the ANXIETY-PANIC internet resource - MEDICATIONS
The first approach to treatment of an anxiety disorder usually
involves the prescription of a psychopharmaceutical drug by a physician or psychiatrist.
Typically an anxiolytic or sedative is recommended. For
more stubborn or chronic cases, it is common that an "antidepressant" and SSRI is used to target
the biological production and/or absorption of the neurochemical serotonin. While the
psychopharmaceutical armament is effective, there is no single drug that offers total
relief or a cure. It should be noted that efficacy and side effects (including
anorgasmia/sexual dysfunction and dependence) vary widely amongst individuals.
Visitors should be aware that there is an ongoing debate as to
whether anxiety disorders are primarily the result of biological predisposition (and thus
amenable to drug treatment) or psychological in nature (and necessitating cognitive
treatments). The general wisdom holds that both physical and psychological causation are
coterminous and that medicine and therapy are inevitable partners in any recovery. Still,
one will find strong advocates for both poles, with some stating that anxiety disorders
are the result of flawed biology while others will argue that the use of medication is
escapist and even dangerous.
Visitors are encouraged to thoroughly research their therapeutic and
medical options and to choose the recovery program that seems most appropriate to their
situation and beliefs. It is suggested that visitors use this area to inform themselves of
their medicinal choices in order to work with their chosen professional from a position of
knowledge. Visitors should also realize that the development and promotion of medications
treating anxiety disorders is big business, with billions of dollars at stake. The
research is active and there are a number of new medications on the horizon.
Medications (from the NIMH)
Psychiatrists or other physicians can prescribe
medications for anxiety disorders. These doctors often work closely with psychologists,
social workers, or counselors who provide psychotherapy. Although medications won't cure
an anxiety disorder, they can keep the symptoms under control and enable you to lead a
normal, fulfilling life.
The major classes of medications used for various anxiety
disorders are described below.
A number of medications that were originally approved for
treatment of depression have been found to be effective for anxiety disorders. If your
doctor prescribes an antidepressant, you will need to take it for several weeks before
symptoms start to fade. So it is important not to get discouraged and stop taking these
medications before they've had a chance to work.
Some of the newest antidepressants are called selective
serotonin reuptake inhibitors, or SSRIs. These medications act in the brain on
a chemical messenger called serotonin. SSRIs tend to have fewer side effects than older
antidepressants. People do sometimes report feeling slightly nauseated or jittery when
they first start taking SSRIs, but that usually disappears with time. Some people also
experience sexual dysfunction when taking some of these medications. An adjustment in
dosage or a switch to another SSRI 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.
Fluoxetine, sertraline, fluvoxamine, paroxetine, and
citalopram are among the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and
social phobia. SSRIs are often used to treat people who have panic disorder in combination
with OCD, social phobia, or depression. Venlafaxine, a drug closely related to the SSRIs,
is useful for treating GAD. Other newer antidepressants are under study in anxiety
disorders, although one, bupropion, does not appear effective for these conditions. These
medications are started at a low dose and gradually increased until they reach a
Similarly, antidepressant medications called tricyclics
are started at low doses and gradually increased. Tricyclics have been around longer than
SSRIs and have been more widely studied for treating anxiety disorders. For anxiety
disorders other than OCD, they are as effective as the SSRIs, but many physicians and
patients prefer the newer drugs because the tricyclics sometimes cause dizziness,
drowsiness, dry mouth, and weight gain. When these problems persist or are bothersome, a
change in dosage or a switch in medications may be needed.
Tricyclics are useful in treating people with co-occurring
anxiety disorders and depression. Clomipramine, the only antidepressant in its class
prescribed for OCD, and imipramine, prescribed for panic disorder and GAD, are examples of
Monoamine oxidase inhibitors, or MAOIs, are
the oldest class of antidepressant medications. The most commonly prescribed MAOI is
phenelzine, which is helpful for people with panic disorder and social phobia.
Tranylcypromine and isoprocarboxazid are also used to treat anxiety disorders. People who
take MAOIs are put on a restrictive diet because these medications can interact with some
foods and beverages, including cheese and red wine, which contain a chemical called
tyramine. MAOIs also interact with some other medications, including SSRIs. Interactions
between MAOIs and other substances can cause dangerous elevations in blood pressure or
other potentially life-threatening reactions.
High-potency benzodiazepines relieve symptoms
quickly and have few side effects, although drowsiness can be a problem. Because people
can develop a tolerance to themand would have to continue increasing the dosage to
get the same effectbenzodiazepines are generally prescribed for short periods of
time. One exception is panic disorder, for which they may be used for 6 months to a year.
People who have had problems with drug or alcohol abuse are not usually good candidates
for these medications because they may become dependent on them.
Some people experience withdrawal symptoms when they stop
taking benzodiazepines, although reducing the dosage gradually can diminish those
symptoms. In certain instances, the symptoms of anxiety can rebound after these
medications are stopped. Potential problems with benzodiazepines have led some physicians
to shy away from using them, or to use them in inadequate doses, even when they are of
potential benefit to the patient.
Benzodiazepines include clonazepam, which is used for
social phobia and GAD; alprazolam, which is helpful for panic disorder and GAD; and
lorazepam, which is also useful for panic disorder.
Buspirone, a member of a class of drugs called azipirones,
is a newer anti-anxiety medication that is used to treat GAD. Possible side effects
include dizziness, headaches, and nausea. Unlike the benzodiazepines, buspirone must be
taken consistently for at least two weeks to achieve an anti-anxiety effect.
Beta-blockers, such as propanolol, are often used to treat
heart conditions but have also been found to be helpful in certain anxiety disorders,
particularly in social phobia. When a feared situation, such as giving an oral
presentation, can be predicted in advance, your doctor may prescribe a beta-blocker that
can be taken to keep your heart from pounding, your hands from shaking, and other physical
symptoms from developing.
For more material, tAPir recommends:
- Internet Drug Index
- Internet Mental Health
- Drug Information