Anxiety – means feelings of worry, fear, nervousness, and uneasiness.
Anxiety is a very normal and often very healthy emotion. This is very common in every individual but if present persistently or intensely, it may indicate an anxiety disorder.
- It leads to excessive nervousness, fear, apprehension, worry. Mild anxiety may be vague but severe and excess anxiety may affect day to day living seriously.
- 40 million people in the USA are affected by these anxiety disorders.
- This is the most common mental illness.
According to many surveys conducted, it was seen that about 33.7% of people will experience some kind of anxiety disorder even once during their entire lifetime.
Medications are there to treat this anxiety. These medications are prescribed alone or in combination with cognitive-behavioral therapy (CBT) or another kind of therapy.
Here we discuss some important anxiety medications, their risks, and side effects.
American psychological association (APA) defines anxiety as -an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.
Treatment of anxiety includes psychotherapy and Medication.
Anxiety medication-Types:
- Several kinds of medications can treat the symptoms of anxiety.
- According to anxiety and depression association of America (ADAA), four major classes of drugs for anxiety disorders are as follows:
Selective serotonin reuptake inhibitors (SSRI’s):
A doctor will prescribe these medications to people with major depressive disorder, anxiety disorder and obsessive-compulsive disorder (OCD). These drugs are the doctor’s first choice when it comes to the treatment of depression as they tend to cause fewer side effects when compared to other antidepressant medications.
Selective serotonin reuptake inhibitors are the type of anti-depressants.
Based on the past results doctors consider these SSRI as the first-line drug treatment for anxiety.
How does SSRI’s act?
They will prevent reabsorption of serotonin by the nerve cells of the brain. Serotonin is a neurotransmitter that plays a vital role in mood regulation.
They will enhance the nerve cell function in the brain that regulates emotion.
Examples of SSRI’S for anxiety are :
Citalopram(Celexa), escitalopram (Lexapro), fluoxetine( Prozac) , fluvoxamine( Luvox) , Paroxetine (Paxil,Pexeva), and sertraline ( Zoloft)
Within 2 to 6 weeks these medications will begin to take effect, but they don’t work for everyone. People will take these SSRI’s for about twelve months and gradually reduce the dosage levels.
These are not habit forming drugs means they don’t form a dependence. However, if medication intake is stopped suddenly it may lead to discontinuation syndrome that causes withdrawal-like symptoms.
Before reducing the dose or before stopping the medication it is better to consult a doctor or a physician.
Serotonin-norepinephrine reuptake inhibitors :
They are another class of anti-depressants that treat anxiety and depression. These are also prescribed by the doctor to treat certain chronic pain conditions. They will reduce the reabsorption of the chemicals serotonin and norepinephrine by the brain. If selective serotonin reuptake inhibitors are unable to ease the symptoms of depression your physician will switch you to serotonin-norepinephrine reuptake inhibitors.
SNRI’s for anxiety some examples are:
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor XR)
These will take several days to show their effects just like SSRI’s
Tricyclic anti-depressants:
These are the older class of anti-depressant drugs. Although they are effective for the treatment of anxiety and depression doctors prescribe SSRIs instead because they cause fewer side effects. They will increase the levels of norepinephrine and serotonin, two neurotransmitters and block the action of another neurotransmitter(acetylcholine). They are used to treat most anxiety disorders except obsessive-compulsive disorder (OCD). These work very similar to SSRI’s. Like SSRI s these are also started with a low dose and then it is increased gradually.
In addition to dealing with depression, these also cause sedation and block the action of histamine.
Examples of TCA’S for anxiety are :
Amitriptyline (Elavil)
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Benzodiazepines:
These are the type of sedative drugs. They help in reducing the physical symptoms of anxiety such as tense muscles (muscle relaxant). But these are known to be highly addictive and they will even cause drowsiness. These will have very few side effects. These can also be habit-forming.
The effects are observed within a few minutes. They help in relaxation. They are used to treat many types of anxiety disorders such as panic disorder, generalized anxiety disorder, and social anxiety disorder.
