Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy.
Medication must be prescribed by practitioners, often psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy.
The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilllling lives.
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.
SSRIs Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac®), sertraline (Zoloft®), fluvoxamine maleate (Luvox®), paroxetine (Aropax®) and escitalopram (Lexapro®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a drug closely related to the SSRIs, is used to treat GAD. These medications are started at low doses and gradually increased until they have a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but they sometimes lead to poor sleep, fatigue, or produce slight nausea or jitters when people first start to take them.
These symptoms fade with time. Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another SSRI.
SSRIs can interact with other drugs so before taking any medication in addition to your SSRI you should check with your practitioner that it is safe to do so.
SNRIs Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant drugs also used in the treatment of anxiety disorders, obsessive-compulsive disorders and ADHD. SNRI's act upon and increase the levels of two neurotransmitters in the brain that are known to play an important part in determining mood, these being serotonic and norepinephrine. Venlafaxine (Effexor®), duloxetine (Cymbalta®), and desvenlafaxine (Pristiq®)
There are fewer SNRIs than SSRIs because SNRIs were developed more recently. They are among the most widely used antidepressants today because they are believed to have slightly less severe side effects than SSRIs. While some SNRIs can have negagtive sexual side effects like SSRIs, many can have the opposite effect of increased libido.
Tricyclics Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They have largely been replaced by SSRIs and SNRIs due to their side effects which can sometimes cause dizziness, drowsiness, dry mouth, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic medication.
Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.
MAOIs Monoamine oxidase inhibitors (MAOIs) are the oldest and now least used class of antidepressant medications. MAOIs can also react with SSRIs to produce a serious condition called “serotonin syndrome,” which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, weight gain, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.
People taking MAOIs have to follow a strict diet because certain foods containing tyramine (e.g.most aged cheeses, most alcoholic beverages, sausage products & Marmite) can interact with the medication to suddenly increase blood pressure and cause symptoms such as headache and vomiting. Users of MAOIs also have to be careful about drugs they take in addition to their MAOI. A severe high blood pressure reaction, in response to inappropriate food, beverages or medication, left untreated can lead to stroke or death.
High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily. Benzodiapines can be abused to they is not recommended for people with a history of substance abuse.
One exception to this rule is people with panic disorder, who can take benzodiazepines for up to a year without harm.
Lorazepam (Ativan®) and diazepam (Valium®) are helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.
Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.
Taking Medications Before taking medication for an anxiety disorder:
• Ask your practitioner to tell you about the effects and side effects of the drug.
• Tell your practitioner about any alternative therapies or over-the-counter medications you are using.
• Ask your practitioner when and how the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a practitioner’s supervision.
• Work with your practitioner to determine which medication is right for you and what dosage is best.
• Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
• Be aware that some medications may take a few weeks to start working.