Anxiety Medications
Medications for Anxiety Disorders
Medications prescribed to treat anxiety disorders fall into two main categories: antidepressants and antianxiety drugs. The latter term is a misnomer because they are no longer the only kinds of drugs that have antianxiety properties. In fact, antidepressants have become the first choice for many anxiety disorders. Other types of medications, such as beta blockers and sedatives, are also used for anxiety.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Dual Reuptake Inhibitor
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase (MAO) Inhibitors
Benzodiazepines
Buspirone (BuSpar), Beta Blockers, and Sedatives
Selective Serotonin Reuptake Inhibitors (SSRIs)
This class of antidepressants became a first-line treatment for many anxiety disorders during the 1990s. The serotonin system is active in many regions of the brain, affecting anxiety, mood, arousal, impulses, and aggression. SSRIs work by slowing the reuptake of serotonin, which means they prevent this neurotransmitter from being quickly reabsorbed by the neurons that released it. This prolongs the time that the serotonin can work at receptor sites. (See How SSRIs Work ).) SSRIs also appear to change the number and sensitivity of receptors and may indirectly influence other neurotransmitters that play a role in anxiety, including norepinephrine and dopamine. (See Brain Cell Communication.)
The main reason for the popularity of SSRIs is that they have fewer and less severe side effects than do older medications for anxiety. SSRIs are prescribed for generalized anxiety disorder, obsessive-compulsive disorder, social phobia, panic disorder, and post-traumatic stress disorder. There are several kinds of SSRIs, each having a slightly different mode of action.
Though they are usually well tolerated, SSRIs can have troublesome effects in some people. They can cause sexual dysfunction, weight gain, and insomnia. Sometimes they even temporarily heighten anxiety symptoms. Your doctor should monitor you closely for this reaction and, if necessary, switch your medication. SSRIs can also interact with certain antihistamines, anticonvulsants, or other antidepressants. Reactions to SSRIs vary. What induces side effects in one person may not cause any problems in another. Therefore, it may take some trial and error to determine which medication is right for you.
For more information, see the chart of Medications for Anxiety Disorders.
Dual Reuptake Inhibitor
Venlafaxine (Effexor) blocks the reuptake of both serotonin and norepinephrine, another neurotransmitter that plays a role in anxiety. To a lesser degree, the drug also blocks the reabsorption of a third neurotransmitter involved in mood, dopamine. Venlafaxine is prescribed for generalized anxiety disorder and post-traumatic stress disorder, either initially or when SSRIs aren’t effective or cause intolerable side effects. Like SSRIs, however, venlafaxine can exacerbate sleep problems and cause nausea and headache. Effexor XR, the extended-release form of the drug, has fewer side effects than the shorter-acting version. For example, it doesn’t cause nausea. And it is taken just once a day.
For more information, see the chart of Medications for Anxiety Disorders.
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants (TCAs) have been used since the 1970s to treat panic disorder and obsessive-compulsive disorder. Their name derives from their three-ring molecular structure. Medications of this class are thought to relieve anxiety and depression mainly by increasing the availability of norepinephrine and serotonin. TCAs do so by slowing the reabsorption of these neurotransmitters into the neurons that released them and by changing the sensitivity of the receptors.
But compared to venlafaxine or the SSRIs, TCAs can cause side effects that are more numerous and more severe, including dizziness, constipation, blurred vision, and trouble urinating. TCAs can also cause weight gain and disturbances in heart rhythm. Thus, people with heart disease should usually avoid these drugs unless they’ve tried other medications without a good response. Because of their side effects, TCAs are considered second-line treatments for generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and panic disorder. They’re sometimes paired with an SSRI when such a drug doesn’t work well enough alone. TCAs are often prescribed as an alternative for people who can’t use or tolerate SSRIs. For some people, TCAs actually work better and cause fewer troublesome side effects than SSRIs. A period of trial and error can help determine which drug will work best.
For more information, see the chart of Medications for Anxiety Disorders.
