What to Know About Anxiety Medications

Anxiety disorders are common.

It’s completely normal to feel anxious sometimes. Whether your concerns are related to work, family or a big event, it’s totally normal to feel anxious from time to time.

“Everybody gets nervous,” says Robert L. Alesiani, a clinical pharmacist and chief pharmacotherapy officer with TabulaRasa HealthCare, Inc. in New Jersey, a health care technology firm that aims to decrease adverse medication-related events.

But for some people who have anxiety disorders, that normal anxiety becomes a constant companion that can hold you back from doing all you need to do each day. An anxiety disorder can make you feel ill and cause other symptoms that interfere with daily life.

According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental illness in the United States. They affect about 40 million adults aged 18 and older each year. That’s 18.1% of the adult population.

“An anxiety disorder is a situation where somebody’s nervousness goes up to the next level. Where they actually can’t continue to function while they’re dealing with the situation. And that’s when things need to be addressed,” Alesiani says.

Symptoms can be difficult to cope with.

Dr. Douglas Misquitta, a psychiatrist and medical director of the Ohio State University Wexner Medical Center’s Harding Hospital Ambulatory Service in Columbus, says that people with anxiety disorders often experience a range of symptoms.

These can include:

— Stomach discomfort that’s sometimes described as butterflies in the stomach or nausea.

— Changes in appetite.

— Diarrhea or constipation.

Headaches.

— Muscle tension in the shoulders, neck or jaw.

— Restlessness.

— Feeling on edge.

— Foot tapping or leg bouncing.

Elevated heart rate or feeling of pounding in the chest.

— Avoidance of situations that might trigger anxiety.

“Those with anxiety might also be ‘worriers,'” Misquitta adds. For these people, “their mind is constantly going and worrying about everything small and big.”

There are a few different types of anxiety disorders.

Different types of anxiety disorders can affect individuals. Among these are:

Generalized anxiety disorder, in which virtually anything can trigger anxiety and constant worry that interferes with various aspects of daily living.

Panic disorder, in which the person has an overwhelming sense of fear and may suffer from frequent, unexpected panic attacks.

Social phobia (also called social anxiety disorder), which features fear or dread in social situations related to irrational fears of embarrassment or rejection.

Separation anxiety disorder, which is usually associated with children who become anxious when parents drop them off at school or otherwise are separated from them.

For people who have an anxiety disorder, “they have to recognize that it’s a real syndrome, a real problem,” Alesiani says. “They need to see a physician.”

Anxiety disorders are treatable.

While these disorders affect a lot of people each year, they are highly treatable, and there are a variety of techniques and medications that can help you navigate life with an anxiety disorder.

For starters, talk therapy can be helpful in treating anxiety disorders and is often the first choice of intervention for an anxiety disorder.

Therapy approaches include:

Cognitive behavioral therapy. This type of therapy is usually the first choice of treatment for anxiety disorder. CBT helps you learn how to identify and change thinking patterns that may be contributing to symptoms. It also helps you learn healthy coping strategies.

Dialectical behavioral therapy. For some people, another type of talk therapy called DBT may be more helpful. It’s sometimes used to treat people who haven’t responded well to CBT or those who have severe symptoms such as being suicidal or having self-destructive tendencies. It teaches you to address and alter your unhealthy behaviors.

Exposure therapy. This type of behavioral therapy can help people with phobias and other types of anxiety disorders confront and overcome their fears by facing them directly in a safe, guided way. This approach can help you gradually get more comfortable facing your fears.

In addition to therapy, you may be prescribed medication to help control symptoms of anxiety. These medications are referred to as anxiolytics, and your health care provider has many options to pursue when trying to find the best fit for your circumstances.

Some medications should be taken every day.

There are several kinds of medications that are prescribed to people with anxiety disorders to take every day to keep them stable. Some of these are antidepressants that are also used to treat depression, Misquitta says.

Examples include:

Selective serotonin reuptake inhibitors, or SSRIs. These medications are widely used to treat depression and work by inhibiting the reuptake of serotonin, a neurotransmitter, or brain chemical, that regulates mood. Examples include fluoxetine (Prozac) and sertraline (Zoloft).

Serotonin-norepinephrine reuptake inhibitors, or SNRIs. These medications are also used to treat depression and sometimes other conditions including diabetic peripheral neuropathy and chronic pain disorders. They work by inhibiting the reuptake, or absorption, of serotonin and another neurotransmitter called norepinephrine. Norepinephrine is associated with high arousal or excitement. Examples include duloxetine (Cymbalta) and venlafaxine (Effexor).

