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.
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.
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 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.
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.
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.