Monoamine Oxidase (MAO) Inhibitors
The neurotransmitters norepinephrine and serotonin are members of a class of compounds called monoamines, which are normally broken down in the body by the enzyme monoamine oxidase. By blocking monoamine oxidase, these drugs raise the levels of norepinephrine and serotonin in the brain, thus decreasing anxiety and improving mood.
If SSRIs aren’t helpful, MAO inhibitors are used for social phobia and panic disorder. Among MAO inhibitors, phenelzine (Nardil) is most commonly prescribed for these disorders, but tranylcypromine (Parnate) and isocarboxazid (Marplan) are also used. Although MAO inhibitors don’t have many of the side effects of TCAs, they can cause dizziness and other serious side effects.
People who take MAO inhibitors must avoid certain foods and beverages, including yogurt, aged cheese, pickles, beer, red wine, and other foods containing tyramine. Combining tyramine, an amino acid, with MAO inhibitors can raise blood pressure to dangerously high levels, possibly resulting in a stroke.
For more information, see the chart of Medications for Anxiety Disorders.
Benzodiazepines
These tranquilizers were the first class of medications used specifically for anxiety. They induce mental and physical relaxation. They enter the brain quickly and bind to receptors for the neurotransmitter gamma-aminobutyric acid (GABA), which reduces brain activity. When they bind to GABA receptors, benzodiazepines enhance GABA’s calming effects. (See How Benzodiazepines Work ).)
The many benzodiazepines include diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax). These medications are used for generalized anxiety disorder, panic disorder, and specific phobias. They’re often paired with a longer-acting drug such as an SSRI, and the dose is gradually reduced once the SSRI starts working. Doctors try to limit the use of benzodiazepines because they can cause tolerance, that is, a need for greater amounts of the drug to produce the same effects. But because these medications are so helpful for generalized anxiety disorder, they’re sometimes used alone for extended periods. In such cases, patients should be monitored carefully for signs of tolerance. Benzodiazepines are also prescribed alone, as needed, to treat specific phobias. Someone with a fear of flying, for example, may take a benzodiazepine before getting on a plane to control anxiety immediately before and during the flight.
In addition to tolerance, benzodiazepines can cause drowsiness and cognitive impairment. Older adults, as well as people with a history of substance abuse, should avoid them whenever possible because such individuals may be particularly sensitive to their side effects.
For more information, see the chart of Medications for Anxiety Disorders.
Buspirone (BuSpar), Beta Blockers, and Sedatives for Anxiety
Buspirone (BuSpar): One of the newest drugs for anxiety, buspirone (BuSpar) binds to receptors for serotonin and dopamine. The effect is to increase serotonin activity and decrease dopamine activity in the brain. Like the SSRIs, buspirone is used for the long-term treatment of generalized anxiety disorder. But it begins to work faster, after about 2 weeks. Because it has few side effects and no serious drug interactions, it’s a good alternative to benzodiazepines in the treatment of generalized anxiety disorder in older individuals or those with a history of substance abuse. However, this medication isn’t effective for most other anxiety disorders.
Beta blockers: Though they’re mainly used to treat high blood pressure, beta blockers can also relieve performance anxiety, a specific social phobia that usually occurs when an individual needs to give a speech or perform in front of an audience. Because beta blockers slow the heart rate, they also help with the physical symptoms of social phobias and panic attacks, such as pounding of the heart and shaking of the hands.
Sedatives: These drugs are prescribed for insomnia, a common symptom in anxiety disorders. Benzodiazepines are sedatives used for short-term treatment of insomnia. Newer medications such as zaleplon (Sonata) and zolpidem (Ambien) have begun replacing the benzodiazepines because they are just as effective, but shorter-acting. This means that they’re less likely to cause side effects, such as tolerance or withdrawal symptoms. Some sedating antidepressants, such as tricyclic antidepressants and trazodone (Desyrel), are also used to improve sleep.
For more information, see the chart of Medications for Anxiety Disorders.
