Working to improve your everyday life with your therapist
Whether you require medication, psychotherapy, or both, establishing a collaborative relationship with your clinician will increase the likelihood that your treatment will be successful. When seeking help for anxiety, it’s important to feel comfortable communicating with your doctor without feeling judged or dismissed. People often turn to their primary care physician first about their anxiety concerns. Although family physicians and internists can prescribe medicines for anxiety, a psychiatrist or psychologist with special training in treating anxiety disorders can be even more helpful in assessing, diagnosing, and treating your problem. Seeking out such a specialist is especially important if you find that you are not getting better while being treated by your primary care doctor.
Recommendations from a trusted friend or physician can help you find the right therapist for you. Prior to your first visit, write down specific questions that you wish to ask. Keeping a journal that details your symptoms and what triggers them will also help the doctor understand your anxiety better.
Before beginning medication for anxiety, be sure your doctor knows about any other medications or over-the-counter drugs or supplements you are taking. Some medicines can cause side effects and so can some combinations of medications. If you do experience side effects, avoid stopping your medication without first consulting your physician. The drug may need to be tapered down rather than discontinued suddenly. Remember that medicines will have their greatest effect if you take them as prescribed by your doctor.
Medications for treatment of anxiety
Several different types of medicines have been shown to be effective for a variety of anxiety disorders, and though they are not all classified as antianxiety drugs, they still relieve many anxiety symptoms. Of course, all medications have pros and cons. For example, benzodiazepines (e.g., Valium, Xanax) are effective for acute anxiety but some patients become physically and psychologically dependent on them. Antidepressants (e.g., Zoloft, Prozac) and buspirone (BuSpar) can control chronic symptoms, but they have to build up in one’s system and have little if any effect during the first few weeks of treatment.
Whenever I prescribe medications to my patients, I try to use the smallest dosage in order to minimize potential side effects. I believe in starting low and going slow when I build the dosage level. This strategy is especially important when treating older adults who tend to be sensitive to even small doses of medicines. Also, if you do develop mild side effects such as an upset stomach or dry mouth, it’s possible that your body will adjust to these discomforts after a few days or weeks.
CLASSES OF MEDICATION FOR TREATMENT OF ANXIETY
- • antidepressants
- • benzodiazepines
- • buspirone
- • anticonvulsants
- • atypical antipsychotics
- • beta-blockers
Although these medicines are called antidepressants, they are used to treat a variety of mental symptoms including anxiety. Antidepressants exert their effects by increasing the levels of serotonin, norepinephrine, and other neurotransmitters or brain messengers that regulate mood.
When starting an antidepressant, remember that it may take several weeks for mood effects to kick in. Patients unaware of this typical delay in treatment response may get discouraged and prematurely stop taking their medicine before they experience the benefits.
Frequently used antidepressants include the selective serotonin reuptake inhibitors (SSRIs), the serotonin-norepinephrine reuptake inhibitors (SNRIs), and the noradrenergic/specific serotonergic antidepressants (NaSSAs). Other antidepressants that are used less often include tricyclics, monoamine oxidase inhibitors (MAOIs), and trazodone. If an antidepressant medication is effective, the patient may remain on the medicine for months or even years.
Many of these medicines are effective in treating different forms of anxiety, while others are reserved for specific disorders. Both SSRIs and SNRIs work well for generalized anxiety, panic, social anxiety, and obsessive-compulsive disorders.
Side effects may develop when the medicine is initiated and vary among these medicines, but some “side effects” can actually improve symptoms. For example, a patient with anxiety and insomnia may respond well to a more sedating antidepressant like trazodone or Remeron taken at bedtime.
ANTIDEPRESSANTS USED TO TREAT ANXIETY
|Category||Examples||Possible Side Effects|
|SSRI||Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline)||Nausea, upset stomach, weight gain, decreased libido, drowsiness|
|SNRI||Cymbalta (duloxetine hydrochloride), Effexor (venlafaxine), Pristiq (desvenlafaxine)||Nausea, insomnia, dizziness, drowsiness, weight loss, headaches|
|NaSSA||Remeron (mirtazapine)||Weight gain, drowsiness|
|Tricyclic||Anafranil (clomipramine), Elavil (amitriptyline), Norpramin (desipramine), Pamelor (nortriptyline)||Dry mouth, constipation, sweating, urinary retention, slowed heartbeat|
|MAOI||Nardil (phenelzine), Parnate (tranylcypromine)||Dizziness (when standing up), dry mouth, constipation, dangerous interaction with certain foods/drugs|
These medicines are very effective in managing acute anxiety since they calm the nervous system almost immediately. The early versions of benzodiazepines—drugs like Valium (diazepam), Klonopin (clonazepam), and Librium (chlordiazepoxide)—are long-acting medicines, which means that they stay in the body for extended periods of time. This can present a problem, particularly in older people, because levels of these drugs build up over time and can cause side effects. In more recent years, safer and shorter-acting drugs, such as Xanax (alprazolam) and Ativan (lorazepam), have become available and are less likely to accumulate in the body and cause long-term side effects.
Benzodiazepines are quite effective in treating panic attacks and other acute anxiety symptoms, but people may become dependent on them and develop side effects like drowsiness and confusion. I saw a patient several years ago who thought he had Alzheimer’s disease. It turned out that he was taking 10 mg of Valium every day for more than a year. When I took him off the Valium, his symptoms of dementia resolved.
Benzodiazepines should not be mixed with alcohol and other sedating medicines. They can also interfere with a person’s ability to drive: use of these medicines has been associated with higher rates of auto accidents.
Buspirone (BuSpar) is effective in treating symptoms of generalized anxiety disorder, and some studies show that it can be as effective as a benzodiazepine without the accompanying risk of dependence and drowsiness. This medicine does not have an immediate effect and can take several weeks before patients notice benefits. Unlike benzodiazepines, which are taken on an as-needed basis, BuSpar needs to be taken every day for it to reduce levels of anxiety. Possible side effects include dizziness, nausea, headaches, nervousness, lightheadedness, and constipation.
Several of these medicines used to treat epilepsy and seizure disorders have also been shown to reduce symptoms of anxiety disorders. Neurontin (gabapentin) is useful in treating social anxiety and panic, while Lyrica (pregabalin) has been effective in treating generalized anxiety disorder. Side effects of Neurontin include unsteady gait, clumsiness, depressed mood, and restlessness; Lyrica may cause shortness of breath, chills, cough, and diarrhea.
This second generation of antipsychotic medication was developed to treat people who are out of touch with reality because of hallucinations or delusions.
Atypical antipsychotics have an effect on several neurotransmitters including serotonin which reduces many symptoms of anxiety. Examples include Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone). Antipsychotic medicines may cause dry mouth, blurred vision, dizziness, weakness, restlessness, movement abnormalities, stiffness, and weight gain. Long-term use can lead to involuntary movements of the upper body and face.
Beta-blockers such as Inderal (propranolol) and Tenormin (atenolol) are medicines originally developed to treat high blood pressure and heart arrhythmias. By blocking adrenaline, they inhibit the fight-or-flight response people experience under acute stress and control such physical symptoms of anxiety as rapid heart rate, sweating, and shakiness. They are particularly effective in treating symptoms associated with fear of public speaking and social phobia. By controlling the physical symptoms, patients also experience fewer psychological symptoms. Possible side effects include fatigue, cold hands, headache, and upset stomach.Image courtesy of Pixabay and some sources from these References