Questions and Answers: Antidepressants for Anxiety Disorders

Antidepressants are often the medication of choice for addressing Anxiety Disorders.

Antidepressants all work because they affect serotonin, an important neurotransmitter in the brain that acts as a chemical messenger. They were first developed for depression, and later were found to be effective for treating most types of Anxiety Disorders, too.

Those taking antidepressants for the first time and even those who have been taking them a while often have many questions about them. These questions may not be answered fully by their doctor or by the information on the prescription bottle.

This post answers the most common questions that people have. If you have further questions, please do not hesitate to ask them in the comments or in a personal message using the “Contact” tab. Please note that this post does not cover the antidepressant medications in detail — there is another post entitled “Medications for Anxiety, Panic and Phobias” that does that. 

What are the antidepressants usually prescribed for Anxiety Disorder?

Not all antidepressants work with Anxiety Disorders, but most do. Any antidepressant that has an effect on the serotonin system can be helpful for patients with anxiety. 

• The Selective Serotonin Reuptake Inhibitors (SSRI) are typically used as the first choice of medications to address Anxiety Disorders. Brands include Celexa, Lexapro, Paxil, Prozac, and Zoloft. Prozac, Zoloft, and Paxil have been approved by the FDA for a wide range of Anxiety Disorders. Other SSRI’s work only on selected Anxiety Disorders.
• The Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) are a newer class of antidepressants. Brands include Effexor and Cymbalta. They work by increasing the levels of both serotonin and norepinephrine in the brain. SNRI’s have been approved to treat a more limited number of Anxiety Disorders than SSRI’s.
• The Tricyclic antidepressants have been around much longer than the SSRI’s and SNRI’s and are used for a limited number of Anxiety Disorders. Brands include Adapin, Anafranil, Elavil, Norpramin, Sinequan, and Vivactil. They work by affecting the concentration and activity of the neurotransmitters serotonin and norepinephrine. This class of antidepressants is not used as much as more modern medications because of their side effects.
• Monoamine Oxidase Inhibitors (MAOI) are the oldest class of antidepressant medications. Brands include Nardil, Parnate, Marplan, Aurorix, and Emsam. MAOI’s are not used much any more because of interactions with some foods, beverages, and other medications. 

Wellbutrin is not used for Anxiety Disorder because it is the only antidepressant that does not affect the serotonin system. It can even cause Anxiety and agitation in some patients. It is sometimes used in combination with SSRI’s for Anxiety Disorder to diminish the side effects of SSRI’s.

How does my doctor choose which antidepressant to give me?

All the SSRI’s and SNRI’s, Tricyclic and MAOI’s work the same way. The choice among them is made mostly on the basis of side effects and a person’s ability to tolerate a specific medication.

Most of the antidepressants are started at a low dose and gradually increased until they reach a therapeutic level. Some antidepressants also need to be gradually decreased in dosage when discontinuing them, particularly the SNRI’s, Effexor and Cymbalta.

How long does it take an antidepressant to start working?

It takes from two to six weeks for an antidepressant to begin to work. You may feel worse before you feel better because side effects can occur almost immediately, whereas therapeutic benefits appear later.

What are some of the side effects of antidepressants?

Side effects differ from person to person, and from medication to medication. The graduated dosages when you start taking antidepressants gives your body a chance to get used to them. Most side effects dissipate within days or weeks. Some of the side effects common to most antidepressants are nausea, nervousness, insomnia, weight gain and sexual dysfunction.

An adjustment in dosage or a switch to another antidepressant will usually correct bothersome problems. It is important to discuss side effects with your doctor so that he or she will know when there is a need for a change in medication.

Are antidepressants habit-forming?

Anti-depressants are not physically habit-forming and are not drugs of abuse. However, people sometimes become psychologically dependent upon them to relieve their symptoms, particularly if they have not participated in therapy, which teaches coping and management skills.

My first antidepressant didn’t work. What should I do?

