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Anxiety (cont.)

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What is the treatment for anxiety?

Medication treatments for anxiety

There are a variety of treatments available for controlling anxiety, including several effective anti-anxiety medications and specific forms of psychotherapy. In terms of medications, buspirone (BuSpar) is known to be quite effective for treating GAD. However, it seems to be less effective in managing many other disorders that often co-occur (are comorbid) with GAD. Therefore, specific members of the serotonin reuptake inhibitor (SRI) and the serotonin and norepinephrine reuptake inhibitor (SNRI) classes of drugs, which are also approved by the U.S. Food and Drug Administration (FDA) for effective treatment of GAD, are prescribed more often. Examples of SRI medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Examples of SNRI medications are duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Some of the newer antidepressants work in a similar way to SRI and SNRI medications but do not yet have an FDA approval for treatment of GAD. Some of these newer medications are levomilnacipran (Fetzima), vilazodone (Viibryd), and vortioxetine (Brintellix).

Benzodiazepine medications like clonazepam (Klonopin) and lorazepam (Ativan) are sedatives sometimes used for treating anxiety. They may be more effective for short-term use (for example, weeks to months), or occasional use in stopping severe anxiety symptoms, like those that occur in panic attacks, rather than the ongoing worry that is usually associated with GAD. Although alprazolam (Xanax) is often used to treat panic attacks, its short duration of action can sometimes result in having to take it several times per day, increasing the risk of tolerance and addiction. Another benzodiazepine, diazepam (Valium), tends to be used less often due to concerns about its long duration of action and addiction potential. Use of benzodiazepines is somewhat controversial; many doctors are reluctant to use them because of the risk of abuse and dependence. There is also some clinical research that suggests PTSD and anxiety disorders may be harder to control later if benzodiazepines are used.

Because of the link between the autonomic nervous system and the fight-or-flight response in anxiety, medications that block this response may be helpful. One example is the beta-blocker family of medications usually used for high blood pressure. Beta-blockers stop some of the effects of epinephrine (adrenaline) that also is involved in anxiety and fear responses. Beta-blockers such as propranolol (Inderal) are sometimes used to decrease episodic anxiety (for example, performance anxiety or test anxiety), and may also relieve some of the physical symptoms associated with a panic attack.

In addition to these medications, a variety of other medication classes are sometimes used to help treat anxiety. Although they don't have a specific approval for treating anxiety from the FDA, people may discuss the risks and benefits with their prescribing doctor and decide which medications may be right for them. Gabapentin (Neurontin) is a medication developed as a seizure medication but has been found to help some individuals with severe anxiety symptoms. Gabapentin may be a less addictive option compared to benzodiazepines. Older sedating anti-histamine medications, such as hydroxyzine (Vistaril), are another nonaddictive type of medication that may be useful for panic attacks or severe episodes of anxiety.

When anxiety disorders are difficult to treat, or an individual has side effects with an SRI/SNRI, they may decide with their doctor to try one of the newer antipsychotic (neuroleptic) medications. This class includes risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), paliperidone (Invega), and lurasidone (Latuda). There are a number of clinical trials showing some reduction of anxiety symptoms from these medications. However, they also have significant possible side effects and require ongoing monitoring by the patient and their doctor.

Zolpidem (Ambien) and trazodone (Desyrel) have been found helpful in treating the insomnia that can often be a symptom of anxiety.

Before SRIs and SNRIs became available, older antidepressant medications including the tricyclic antidepressant (TCA) and monoamine oxidase inhibitor (MAOI) classes were often used to treat anxiety disorders. Although both of these medication classes have been found to be effective in treating anxiety disorders, the newer classes of medications (SRIs and SNRIs) have been proven to be safer and better tolerated. Therefore TCAs and MAOIs are used much less often than they used to be. When used in the appropriate person with close monitoring, these medications can be quite effective as part of treatment for panic disorder.

Medically Reviewed by a Doctor on 12/7/2015


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