Tricyclics. These older antidepressant medications have been replaced to some extent by SSRIs and SNRIs, but may still be useful for some people. They block the reuptake of both norepinephrine and serotonin, similar to how SNRIs work. However, these medications also can block muscarinic, alpha1 adrenergic and histamine receptors, which can lead to various side effects that can either be positive or negative depending on the person and their sensitivity to the side effects.

Buspirone. Buspirone is an oral tablet that modulates levels of serotonin in the brain to reduce symptoms of anxiety disorders. Misquitta says this medication is used “primarily for anxiety,” rather than for depression or other mental health issues.

Some medications can help with acute symptoms.

While some medications for anxiety are intended to be taken every day to help keep your brain chemicals on an even keel, “there are also as-needed medications that are to be taken only when you’re feeling very anxious or having a panic attack,” Misquitta says. Examples include:

Benzodiazepines. These psychoactive medications help lower brain activity, which can quell panic and help you relax. Alesiani says they work by stimulating another neurotransmitter called gamma-aminobutyric acid, or GABA, which “helps support rest” and reduces feelings of anxiety. Examples include alprazolam (Xanax) or lorazepam (Ativan). Misquitta notes that taking these medications regularly elevates the risk of becoming tolerant or dependent on them, and “other side effects are possible too, including nausea.”

Hydroxyzine. Hydroxyzine (Vistaril) is an antihistamine medication that’s used to reduce the effects of histamine in the body. Histamine is produced when the immune system is faced with an allergen and can cause itching or hives on the skin. Because hydroxyzine has a sedative effect on the central nervous system, it’s also used for some patients with anxiety disorders.

Beta blockers. Beta blockers tamp down your body’s fight-or-flight response, and as such are often used to treat heart-related problems such as an irregular heartbeat or high blood pressure. When it comes to anxiety symptoms, beta blockers block the effects of norepinephrine which can slow a rapid heart rate or reduce shaking, trembling and other physical signs of anxiety. As such, these medications “can be used to treat performance anxiety or to reduce the physical effects of anxiety,” Misquitta says. Propranolol (Inderal) is an example of this type of medication.

Some medications carry extra warnings.

Another group of antianxiety medications called monoamine oxidase inhibitors, or MAOIs, are approved by the Food and Drug Administration for the treatment of depression. They are also sometimes used for anxiety, panic disorder and social phobias.

Examples of MAOIs include:

— Phenelzine (Nardil).

— Isocarboxazid (Marplan).

— Tranylcypromine (Parnate).

— Selegiline (Emsam).

While these medications can be very helpful for some people, they come with a range of strong warnings and need to be used very carefully. That’s because these medications can have very severe side effects and can lead to death when used inappropriately or when taken in conjunction with other medications, including:

— Other antidepressants.

— Anxiolytics.

Drugs of abuse.

— Various cough medications.

— Some anti-nausea medications.

— Certain antibiotics.

They must be taken exactly as indicated and all changes must be made by a medical professional, Misquitta warns.

Always follow your prescriber’s directions exactly.

As with MAOIs, the key thing to know about all of these medications used to treat anxiety disorders is that they’re powerful and using them incorrectly or stopping them suddenly can lead to potentially dangerous consequences.

As with any medication, know that side effects are possible. Misquitta says that “often, there can be sedation or sleepiness. There can also be confusion or dizziness.” If you take your medications at night before bed, he adds that “there may be some lingering effect in the morning such that you feel groggy or have trouble getting up.”

Some of these medications can also have muscle-relaxant qualities, so “they can cause increased risk of falls and things of that nature,” Alesiani says. They can also be dangerous to use when driving or operating heavy equipment. At high doses, “they can suppress the respiratory urge,” meaning they can make it difficult to breathe. This effect may be heightened when these medications are used in combination with central nervous depressants such as alcohol or opioids, potentially leading to death.

Over time, dependence on the medication can become an issue, Alesiani says, especially in situations where they’re using medications like benzodiazepines for acute symptoms. “Some people use drugs to get through the situation and then it becomes the rule rather than the exception. They reach for it anytime they have a problem.”

This can build tolerance, meaning that you’ll get less effect from each dose than you’re used to, which leads some people to increase their dosing. This is particularly common with Benzodiazepines and can be very dangerous.