It is not unusual for the first antidepressant tried either not to work or to have intolerable side effects. Finding the appropriate medication and dosage may take time. There are many antidepressants to choose from, and one of them is right for you.

The most frequent reasons for an antidepressant failure are that the dose was too low or the duration of treatment too short.

I feel so much better. Can I stop taking the antidepressant?

Feeling better is not a good reason for discontinuing or reducing your medications. People often are tempted to stop medication too soon, risking relapse or recurrence. For some Anxiety Disorders, medication may have to become part of everyday life to avoid return of disabling symptoms.

I want to take some herbs and diet supplements. Are they safe with antidepressants?

You should never mix medications of any kind — prescribed, over-the counter, herbs, or borrowed — without consulting your doctor. Some substances, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer and hard liquor. Grapefruit juice also has a negative effect on some antidepressants. Always follow the instructions of your doctor and on the prescription label to the letter.

Some medications, which are usually safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Always tell dentists, pharmacists and other medical specialists that you are taking antidepressants.

How long will I have to take antidepressants?

The length of time you will need to take antidepressants varies from person to person, and depends on the severity of the Anxiety Disorder. It also depends strongly on whether the drug is taken alone or is combined with therapy. 

Are antidepressants enough to control my Anxiety Disorder?

Antidepressants work best in most people when prescribed alongside a course of psychotherapy. People taking both medication and engaging in psychotherapy generally take less time to feel better. They also maintain their gains longer than those taking antidepressant medications alone.

Where do I find information about the medications I am taking?

It is sometimes hard to tell if what you are feeling is a drug side effect or a symptom of a physical condition. It is a good practice to look up the drugs you are taking and make a list of the “normal” side effects and the serious side effects. That way you will know when to call the doctor about an uncomfortable feeling or illness. And you will also be better informed about your side effects when you visit your doctor.

These online resources are particularly good for researching prescription medications, over-the-counter drugs, and diet supplements, such as herbs:

• Medline Plus 
• Mayo Clinic 
• PDRHealth (Physician’s Desk Reference) 

When taking any medication for Anxiety Disorders, you should…

• Ask your doctor to tell you about the effects and side effects of the drug being prescribed.
• Tell your doctor about any alternative therapies or over-the-counter medications you are using.
• Ask your doctor when and how the medication will be stopped. Some drugs can’t safely be stopped abruptly. They have to be tapered off slowly under a doctor’s supervision.
• Be aware that some medications are effective in Anxiety Disorders only as long as they are taken regularly, and symptoms may occur again when the medications are discontinued.
• Work together with your doctor to determine the right dosage of the right medication to treat your anxiety disorder.

In Summary

Despite the long list of facts, taking antidepressants is not a complicated affair. However, it is very important that you:

• Follow your doctor’s orders explicitly.
• Follow the diet and other instructions on the prescription bottle faithfully.
• Be informed about the side effects of your medications.
• Be patient: It sometimes takes a while for you and your doctor to find the right medications for you.

What do you think?

• Do you have any questions that are not on the list?
• Have you found any other good online sources of drug information?
• What are your experiences taking antidepressants?

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©2008 Anxiety, Panic & Health. All rights reserved.
Resources used in this post:

Chong, Josepha. (2006, August 30). Key Points about Antidepressant Therapy. Retrieved June 27, 2008 from Psych Central Web site: http://psychcentral.com/lib/2006/key-points-about-antidepressant-therapy/

Hartman, Daniel G. (2007, June 12). Treating Anxiety with Antidepressants. Retrieved September 26, 2008 from The Sidewalk Psychiatrist Web site: http://thesidewalkpsychiatrist.wordpress.com/2007/06/12/treating-anxiety-with-antidepressants/

HealthyPlace. (2008). Medications for Treating Anxiety. Retrieved September 26, 2008 from HealthyPlace Anxiety Community Web site: http://www.healthyplace.com/Communities/anxiety/treatment/medications_2.asp