Anxiety disorders are prevalent yet treatable.
An occasional bout of anxiety is quite normal, especially during difficult times. But usually those feelings are short-lived. Those who feel chronically anxious may be diagnosed with an anxiety disorder.
Anxiety disorders are “the No. 1 diagnosable mental health condition in America,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University and founder of the Brain Food Clinic, which uses evidence-based nutrition and integrative psychiatry treatments to augment psychotherapy, coaching and medication management. Anxiety affects 40 million adults in the U.S. age 18 and older, or 18.1% of the population every year, according to the Anxiety and Depression Association of America. That number is probably even higher now during the COVID-19 pandemic, says Ramsey, who also is chair of the American Psychiatric Association’s Council on Communications.
The causes of anxiety disorders include family history, brain chemistry, life events and other factors, often interwoven into complex patterns. The ADAA says anxiety disorders — including generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias — are highly treatable, but only 36.9% of those who experience anxiety receive treatment.
Along with psychotherapy and lifestyle changes, medications are often prescribed for an anxiety disorder.
Common types of anxiety medication treatments
Anxiety medications cannot cure anxiety; they can, however, help you control your symptoms and allow you to function better in your daily life.
These medications can be prescribed by a physician, typically through a psychiatrist, family physician, pediatrician or OB-GYN, and some states allow nurse practitioners to prescribe them as well. Many of these medications are also used to treat depression.
Anxiety medications may be prescribed for short- or long-term relief. There are four main classifications, or types, of medication used to treat anxiety:
— Selective serotonin reuptake inhibitors, or SSRIs.
— Serotonin-norepinephrine reuptake inhibitors, or SNRIs.
“Relatively acute or time-limited anxiety — for example, a fear of flying for someone who flies infrequently — are easily treated by benzodiazepines,” says Dr. Michael Thase, professor of psychiatry and chief of the Division of Mood and Anxiety Disorders Treatment and Research Program at the University of Pennsylvania. “More longstanding or recurrent anxiety disorders are better treated with antidepressants (SSRI/SNRI), though many doctors will prescribe a benzodiazepine at the beginning while the antidepressant is being initiated and the dose adjusted.”
These medications are considered generally safe and effective, but mild to serious side effects can sometimes occur. It often takes time, patience and experimentation to find the drug that works best for you. “A lot of things can cause anxiety and depression, and some patients respond more to different meds,” Ramsey says.
Selective serotonin reuptake inhibitors
SSRIs, which are also used to treat depression, block the reuptake (reabsorption) of the neurotransmitter serotonin, a brain chemical that improves mood. This makes more serotonin available to the brain. They are considered first-line treatment options.
Commonly prescribed SSRIs include:
— Citalopram (Celexa).
— Escitalopram (Lexapro).
— Fluoxetine (Prozac).
— Paroxetine (Paxil).
— Sertraline (Zoloft).
Commonly reported side effects may include dizziness, headache, insomnia or sleepiness, sexual dysfunction and weight gain.
Serotonin-norepinephrine reuptake inhibitors
Medications in the SNRI class increase levels of two neurotransmitters, serotonin and norepinephrine, to help restore balance in the brain. Physicians also prescribe these as a first line of treatment for anxiety.
SNRI drugs include:
— Venlafaxine (Effexor XR).
— Duloxetine (Cymbalta).
Side effects include upset stomach, insomnia, headache, sexual dysfunction, weight gain and increased blood pressure.
The ADAA says this class of drugs is used for short-term management of anxiety, or as a second line of additional treatment for treatment-resistant anxiety disorders. Benzodiazepines work through an internal “calming” process controlled by the neurotransmitter gamma-aminobutyric acid, or GABA, which helps inhibit or “turn off” brain activity and aids in sleep, muscle relaxation and calming the brain. “They can be remarkably and rapidly effective — within a few minutes or within an hour,” Thase says.
— Alprazolam (Xanax).
— Clonazepam (Klonopin).
— Diazepam (Valium).
— Lorazepam (Ativan).
— Chlordiazepoxide (Librium).
Possible side effects include sleepiness, confusion, dizziness, loss of coordination and vision problems. These should never be mixed with alcohol. Benzodiazepines are not safe for long-term use because of the risk for addiction. “This is a workhorse medication, and also something to be used with professional supervision and a lot of caution, because it can become habit-forming,” Ramsey warns.
The ADAA says the concerns about benzodiazepines have caused many doctors to instead prescribe tricyclic antidepressants, including:
— Amitriptyline (Elavil).
— Imipramine (Tofranil).
— Nortriptyline (Pamelor).
They are effective in treatment of some anxiety disorders (but not, for example, social anxiety disorder), and carry the risk of significant side effects, including orthostatic hypotension (drop in blood pressure on standing), constipation, urinary retention, dry mouth and blurry vision.
Along with the four main drug classes, doctors may prescribe other medications to treat anxiety.
— Buspirone, part of a class of medications called anxiolytics, affects the amounts of certain neurotransmitters.
— Monoamine oxidase inhibitors, or MAOIs, are approved to treat depression, but some doctors prescribe them “off-label” (used for non-FDA-approved treatment) to treat panic disorder and social phobia. MAOIs include isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam) and tranylcypromine (Parnate).
— Beta-blockers, commonly prescribed to treat high blood pressure and other cardiovascular conditions, are sometimes used off-label to treat social anxiety. “One form of social phobia — illustrated by public-speaking fears or a musician’s performance anxiety — can be treated with a beta-blocker, which blocks the over-arousing effects of the neurotransmitter norepinephrine,” Thase says.
Work with your doctor.
Anxiety medications are usually safe and effective, but they need monitoring by your physician. They work only if you follow your doctor’s instructions closely. They also may take time to have an effect and may not resolve all your symptoms.
Contact your doctor if you have any side effects, questions or concerns about the medication. And never stop taking a medication without talking to your prescribing physician first. Stopping too quickly may cause withdrawal symptoms or other health risks, including thoughts of suicide. New data reveals the need to taper off these meds more slowly, Ramsey says.
Children are also sometimes prescribed antianxiety medication, usually along with psychotherapy. The American Academy of Child and Adolescent Psychiatry says that antidepressant medications that have proven to be effective for childhood anxiety disorders include duloxetine (Cymbalta), which is the only FDA-approved antidepressant for children age 7 and older, and “off-label” meds such as sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and venlafaxine ER (Effexor XR). Benzodiazepines, beta-blockers and some other medications are also used for short-term treatment in some cases. Dosages depend on the age and weight of the child.
Anxiety relief without medication
Anxiety can be managed with lifestyle choices that help reduce symptoms. Among these are:
— Exercise. Just 10 minutes of exercise can help lift your mood, the ADAA reports.
— Meditation. Deep breathing and relaxation calms an anxious mind.
— Yoga. Gentle stretching relieves stress.
— Chamomile. Chamomile tea or a chamomile supplement might help reduce anxiety. A 2016 study found that a 500-milligram chamomile supplement taken three times a day reduced moderate to severe generalized anxiety.
— Aromatherapy. A 2017 study showed that lavender oil can help reduce anxiety in the short term.
— Avoid stimulants. Caffeine and other stimulating foods and beverages like alcohol can bring on or increase anxiety, so keep them out of your diet.
— Psychotherapy. Medications only treat symptoms, but psychotherapy can uncover the root cause of anxiety and help you address that.
“Psychodynamic psychotherapy, natural treatments like lavender — these all are first steps in how I treat anxiety,” Ramsey says.
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