The Role Of Medication In Anxiety Treatment
When you are overcome with heart-pounding terror, frozen by fear, and drained after another sleepless night of stress, you will try everything to find comfort. And there is little doubt that when anxiety is incapacitating, drugs may be beneficial. But are medications usually the best solution?
Traditional anti-anxiety pharmaceuticals such as benzodiazepines (usually prescribed for short-term usage) and more recent choices such as SSRI antidepressants are used to treat anxiety disorders (often recommended as a long-term anxiety solution). These medications can give brief comfort, but they come with severe side effects and safety issues.
Also, they are not a treatment. In fact, there are several concerns over their long-term efficacy. After four to six months of consistent usage, benzodiazepines lose their therapeutic anti-anxiety impact, according to the American Academy of Family Physicians. And according to a new study published in JAMA Psychiatry, the efficacy of SSRIs in treating anxiety has been exaggerated and, in some circumstances, is no better than a placebo.
In addition, it can be extremely difficult to discontinue anxiety drugs without withdrawal symptoms, including rebound anxiety that might be worse than the original issue.
I Need Relief, And I Need It Now!
Where does that leave someone who is suffering? When worry and terror dominate your life, even if anxiety alleviation comes with side effects and risks, it may seem like a reasonable bargain.
The final truth is that anxiety medicine has a time and a place. Medication may be useful if your extreme anxiety is interfering with your ability to operate, especially as a short-term therapy. However, many patients use anti-anxiety medications when counseling, exercise, or other self-help measures might be just as effective or more so, with fewer side effects.
Anxiety drugs can alleviate symptoms, but they are not appropriate for everyone, nor are they the sole solution. You are responsible for evaluating your alternatives and choosing the best course of action.
Benzodiazepines For Anxiety
Benzodiazepines (often referred to as tranquilizers) are the most commonly prescribed anxiety medicine. In most cases, drugs like Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) provide relief within 30 minutes to one hour. This makes them highly helpful during panic attacks and other episodes of intense anxiety. However, due to their physical dependence, they are not suggested for long-term use.
By slowing down the nervous system, benzodiazepines help you relax both physically and psychologically. However, it may also cause undesirable side effects. In general, the higher the dosage, the more significant these adverse effects are; nevertheless, some individuals experience drowsiness, confusion, and lack of coordination even at moderate doses. This might interfere with the job, school, and daily activities like driving. The medicine hangover may last throughout the following day.
Common benzodiazepine side effects include:
- Drowsiness
- Dizziness
- Poor balance or coordination
- Slurred speech
- Trouble concentrating
- Memory problems
- Confusion
- Stomach upset
- Headache
- Blurred vision
Benzodiazepine Safety Concerns
Long-term use of benzodiazepines is typically discouraged due to safety issues and misuse potential that rises with tolerance development.
Drug Dependence and Withdrawal
Regular use of benzodiazepines results in physical dependency and tolerance, requiring ever-increasing dosages to get the same level of anxiety alleviation as previously. This occurs rapidly, typically within a few months, but occasionally within a few weeks.
You may have significant withdrawal symptoms if you suddenly stop taking your medicine, including:
- Enhanced anxiety, restlessness, and trembling.
- insomnia, disorientation, and abdominal discomfort.
- Despair, bewilderment, and panic attacks.
- In extreme situations, a pounding heart, profuse perspiration, and convulsions are symptoms of a heart attack.
Many individuals confuse withdrawal symptoms for a recurrence of their initial anxiety disorder, leading them to believe they must resume their medicine. Tapering off the medicine gradually will help reduce withdrawal symptoms.
Drug Interactions And Overdose
Benzodiazepines are usually safe when used seldom and in modest doses, but when mixed with other depressants of the central nervous system, they can be fatal. Always with a physician or pharmacist prior to mixing drugs.
Don’t drink benzodiazepines. Mixing benzodiazepines with alcohol can result in a lethal overdose. Do not combine with analgesics or sedatives. Combining benzodiazepines with painkillers or sleep aids might potentially result in a lethal overdose.
Antihistamines increase their effectiveness. Antihistamines, which are contained in several over-the-counter sleep, cold, and allergy medications, are naturally sedating. Be careful while combining benzodiazepines in order to prevent oversedation.