Copyright © 2008 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service
Medications prescribed to treat anxiety disorders fall into two main categories: antidepressants and antianxiety drugs. The latter term is a misnomer because they are no longer the only kinds of drugs that have antianxiety properties. In fact, antidepressants have become the first choice for many anxiety disorders. Other types of medications, such as beta blockers and sedatives, are also used for anxiety.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Dual Reuptake Inhibitor
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase (MAO) Inhibitors
Benzodiazepines
Buspirone (BuSpar), Beta Blockers, and Sedatives
Selective Serotonin Reuptake Inhibitors (SSRIs)
This class of antidepressants became a first-line treatment for many anxiety disorders during the 1990s. The serotonin system is active in many regions of the brain, affecting anxiety, mood, arousal, impulses, and aggression. SSRIs work by slowing the reuptake of serotonin, which means they prevent this neurotransmitter from being quickly reabsorbed by the neurons that released it. This prolongs the time that the serotonin can work at receptor sites. (See How SSRIs Work ).) SSRIs also appear to change the number and sensitivity of receptors and may indirectly influence other neurotransmitters that play a role in anxiety, including norepinephrine and dopamine. (See Brain Cell Communication.)
The main reason for the popularity of SSRIs is that they have fewer and less severe side effects than do older medications for anxiety. SSRIs are prescribed for generalized anxiety disorder, obsessive-compulsive disorder, social phobia, panic disorder, and post-traumatic stress disorder. There are several kinds of SSRIs, each having a slightly different mode of action.
Though they are usually well tolerated, SSRIs can have troublesome effects in some people. They can cause sexual dysfunction, weight gain, and insomnia. Sometimes they even temporarily heighten anxiety symptoms. Your doctor should monitor you closely for this reaction and, if necessary, switch your medication. SSRIs can also interact with certain antihistamines, anticonvulsants, or other antidepressants. Reactions to SSRIs vary. What induces side effects in one person may not cause any problems in another. Therefore, it may take some trial and error to determine which medication is right for you.
For more information, see the chart of Medications for Anxiety Disorders.
Dual Reuptake Inhibitor
Venlafaxine (Effexor) blocks the reuptake of both serotonin and norepinephrine, another neurotransmitter that plays a role in anxiety. To a lesser degree, the drug also blocks the reabsorption of a third neurotransmitter involved in mood, dopamine. Venlafaxine is prescribed for generalized anxiety disorder and post-traumatic stress disorder, either initially or when SSRIs aren’t effective or cause intolerable side effects. Like SSRIs, however, venlafaxine can exacerbate sleep problems and cause nausea and headache. Effexor XR, the extended-release form of the drug, has fewer side effects than the shorter-acting version. For example, it doesn’t cause nausea. And it is taken just once a day.
For more information, see the chart of Medications for Anxiety Disorders.
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants (TCAs) have been used since the 1970s to treat panic disorder and obsessive-compulsive disorder. Their name derives from their three-ring molecular structure. Medications of this class are thought to relieve anxiety and depression mainly by increasing the availability of norepinephrine and serotonin. TCAs do so by slowing the reabsorption of these neurotransmitters into the neurons that released them and by changing the sensitivity of the receptors.
But compared to venlafaxine or the SSRIs, TCAs can cause side effects that are more numerous and more severe, including dizziness, constipation, blurred vision, and trouble urinating. TCAs can also cause weight gain and disturbances in heart rhythm. Thus, people with heart disease should usually avoid these drugs unless they’ve tried other medications without a good response. Because of their side effects, TCAs are considered second-line treatments for generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and panic disorder. They’re sometimes paired with an SSRI when such a drug doesn’t work well enough alone. TCAs are often prescribed as an alternative for people who can’t use or tolerate SSRIs. For some people, TCAs actually work better and cause fewer troublesome side effects than SSRIs. A period of trial and error can help determine which drug will work best.
For more information, see the chart of Medications for Anxiety Disorders.