Talk through the pros and cons of using any medication with your health care provider to make sure you understand how it works and what potential side effects you may encounter. Be clear in sharing what other providers prescribed, as well as non-prescribed drugs and supplements you’re using.

It may take some time to find the right medication for you.

Each case of anxiety disorder is different, and you’ll have to work with your health care provider to find the right medication for your situation. Sometimes it takes a little trial and error to dial into the right medication at the right dose.

Misquitta notes that each patient needs to be assessed “case by case. One person’s needs are often different from another’s.”

Some factors that may guide your prescriber’s approach include:

— The intensity and frequency of the anxiety.

— Your line of work or other responsibilities might make certain side effects, such as sedation, too much of a risk.

— Other medical conditions. If you have a kidney or liver disorder, that can limit which medications you use, Alesiani says, depending on how the medication is metabolized by the body.

— Other medications or treatments that you’re already on. “That might limit or influence options, as well,” Misquitta says.

He adds that working with a psychiatrist or family physician who’s familiar with these medications “can help with determining the right course with medications, and working with a therapist can help develop strategies and coping skills that can help bring about less of a need for medications.”

Other interventions can help too.

In addition to medication, there are other ways you can help keep symptoms of your anxiety disorder in check. These include:

Diet. Caffeine and other stimulants can exacerbate symptoms of anxiety, while things like chamomile tea can help soothe you. Talk with your doctor or a registered dietitian about the best diet to support your overall health and wellness.

Exercise. Exercise helps release endorphins and other chemicals in the body that can produce a mood boost — think runner’s high. Getting regular physical activity, especially outdoors, can provide an important outlet to support your efforts to control symptoms of anxiety.

Sleep. One symptom of anxiety is sleeplessness, and while it can be difficult to get enough sleep when you’re dealing with an anxiety disorder, making sleep a priority is a big piece of helping yourself move beyond the disorder. Institute good sleep hygiene practices and talk with your doctor if insomnia is an issue for you.

Mindfulness practices. Mindfulness means bringing nonjudgmental awareness of your thoughts, emotions and experiences. Meditation and breathing exercises can help you achieve a more mindful state that can help you cope with symptoms of anxiety.

And, of course, therapy is a key piece of the puzzle, Misquitta adds. “Therapy can bring more lasting, long-term success without needing to be dependent on medication. In many cases, medications may serve only as a bandage on the symptoms of anxiety, not getting at the root of what’s causing it.”

Alesiani agrees, adding that while some people “are looking for a quick fix, a medication or drug, that has to come in conjunction with therapy for the best long-term results. Just like for someone who has severe arthritis and needs a knee replacement — the knee replacement by itself is not the (whole) cure for the problem. They have to go through therapy to get back to what is considered normal.”

Therapy’s big strength comes from its ability to help people develop strategies and techniques to help in the face of anxiety and to overcome adversity.

Misquitta adds, “these can, with time, help reduce the body’s fight-or-flight response, the physical symptoms that can flare-up when you’re anxious and help retrain the mind and body to recognize it’s not in danger in the scenarios that typically trigger the anxiety.”

You may not need medication forever.

Some people worry that if they start an anti-anxiety medication, they might be on it for the rest of their lives. That’s possible for some people, but not true in all cases, Alesiani says. “As long as the patient is stable, yes, they can come off anxiety medication.”

It may take a few trial periods, but over time, and with the right support, you may not need to take anxiety medications forever.

“Many individuals can successfully come off of their medications, especially with the help of therapy,” Misquitta says. “With time, as successful new strategies and behaviors from talk therapy took root and become habits, there can be less of need for medication and eventually the possibility of not needing medications at all.”

In addition, some people need the support of anxiety medications during certain difficult points in time, but not long-term. “Events or situations can come up in life that provoke anxiety, but will resolve with time, such that high anxiety might only be temporary,” Misquitta says. So, don’t despair if your doctor recommends medication.

What to know about anxiety medications:

— Some medications are taken every day.

— Some medications are used to treat acute symptoms.

— Some medications carry extra warnings.

— Always follow your prescriber’s directions exactly.

— It may take some time to find the right medication for you.

— Other interventions can help too.

— You may not need medication forever.

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What to Know About Anxiety Medications originally appeared on usnews.com

Update 04/14/22: This story was previously published at an earlier date and has been updated with new information.

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