Anxiety disorder medicines

Treatment for anxiety will depend on things such as the type of anxiety disorder you have and your general health. Psychological (talking) treatments and medicines are the 2 main treatment options, which can be used in combination. Lifestyle measures are also an important part of treatment.

Psychological therapy is often preferred over medicines because it is generally more effective for treating anxiety in both the short and long term. In people with more severe symptoms, medicines may be prescribed in addition to psychological therapy.

If your anxiety is caused by another medical condition or mental illness, your doctor may give you a short course of anti-anxiety medicines or counselling as well as treatment for the underlying condition.

Self-care for anxiety

There are several lifestyle adjustments that can help in the treatment of anxiety.

  • Getting regular physical activity is important as it has been shown to be effective in improving mood and can help reduce stress and symptoms of anxiety.
  • Eating a healthy, balanced diet is also important. Try to limit the amount of processed foods you eat and make sure you eat plenty of fruit and vegetables, whole grains and fish.
  • Avoid or cut down on caffeine, which can make anxiety symptoms worse.
  • Nicotine can also worsen symptoms, so if you are a smoker, quit.
  • Alcohol and recreational drugs can make anxiety worse. Talk to your doctor if you are drinking more than 2 standard drinks of alcohol on most days - they will be able to help you to get your drinking to a healthy level, which should improve both your anxiety and your physical health.
  • Getting enough sleep plays a big role in treating anxiety. This may not be as easy as it sounds, though, so talk to your doctor if you are having difficulty sleeping.
  • Make time for regular relaxation - this may simply be a relaxing activity that you enjoy such as listening to music.

Psychological therapy

The main psychological treatment that helps people with anxiety disorders is cognitive behavioural therapy (CBT). There are specific types of CBT used for different anxiety disorders, and therapy may be individual or in a group. Therapy is usually made up of about 10-14 weekly sessions.

In general, CBT involves learning to understand your anxiety disorder and developing strategies to manage your symptoms. Your psychologist will ask about your thinking patterns and encourage you to challenge negative thoughts. Over the course of the treatment, the aim is to gradually change your behaviour and return to activities that you have been avoiding due to your anxiety.

CBT requires considerable practice and can actually make your symptoms worse in the initial stages. Sometimes anxiety medicines are prescribed for when you first start CBT.

Access to CBT with a psychologist can be difficult for some people, including those living in rural and remote areas of Australia. However, there are some internet-based psychological treatments available for anxiety disorders - these programmes may be guided by a therapist or self-guided.

Anxiety medicines

Medicines are usually recommended for people with severe or persistent anxiety or if you have both anxiety and depression. Different types of medicines are used to treat different types of anxiety disorders.

Antidepressants

Certain antidepressant medicines can be used to treat anxiety disorders. The selective serotonin reuptake inhibitors (SSRIs) and the serotonin and noradrenaline reuptake inhibitors (SNRIs) are effective for most anxiety disorders.

Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) are alternative antidepressant medicines that can be used for some anxiety disorders.

The best choice of antidepressant medicine for you will depend on your symptoms, other conditions you have, and any other medicines and complementary treatments you are taking.

Antidepressants are started with a gradually increasing dose, and usually take several weeks to work. It may be 6 months before you feel the full effects of these medicines.

Some people find their anxiety increases slightly after they start taking antidepressants. This usually lessens after a few days. Talk to your doctor if you are being affected in this way and it persists or worries you, or if you experience side effects.

Sometimes changing the way you take the medicine (such as timing of the dose) can help reduce side effects. Alternatively, the dose may need to be adjusted or your doctor may recommend changing to a different medicine.

When stopping antidepressants, it’s important that you don’t suddenly stop taking them. Your doctor can advise you on how to gradually reduce the dose.

Benzodiazepines

Benzodiazepines can help some types of anxiety disorders. This type of medicine is usually only prescribed for a short time - from a few days to a few weeks weeks to relieve symptoms during periods of severe anxiety.

Benzodiazepines can also be used short-term to reduce symptoms that have become worse when antidepressants have just been started.

Long-term use of benzodiazepines is not recommended, as they cause sedation (drowsiness) and do not treat the underlying cause of the anxiety. They can also become addictive, meaning that it can be extremely difficult to stop taking them.

Examples of benzodiazepine tablets used for the short-term treatment of anxiety symptoms include:

  • alprazolam (e.g. Alprax, Kalma);
  • bromazepam (e.g. Lexotan);
  • clobazam (e.g. Frisium);
  • diazepam (e.g. Antenex, Ranzepam, Valium, Valpam);
  • lorazepam (e.g. Ativan); and
  • oxazepam (e.g. Alepam, Murelax, Serepax).

If you experience any drowsiness or mental slowing while you are taking benzodiazepines, 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. This can lead to serious and life-threatening complications, so you must not drink alcohol when taking benzodiazepines.

You should never stop taking a benzodiazepine suddenly if you have been taking it for several 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.

Support

Having an anxiety disorder can be an isolating experience, but anxiety is actually very common and there are many people who know exactly how you feel. Joining a support group can help you connect with other people with your particular anxiety disorder. Ask your doctor or psychologist, or search online for a group that will suit you.

References

1. Royal Australian College of General Practitioners (RACGP). Clinical guidelines 2.3 Anxiety disorders, June 2015. https://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-b/2-evidence-based-guidance-for-benzodiazepines/23-anxiety-disorders/ (accessed Jul 2018).
2. Lampe L. Drug treatment for anxiety. Australian Prescriber 2013;36:186-9 (2 Dec 2013). https://www.nps.org.au/australian-prescriber/articles/drug-treatment-for-anxiety (accessed Jul 2018).
3. SANE Australia. Anxiety disorder guide (updated 10 May 2018). https://www.sane.org/mental-health-and-illness/facts-and-guides/anxiety-disorder#understanding-anxiety-disorders (accessed Jul 2018).
4. Reavley NJ, Allen NB, Jorm AF, Morgan AJ, Ryan S, Purcell R. A guide to what works for anxiety: 2nd Edition. beyondblue: Melbourne, 2013. http://resources.beyondblue.org.au/prism/file?token=BL/0762 (accessed Jul 2018).
5. Mayo Clinic. Anxiety disorders (updated 4 May 2018). https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961 (accessed Jul 2018).
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