Monoamine Oxidase (MAO) Inhibitors
The neurotransmitters norepinephrine and serotonin are members of a class of compounds called monoamines, which are normally broken down in the body by the enzyme monoamine oxidase. By blocking monoamine oxidase, these drugs raise the levels of norepinephrine and serotonin in the brain, thus decreasing anxiety and improving mood.
If SSRIs aren’t helpful, MAO inhibitors are used for social phobia and panic disorder. Among MAO inhibitors, phenelzine (Nardil) is most commonly prescribed for these disorders, but tranylcypromine (Parnate) and isocarboxazid (Marplan) are also used. Although MAO inhibitors don’t have many of the side effects of TCAs, they can cause dizziness and other serious side effects.
People who take MAO inhibitors must avoid certain foods and beverages, including yogurt, aged cheese, pickles, beer, red wine, and other foods containing tyramine. Combining tyramine, an amino acid, with MAO inhibitors can raise blood pressure to dangerously high levels, possibly resulting in a stroke.
For more information, see the chart of Medications for Anxiety Disorders.
Benzodiazepines
These tranquilizers were the first class of medications used specifically for anxiety. They induce mental and physical relaxation. They enter the brain quickly and bind to receptors for the neurotransmitter gamma-aminobutyric acid (GABA), which reduces brain activity. When they bind to GABA receptors, benzodiazepines enhance GABA’s calming effects. (See How Benzodiazepines Work ).)
The many benzodiazepines include diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax). These medications are used for generalized anxiety disorder, panic disorder, and specific phobias. They’re often paired with a longer-acting drug such as an SSRI, and the dose is gradually reduced once the SSRI starts working. Doctors try to limit the use of benzodiazepines because they can cause tolerance, that is, a need for greater amounts of the drug to produce the same effects. But because these medications are so helpful for generalized anxiety disorder, they’re sometimes used alone for extended periods. In such cases, patients should be monitored carefully for signs of tolerance. Benzodiazepines are also prescribed alone, as needed, to treat specific phobias. Someone with a fear of flying, for example, may take a benzodiazepine before getting on a plane to control anxiety immediately before and during the flight.
In addition to tolerance, benzodiazepines can cause drowsiness and cognitive impairment. Older adults, as well as people with a history of substance abuse, should avoid them whenever possible because such individuals may be particularly sensitive to their side effects.
For more information, see the chart of Medications for Anxiety Disorders.
Buspirone (BuSpar), Beta Blockers, and Sedatives for Anxiety
Buspirone (BuSpar): One of the newest drugs for anxiety, buspirone (BuSpar) binds to receptors for serotonin and dopamine. The effect is to increase serotonin activity and decrease dopamine activity in the brain. Like the SSRIs, buspirone is used for the long-term treatment of generalized anxiety disorder. But it begins to work faster, after about 2 weeks. Because it has few side effects and no serious drug interactions, it’s a good alternative to benzodiazepines in the treatment of generalized anxiety disorder in older individuals or those with a history of substance abuse. However, this medication isn’t effective for most other anxiety disorders.
Beta blockers: Though they’re mainly used to treat high blood pressure, beta blockers can also relieve performance anxiety, a specific social phobia that usually occurs when an individual needs to give a speech or perform in front of an audience. Because beta blockers slow the heart rate, they also help with the physical symptoms of social phobias and panic attacks, such as pounding of the heart and shaking of the hands.
Sedatives: These drugs are prescribed for insomnia, a common symptom in anxiety disorders. Benzodiazepines are sedatives used for short-term treatment of insomnia. Newer medications such as zaleplon (Sonata) and zolpidem (Ambien) have begun replacing the benzodiazepines because they are just as effective, but shorter-acting. This means that they’re less likely to cause side effects, such as tolerance or withdrawal symptoms. Some sedating antidepressants, such as tricyclic antidepressants and trazodone (Desyrel), are also used to improve sleep.
For more information, see the chart of Medications for Anxiety Disorders.
Copyright © 2008 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service
posted by Cyndee at 3:53 AM
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