

Antihistamine - Hydroxyzine (Atarax) is an antihistamine which has anti-anxiety properties. It is indicated for use in anxiety and tension in preparation for dental procedures and acute emotional problems. It is also used in managing anxiety associated with organic disturbances and as add on therapy in alcoholism and allergic conditions such as chronic itching and contact allergies. People with allergic conditions with a strong anxious or emotional component such as asthma might also benefit from hydroxyzine as a medication choice.

Side effects - Common side effects are often mild and disappear after several days on the medications. They are drowsiness, dry mouth, and headache.

Precautions - Patients need to take caution or avoid tasks which require alertness such as driving or operating dangerous equipment, side effects disappear, avoid drinking alcohol or taking other medication which have similar (CNS depressant) effects.

Azapirone - Buspirone (Buspar) This is a class of drugs which help in anxiety but are not related to the benzodiazepines. They can be useful in patients with a history of substance or alcohol abuse or patients for whom it is important not to have side effects which might cause sedation or psychomotor impairment. 4 Buspirone is indicated in generalized anxiety disorder. It has demonstrated positive effects in chronic anxiety, prost traumatic stress disorder, social phobia and alcohol withdrawal.

Side effects - The common side effects of this medication are seen at the beginning of treatment and generally decrease or go away with continued use or a decreased dose. They are headache, dizziness, lightheadedness, nervousness, excitement, fatigue, nausea, clamminess, or sweatiness.

Antidepressants - A number of antidepressants are used in anxiety disorders. Patients sometimes resist these treatments, reporting “but I am not depressed.” However, the neurotransmitters and areas of the brain involved in anxiety and depression have considerable overlap and interaction with each other. It stands to reason, then, that the same medications will sometimes be useful for both disorders. This is the case with anxiety and many antidepressants are found to be effective for these disorders.

Two groups of newer medications with less side effects than older antidepressant medications are SSRIs Selective Serotonin Reuptake Inhibitors i.e. paroxetine (Paxil) and SNRIs Serotonin Norepinephrine Reuptake Inhibitors ie venlafaxine (Effexor) are used for anxiety disorder. Both paroxetine and venlafaxine have received approval for use in anxiety. Other SSRIs are fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram which are also commonly seen in the various disorders. A list below shows medications that have gained approval from regulating bodies for specific disorders, while some of the other SSRIs may still have ongoing studies in the various disorders and may be tried for these disorders by your physician for a variety of reasons such as drug interactions or side effects from one of the approved medications.

Obsessive Compulsive Disorder - [SSRI]
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Obsessive Compulsive Disorder - [Tricyclic Antidepressant]
• Clomapramine (Anafranil)

Panic Disorder - [SSRI]
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Post Traumatic Stress Disorder - [SSRI]
• Paroxetine (Paxil)

Social Phobia
• Paroxetine (Paxil) - [SSRI]
• Venlafaxine (Effexor) - [SNRI]

Monoamine oxidase inhibitors - These are the oldest class of antidepressants. Phenelzine (Nardil) and tranylcypromine (Parnate) are still available today. They have more side effects and drug interactions than many of the newer classes of effective drugs. Some have been useful in anxiety disorders such as social phobias and panic disorder but diet restrictions and some serious interactions generally means other safer medications will be tried first.

Beta-blockers - These medications are used to treat heart and blood pressure problems. They have however been used for anxiety disorders such as social phobia when one has had to do a presentation and have been effective in reducing a pounding heart rate, shaking hands and other physiological symptoms from developing.

Beta-blockers - Many mental health workers, psychiatrists, psychologists, social workers, or counselors are trained in ‘talking’ therapy which can help people with anxiety disorders learn how to deal with their problems.

A common and effective psychotherapeutic approach used in many anxiety disorders is called Cognitive-Behavioral Therapy. Cognition is knowing or understanding things through our thinking. This therapy then helps the person to learn to think about things differently, in ways that might help them to not respond with anxiety. They can help a person recognize faulty thinking and develop new healthy thinking patterns. The behavioral aspect of the therapy involves encouraging the person to expose themselves to the anxiety provoking situation for brief periods or in a controlled manner and then help them deal with the emotions that arise from the exposure.

Patients may initially participate in this through pictures or movies and then be encouraged when they are ready to enter the real situation with the therapist present and then alone. Patients are not forced into these situations. They are in control of determining if they are willing, how long or when they are willing to begin or end the process. They set the pace for what they can comfortably handle. Since the therapist’s goal is to reduce anxiety and not provoke it, they need to remember and be comfortable with this fact and understand that therapy will be tailored to their specific need.

Sometimes a combination of psychotherapy and medication treatment is more effective than either form of treatment used alone. It is also important to realize that a patient with an anxiety disorder may be treated and remain symptom free of a period of time, only to have the symptoms return later. It is not uncommon for a number of mental disorders to have relapses. Remain optimistic. The best solution is to return to your physician as soon as you may become concerned that a relapse is taking place and be followed by your physician. You might need to return to medication or psychotherapy for another period of time and the best results are obtained the earlier a patient receives treatment.