Medications for Anxiety, Panic and Phobias

If you are suffering from an Anxiety Disorder, you may be facing the issue of whether to take medications or not. It may even increase your anxious worrying!

Excessive worry is a symptom of Anxiety Disorders. It is common for the issue of taking medications to become a focus of worry.

And excessive worry is often associated with procrastination and difficulty with decision making. This makes the task of deciding about the use of medication all the more difficult.

Medication for the treatment of Anxiety is generally safe and effective. But it often takes time and patience to find the drug that works for you.

Medication vs. Therapy

The first treatment many people receive for Anxiety Disorder is therapy. Most psychologists believe that the most effective treatment for Anxiety is Cognitive-Behavioral Therapy (CBT). It has two components: cognitive and behavioral. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. The behavioral component seeks to change a person’s reactions to Anxiety-provoking situations. CBT is effective in a majority of cases.

But some people find that excessively high levels of Anxiety make them unable to get the most out of therapy. They may avoid therapy sessions or feel unable to carry out the instructions of the therapist between sessions. 

Medication may help these people’s overall levels of Anxiety and allow full participation in therapy. Those without access to CBT or those who have not had a satisfactory response to it may benefit from medication, as well.

For some, though, medication may be required from the beginning of their diagnosis. This is particularly true in panic attacks, Panic Disorder, Post Traumatic Stress Disorder, and General Anxiety Disorder sufferers who have chronic insomnia. 

Remember that it is important to give medication a fair trial. Some drugs take several weeks to take effect. If one drug doesn’t work, the odds are that another one will, so don’t give up hope!

The Varieties of Medications

There are four major classes of medications that are used in the treatment of Anxiety Disorders:

• Benzodiazepines
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Benzodiazepines

The Benzodiazepine class of drugs was introduced in the 1960’s. Brands include Ativan, Klonopin, Halcion, Xanax and Valium and the generic Alprazolam. The exact mechanism of how these drugs work is unkown. Some research has shown that they enhance the function of gamma aminobutyric acid (GABA) in the brain.

The Benzodiazepines are very frequently used for the short-term management of Anxiety Disorders of all types. They are often prescribed on an as-needed basis rather than being taken daily. The Benzodiazepines are highly effective in promoting relaxation, reducing muscular tension, and other physical symptoms of Anxiety.

Long-term use may require increased doses to achieve the same effect. This may lead to problems related to drug tolerance and dependence. Abruptly stopping the drugs may result in significant withdrawal symptoms, including rebounding Anxiety and insomnia.

Tricyclic Antidepressants

Concerns about the long-term effects of the Benzodiazepines has led many doctors to favor the Tricyclic Antidepressants for treatment of Anxiety. This class of drugs was first introduced in the 1950’s. Brands include Adapin, Anafranil, Elavil, Norpramin, Sinequan, and Vivactil. 

The Tricyclic Antidepressants are prescribed for Panic Disorder, Post Traumatic Stress Disorder, and General Anxiety Disorder. Of all the Tricyclic Antidepressants, only Anafranil is used for Obsessive-Compulsive Disorder. They work by affecting the concentration and activity of the neurotransmitters serotonin and norepinephrine, chemicals in the brain thought to be linked to Anxiety Disorders.

Although effective in the treatment of Anxiety Disorders, the Tricyclic Antidepressants  can cause significant side effects. These include a drop in blood pressure on standing, constipation, urinary retention, dry mouth and blurry vision.

Selective Serotonin Reuptake Inhibitors (SSRI’s)

The Selective Serotonin Reuptake Inhibitor class of drugs was introduced in the 1980’s for the treatment of depression. Testing of this medication class led to its being used for treating Anxiety Disorders. Brands include Celexa, Lexapro, Paxil, Prozac, and Zoloft. SSRI’s work by affecting the concentration and activity of the neurotransmitter serotonin.

The SSRI’s quickly gained popularity for treating all types of Anxiety Disorders. Doctors and patients liked them because they generally produced fewer side effects, especially when compared with the Tricyclic Antidepressants. However, there are side effects with the SSRI’s. Among them are insomnia or sleepiness, sexual dysfunction, and weight gain.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s)

The Serotonin-Norepinephrine Reuptake Inhibitor class of drugs were first used for depression. They later were discovered to be effective for Anxiety Disorders, as well. Brands include Effexor and Cymbalta. They work by increasing the levels of serotonin and norepinephrine in the brain.

The SNRI’s are used to treat all types of Anxiety Disorders, although the use in Post Traumatic Stress Disorder has not been fully researched. 

The SNRI’s side effects include stomach upset, insomnia, headache, sexual dysfunction and a minor increase in blood pressure. Both Effexor and Cymbalta cause withdrawal symptoms in people quitting the drugs.

Atypical Antipsychotics

The newest class of drugs used to treat Anxiety Disorders are called “second-generation” drugs, or Atypical Antipsychotics. Brands include Abilify, Geodon, Risperdal, Seroquel, and Zyprexa. They work by effecting the concentration and activity of the neurotransmitter serotonin, a chemical in the brain thought to be linked to Anxiety Disorders.

The Atypical Antipsychotic medications are usually prescribed at low doses for the treatment of Anxiety. They are used to augment the action of other drugs rather than being used by themselves. The Atypical Antipsychotics may be especially effective in treating ruminative worry and in aiding sleep. 

Anxiolytics

The only Anxiolytic drug used for Anxiety Disorders is BuSpar, which is usually prescribed only for General Anxiety Disorder. It works by enhancing the action of serotonin in the brain.

BuSpar takes more time than the Benzodiazepines to achieve an anti-Anxiety effect, typically three to four weeks. However, it has not been associated with the tolerance or dependency problems of the Benzodiazepines.

Making a Decision

If you and your doctor have decided on medication as a treatment option, you have many choices. Work with your doctor to find the medication that is right for you. With patience and persistence, you will find a treatment that will help alleviate your Anxiety symptoms.

Always remember that any psychiatric medication is intended to combat the symptoms of Anxiety — they are not a cure. Therapy is the first choice among treatments. It can help you learn how to manage your symptoms, not only in the short term, but for the rest of your life.

What Do You Think?

It seems like I have taken almost every one of the drugs mentioned in this post! It has taken quite a while for my psychiatrists to find a combination of drugs that are effective for both my Bipolar Disorder and my Anxiety Disorders. But now I feel better than I have in years.

• Have you taken any of the medications mentioned in this post?
• How long has it taken you to find an effective medication?
• Are you and your psychiatrist still searching for the medication that’s best for you?

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Resources used in this post:

Kent, Justine. (2008). Treating Anxiety Disorders With Medications. Retrieved July 24, 2008 from the Anxiety Disorders Association of America Web site: http://www.adaa.org/gettinghelp/newsletter/2008/TreatingAnxietyDisordersWithMedications.asp

Anxiety Disorders Association of America. (2008, April). Medications. Retrieved July 24, 2008 from the Anxiety Disorders Association of America Web site: http://www.adaa.org/gettinghelp/anxietydisorders/chart.htm

For further reading: 

Anxiety Medication Chart from the Anxiety Disorders Association of America  

Introduction: Common Medications for Anxiety Disorders article from HealthyPlace.com  

Psychiatric Medications for Mental Illness: Antianxiety Medications article (long) from HealthyPlace.com  

©2008 Anxiety, Panic & Health. All rights reserved.