Anxiety disorder medicines

Anxiety: what is normal?

Anxiety is a part of normal life and can be caused by changing life circumstances, such as job loss, an accident or the breakdown of a relationship. However, if you experience prolonged episodes of anxiety, or recurrent anxiety (panic) attacks, it can make the activities of your day-to-day life difficult or impossible. In such a situation, your quality of life can be severely impaired and this is where treatment with medicine can be of great help.

Different classes of medicines are used to treat different types of anxiety disorders (such as agoraphobia, post-traumatic stress disorder and obsessive-compulsive disorder) and your doctor will advise which one will be best for you.

Sometimes anxiety symptoms exist alongside other mental illnesses or are secondary to them. If your anxiety is secondary to another medical condition or mental illness, your doctor may give you a short course of anti-anxiety medicines or counselling until the underlying disorder can be treated, which, hopefully, may remove your anxiety symptoms. Often people with anxiety disorders suffer from depression or may have problems with substance abuse.

Education and counselling: part of your treatment

In addition to medicines for your anxiety disorder you may also be offered education and counselling. These can help to prevent future anxiety symptoms and are usually a part of your doctor’s management strategy for you.

Benzodiazepines

These are probably the most well-known anti-anxiety medicines (also called anxiolytics). They include diazepam (e.g. Valium), oxazepam (e.g. Serepax), alprazolam (e.g. Xanax, Ralozam) and lorazepam (Ativan). They are believed to act on brain chemicals, relaxing and calming you.

Your doctor will usually start you on a low dosage and may increase it until your anxiety is controlled. This, of course, will depend on your particular anxiety symptoms and other aspects of your overall medical condition.

If you experience any drowsiness or mental slowing while you are taking benzodiazepines, which is possible, you should not drive or operate machinery, especially if you are just starting treatment.

Alcohol depresses the central nervous system just like benzodiazepines, and the effect is additive and can lead to serious and life-threatening complications, so you must not drink alcohol when taking benzodiazepines.

Usually, your doctor will prescribe benzodiazepines for a short period of 2 to 4 weeks and stop them as soon as possible. Continuous long-term use is not recommended unless your doctor advises it. This is because long-term use may lead to a dependence upon the medicine and withdrawal reactions when it is stopped. In some cases, it can be extremely difficult to stop taking it. Because of this, doctors usually prescribe benzodiazepines for brief periods of only a few days or weeks during periods of severe anxiety.

You should never stop taking a benzodiazepine suddenly if you have been taking it for more than 2 weeks. If you do, you may get a withdrawal reaction with unpleasant symptoms such as headache, shakiness and dizziness. You may also feel as if your anxiety is returning. If you have been taking a benzodiazepine for a long time, your doctor will need to gradually taper off your dosage until you can stop taking it completely.

Antidepressants

Nowadays, antidepressant medicines are very widely used to treat certain kinds of anxiety disorders. They appear to be very effective and helpful for many people, particularly if depression is part of your overall anxiety condition. Even if it is not, many patients with anxiety still benefit greatly from these medicines. Unlike benzodiazepines, these medicines are not habit-forming.

Selective serotonin reuptake inhibitors

In certain anxiety disorders a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI) might be your doctor’s first choice to treat your anxiety. These medicines include paroxetine (e.g. Aropax), fluoxetine (e.g. Prozac), fluvoxamine (e.g. Luvox), sertraline (e.g. Zoloft), escitalopram (Lexapro) and citalopram (e.g. Cipramil). Your doctor may use one of them as the first treatment for:

  • panic disorder;
  • social anxiety disorder;
  • generalised anxiety disorder; or
  • obsessive-compulsive disorder.

Selective serotonin and noradrenaline reuptake inhibitors

Venlafaxine (brand name Efexor-XR), a selective serotonin and noradrenaline reuptake inhibitor (SNRI), is used for treating panic disorder and generalised anxiety disorder (as an alternative to SSRIs).

Duloxetine (Cymbalta) is another SNRI that can be used to treat generalised anxiety disorder.

Some people with anxiety disorders may find their anxiety increases slightly after they start taking SSRIs or SNRIs. This usually lessens after a few days, but talk to your doctor if you are being affected in this way and it persists or worries you — the dose may need to be adjusted or your doctor may decide to change the medicine.

In the treatment of some anxiety disorders, if SSRIs do not help, doctors may prescribe a tricyclic antidepressant or monoamine oxidase inhibitor (MAOI), for example phenelzine (Nardil).

Tricyclic antidepressants

Tricyclic antidepressants, such as imipramine (e.g. Tofranil) or clomipramine (e.g. Anafranil) have been found to help some people with panic disorder, generalised anxiety disorder and obsessive-compulsive disorder. If you are given a tricyclic there may be a lag time before you begin to feel better and you should be aware that you may feel sleepy during the day. You must continue to take your medicine as prescribed even if you feel it is not working yet. Do not drink alcohol while you are on tricyclic antidepressants as alcohol may add to the sedative effects of the medicine.

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs), especially phenelzine, can be effective for panic disorder and generalised social anxiety disorder, but they have some disadvantages, mainly the need for people to follow strict dietary guidelines, and the fact that they interact with many other medicines. Your doctor will be able to advise you on what foods you must avoid if you are prescribed this medicine. You must never combine a MAOI with other medicines unless expressly advised by your doctor.

With all antidepressants, it is important you follow your doctor’s advice exactly to get the best benefit from these medicines.

Buspirone

Buspirone (Buspar) is chemically unrelated to any other medicine used for treating anxiety. It is used for short-term treatment of anxiety disorders. Unlike benzodiazepines, there is no evidence that buspirone is addictive or causes withdrawal problems. However, it takes longer to work than the benzodiazepines. If you are prescribed buspirone you may need to take it for one to 2 weeks before you notice your anxiety reducing.

Beta-blockers

If you get physical anxiety symptoms such as heart palpitations, tremor or sweating, your doctor may prescribe a small dose of a beta-blocker such as propranolol (e.g. Inderal). Beta-blockers, which are also used to control high blood pressure, slow down the heart rate and reduce these unpleasant sensations. Of course, your doctor will need to make sure that any physical symptoms you experience do not have a physical cause.

You may not be able to take beta-blockers for anxiety if you have asthma, heart failure or severe peripheral vascular disease.

Last Reviewed: 20 July 2011
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References

1. Anxiety and associated disorders (revised October 2008). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2011 Mar. http://online.tg.org.au/complete/ (accessed July 2011).
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