Patient introduction to the medication treatment of anxiety disorders

Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. Medication must be prescribed by physicians, usually psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.

Antidepressants

Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.

SSRIs

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.

Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a drug closely related to the SSRIs, is used to treat GAD. These medications are started at low doses and gradually increased until they have a beneficial effect.

SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time. Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another SSRI.

Tricyclics

Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They sometimes cause dizziness, drowsiness, dry mouth, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic medication.

Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia. People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help lessen these risks. MAOIs can also react with SSRIs to produce a serious condition called “serotonin syndrome,” which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.

Anti-Anxiety Drugs

High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily. One exception to this rule is people with panic disorder, who can take benzodiazepines for up to a year without harm.

Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.

Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.

Buspirone (Buspar®), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.

Beta-Blockers

Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.

Taking Medications

Before taking medication for an anxiety disorder:

• Ask your doctor to tell you about the effects and side effects of the drug.
• Tell your doctor about any alternative therapies or over-the-counter medications you are using.
• Ask your doctor when and how the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s supervision.
• Work with your doctor to determine which medication is right for you and what dosage is best.
• Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.

Fourteen Great Books on Anxiety Disorders:

1. What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety (What to Do Guides for Kids) by Dawn Huebner and Bonnie Matthews (Paperback - Sep 2005)
2. Overcoming Generalized Anxiety Disorder - Client Manual: A Relaxation, Cognitive Restructuring, and Exposure-Based Protocol for the Treatment of GAD (Best Practices for Therapy) by John White (Paperback - Jan 1, 1999)
3. Overcoming Anxiety for Dummies (Paperback) by Laura L. Smith (Author), Charles H. Elliott (Author)
4. The Anxiety & Phobia Workbook, Fourth Edition (Paperback) by Edmund J. Bourne
5. Overcoming Anxiety: From Short-Time Fixes to Long-Term Recovery (Paperback) by Reneau Peuifov Overcoming Social Anxiety and Shyness Self-help Course (Overcoming) by Gillian Butler (Paperback - Aug 30, 2007)
6. Free Yourself from Fears: Overcoming Anxiety and Living Without Worry by Joseph O'Connor (Paperback - Sep 25, 2005)
7. Overcoming Panic, Anxiety, & Phobias: New Strategies to Free Yourself from Worry and Fear by Carol Goldman and Shirley Babior (Paperback - Jan 1996)
8. If Your Adolescent Has an Anxiety Disorder: An Essential Resource for Parents (Adolescent Mental Health Initiative) by Edna B. Foa and Linda Wasmer Andrews (Paperback - April 1, 2006)
9. Overcoming Anxiety: A Self Help Guide Using Cognitive Behavioral Techniques (Overcoming) by Helen Kennerley (Paperback - Feb 1, 1997)
10. Panic and Anxiety Disorder: 121 Tips, Real-life Advice, Resources & More, Second Edition by Linda Manassee Buell and Brenda K., Ph.D. Wiederhold (Paperback - May 1, 2003)
11. Living Fully with Shyness and Social Anxiety: A Comprehensive Guide to Gaining Social Confidence by Erika B. Hilliard (Paperback - April 11, 2005)
12. Your Life is Waiting: The Average Joe's Guide to Overcoming Panic Attacks and Anxiety by Rafe R. Martin (Kindle Edition - Nov 6, 2007) - Kindle Book
13. Overcoming Social Anxiety and Shyness: A Self-Help Guide Using Cognitive Behavioral Techniques (Overcoming) by Gillian Butler (Paperback - May 12, 2008)
14. Overcoming Anxiety: Panic Attacks and Anxiety Disorders (Health Body, Healthy Soul Series) by David Hazard (Paperback - Sep 2003)

Thirteen Resource and Support Groups for Anxiety Disorders:

1. Anxiety Friends 
2. Anxiety Zone 
3. Yahoo Anxiety Support Groups
4. BP Panic  
5. MDJunction
6. Center for Emotional Wellbeing  
7. Social Anxiety Anonymous 
8. The Anxiety Community 
9. Yahoo Panic Support Groups
10. Anxiety Disorders Association of America
11. Anxiety Connection.com
12. Google Anxiety Support Groups
13. Social Anxiety Support

Additional Resources:

• For related articles on anxiety disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
• For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to  “Psychiatric Disorders: Anxiety” or type in the keyword “anxiety disorders” into “Google Search” located in the sidebar.
• For related articles from  Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keyword, “anxiety disorders” into the Psychology Today “Search”.
• For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “anxiety disorders” into “Amazon Search” on the Amazon banner located in the side bar.

Sources: National Institute of Mental Health, Also see blogposts in: Psychiatric Disorders: Anxiety Disorders

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com