Combine with caution with antidepressants. SSRIs such as Prozac and Zoloft can increase the toxicity of benzodiazepines. It may be necessary to alter your dosage accordingly.
Paradoxical Effects Of Benzodiazepines
Benzodiazepines are effective because they slow the neurological system. However, occasionally, for unknown reasons, they have the opposite effect. Children, the elderly, and individuals with developmental problems are especially prone to paradoxical reactions. They consist of:
- Anxiety, impatience, agitation, anger, and fury intensify.
- Mania, impulsive conduct, and hallucinations are symptoms of bipolar disorder.
Special Benzodiazepine Risk Factors
Everyone who uses benzodiazepines is susceptible to unpleasant or even deadly side effects. However, the following individuals are at greater risk:
People over 65. Benzodiazepines have a greater sedative impact on senior citizens. Small amounts can induce dementia-like disorientation, forgetfulness, loss of balance, and cognitive decline. The use of benzodiazepines by the elderly is connected with an increased risk of falls, hip and leg fractures, and automobile accidents. Additionally, long-term benzodiazepine usage raises the risk of Alzheimer’s disease and dementia.
People with a substance addiction history. Because benzodiazepines are physiologically addictive and harmful when taken with alcohol or other substances, anybody with a current or past substance misuse issue should use them with great caution.
Pregnant and nursing mothers. The use of benzodiazepines during pregnancy might result in dependency and withdrawal in the developing infant. Additionally, benzodiazepines are excreted in breast milk. Therefore, pregnant women must have a full conversation with their prescribing physician regarding the risks and advantages of these drugs. If the medicine is required, the objective is to use the least effective dose.
SSRI Antidepressants For Anxiety
Numerous antidepressants that were first licensed to treat depression are also taken for anxiety. Compared to benzodiazepines, the likelihood of dependence and misuse is lower. As a result, antidepressants cannot be used “as required” because it takes between 4 and 6 weeks for them to begin alleviating anxiety symptoms. Their application is restricted to persistent anxiety disorders requiring continuing therapy.
The most commonly recommended antidepressants for anxiety are SSRIs, including Prozac, Zoloft, Paxil, Lexapro, and Celexa. Generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder have all been treated with SSRIs.
Common SSRI side effects include:
- Fatigue
- Nausea
- Agitation
- Drowsiness
- Weight gain
- Diarrhea
- Insomnia
- Sexual dysfunction
- Nervousness
- Headaches
- Dry mouth
- Increased sweating
SSRI Withdrawal
Although physical dependency on antidepressants develops more slowly, withdrawal can still be a problem. If antidepressants are abruptly withdrawn, withdrawal symptoms might include acute sadness and exhaustion, irritability, anxiety, flu-like symptoms, and sleeplessness.
Other Types Of Medication For Anxiety
In addition to buspirone, beta-blockers, and bupropion, other medications may be used to treat anxiety.
Buspirone (BuSpar)
Buspirone, also known by its brand name BuSpar, is a relatively new anti-anxiety medication with a slight tranquilizing effect. As with SSRIs, buspirone lowers anxiety by raising serotonin and lowering dopamine in the brain. In comparison to benzodiazepines, the onset of action for buspirone is around two weeks. However, it is not as sedating, memory and coordination are not impaired, and withdrawal symptoms are limited.
Buspirone is a preferable alternative for older patients and those with a history of substance misuse because it has a minimal risk of dependency and no major medication interactions. However, it has little efficacy. It is effective for generalized anxiety disorder (GAD) but not for other anxiety disorders.
Common buspirone adverse effects include:
- Nausea
- Headaches
- Dizziness
- Drowsiness
- Weight gain
- Upset stomach
- Constipation
- Nervousness
- Diarrhea
- Dry mouth
Beta-blockers
Beta-blockers, which include propranolol (Inderal) and atenolol (Tenormin), are a class of medications used to treat excessive blood pressure and cardiac conditions. However, they are also used for anxiety off-label. Beta-blockers function by inhibiting the effects of the stress hormone norepinephrine, which is implicated in the fight-or-flight response. This helps regulate the bodily manifestations of worry, such as a racing heart, a shaking voice, perspiration, vertigo, and trembling hands.
