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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.
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| Antidepressants |
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.
Selective serotonin reuptake inhibitors (SSRI), which
act on a chemical in the brain known as serotonin, are some
of the newest medications available. 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 therapeutic level.
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 tricyclics.
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.
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| Anti-Anxiety
Medications |
High-potency
benzodiazepines relieve symptoms quickly and have few side effects,
although drowsiness can be a problem. Because people can develop
a tolerance to them-and would have to continue increasing the
dosage to get the same effect-benzodiazepines 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.
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| Other
Medications |
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.
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| Taking
Medications |
Before taking
medication for an anxiety disorder:
- Ask your doctor to tell you about the effects and side
effects of the drug he or she is prescribing.
- 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 slowly under a physician'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.
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