Since beta blockers have little effect on the emotional manifestations of anxiety, such as concern, they are most useful for phobias, especially social phobia, and performance anxiety. Taking a beta blocker in advance of a potentially anxiety-inducing circumstance (such as delivering a speech) will assist calm your “nerves.”
Common beta blocker adverse effects include:
- Dizziness
- Sleepiness
- Weakness
- Fatigue
- Nausea
- Headache
- Constipation
- Diarrhea
Bupropion
Antidepressants include Wellbutrin, Forfivo, and Zyban (brand names of bupropion). Nonetheless, there is evidence that it may be an effective treatment for anxiety and panic disorders.
Depending on the dosage, bupropion might cause anxiety in certain individuals (as can other antidepressants). In others, though, it can aid with generalized anxiety and depression-related anxiety symptoms. A number of studies indicate that it may be equally helpful as SSRIs for treating depression with anxiety.
The following are frequent adverse effects of bupropion:
- Dizziness
- Nausea
- Dry mouth
- Drowsiness
- Anxiety
- Insomnia
- Loss of appetite
- Headache
Hydroxyzine
Hydroxyzine is a common antihistamine for treating allergic responses. However, it can also be used to treat signs of anxiety, such as tension and uneasiness. It works by modifying the amounts of histamine and serotonin in the body, resulting in mood changes. Typically, it is recommended as a short-term therapy, meaning you only take it when you have anxiety symptoms.
In treating generalized anxiety disorder, hydroxyzine may be equally effective as benzodiazepines and buspirone, according to 2020 research.
Common hydroxyzine side effects include:
- Dry mouth
- Dizziness and confusion
- Headache
- Constipation
- Drowsiness
Medication Isn’t Your Only Option For Anxiety Relief
If you are nervous due to growing debt, a tendency to focus on “worst-case scenarios,” or an unpleasant relationship, anxiety medication will not help. This is when self-help, counseling, and other modifications in lifestyle come into play. These non-drug approaches can result in long-term improvements and alleviation.
- Exercise is an effective therapy for anxiety. Studies demonstrate that regular exercise can alleviate symptoms as efficiently as medicine.
- You can retrain your brain to quit worrying and adopt a more tranquil and balanced outlook on life.
- Cognitive behavioral therapy can teach you how to manage your anxiety, eliminate anxious thoughts, and overcome your worries.
- Yoga and tai chi – Yoga and tai chi are mind-body practices that engage you mentally, emotionally, and spiritually. Their effectiveness has been demonstrated for several medical disorders, including anxiety.
- Mindfulness and meditation — Mindfulness is a mental state in which you examine your thoughts, emotions, and behaviors in a present, compassionate, and nonjudgmental manner. It frequently induces calm and relaxation.
Deciding If Anxiety Medication Is Right For You
When deciding whether or not to treat your anxiety with medication, it is essential to discuss the advantages and downsides with your physician. It is also crucial to research the usual side effects of any anxiety medication you are contemplating taking. The adverse effects of anti-anxiety medications range from slight annoyances, such as dry mouth, to more severe difficulties, such as severe nausea and weight gain. For every anxiety medicine, the negative effects must be weighed against the benefits.
Questions To Ask Yourself And a Mental Health Professional
- Is medicine the best treatment choice for my anxiety?
- Am I ready to endure undesirable side effects in exchange for anxiety relief?
- Which non-drug therapies for anxiety may be beneficial?
- Cognitive-behavioral therapy is an example of a non-drug treatment.
- What self-help practices may help me gain control over my anxiety?
- Should I pursue further counseling if I decide to take anti-anxiety medication?
- Is anxiety truly my issue? Or is there anything else occurring, such as an underlying medical issue or pain?
Questions To Ask Your Doctor
- What effect will the drug have on my anxiety?
- What are the frequent adverse effects of the drug?
- Are there any foods and beverages I should avoid?
- How will this medication interact with my current medications?
- How long will I need to take the medicine for anxiety?
- Will withdrawal from the drug be challenging?
- Will my anxiety return if I discontinue treatment?
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