These includes
- Alprazolam( Xanax)
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Clonazepam( Klonopin)
Among this Diazepam (Valium) is most commonly prescribed. Some people with short term anxiety usually take Benzodiazepines. People with a fear of flying may take them before a flight.
People may take Benzodiazepines along with SSRIs for a few weeks until SSRI takes effect. These will help control depression and anxiety as well. People usually take serotonin reuptake inhibitors that have few side effects than an old group of antidepressants.
But there are possibilities of causing sexual dysfunctions, nausea, jitters when treatment begins. Other antidepressants are fluoxetine, Prozac, citalopram, Celexa.
Beta-blockers :
Mainly indicated for people with heart problems and high blood pressure. Beta-blockers reduce the effects of norepinephrine meaning they relieve some of the physical symptoms of anxiety. They reduce the symptoms of anxiety under stressful situations like giving a speech, attending a party.
Examples are:
Atenolol(Tenormin), and propranolol (Inderal).
Buspirone:
It is used to treat short or long term anxiety symptoms. It may not treat all types of anxiety disorders. It works much more slowly than Benzodiazepines, the risk of dependency is low with these medications and they carry fewer side effects.
It was not known exactly how this buspirone works but it affects the chemicals in the brain that regulates the mood. It is available in generic form as well as brand name drug Buspar.
Monoamine oxidase inhibitors (MAOI’s)
To treat the symptoms of panic disorder, social phobia, these are the earliest type of anti-depressants. These will work by increasing the levels of neurotransmitters that will play a role in mood regulation.
Examples are:
Isocarboxazid ( Marplan)
Phenelzine ( Nardil)
Selegiline ( Emsam)
Tranylcypromine ( Parnate)
These are used off-label and are approved by the FDA. MAOI’s comes with certain restrictions. Foods that should not be taken are red wine, and cheese.
MAOIs interact with certain other medications like birth control pills, SSRIs, pain relievers such as ibuprofen, acetaminophen, cold and allergy medications and certain herbal supplements such as St. John’s wort, and Medicinal marijuana.
Taking these MAOI’s along with these medications or food may increase the blood pressure and may even cause other potentially life-threatening side effects.
SIDE EFFECTS:
Anxiety drugs and anti-depressants are known to cause side effects in some people. Mild symptoms may resolve on its own but if symptoms are severe and persisting it is advisable to consult a doctor.
Side effects depend on the type of medication taken:
SSRI’s (Selective Serotonin Re-uptake Inhibitors):
The possible side effects are :
Blurred vision, drowsiness, fatigue, dizziness, xerostomia (dry mouth), headache, weight gain, nausea, increased risk of bone fracture, suicidal thoughts, sensitive to light, agitation, restlessness, stomach problems, the problem with sleep, sexual problems like erectile dysfunction are the common side effects people usually experience when they are taking SSRIs.
SNRI’S ( Serotonin-norepinephrine reuptake inhibitors):
Drowsiness, dizziness, fatigue, constipation, dry mouth, headache, hypertension, nausea, weight gain, loss of appetite, upset stomach, and sexual problems like erectile dysfunction, sleep problems, hyperhidrosis (excess sweat) are the common side effects of SNRIs.
TCA’s (Tricyclic antidepressants)
Blurred vision, difficulty urination, constipation, dry mouth, drowsiness, increased appetite, light-headedness, low blood pressure, sexual problems, erectile dysfunction, tremors, and weight loss or gain are the side effects of tricyclic antidepressants.
Benzodiazepines
These will cause many side effects:
Confusion, dizziness, blurred vision, drowsiness, fatigue, headache, loss of memory, lack of concentration, problems with balance, coordination, or speech, an upset stomach.
These will carry certain risks, they will cause physical dependence even after a short period of use.
Withdrawal leads to anxiety, restlessness, depression, sleep problems, sweating, convulsions.
Other Severe risks of Benzodiazepines are
Addiction, Cognitive decline, fracture of hip, motor vehicle accident, overdose especially in combination with opioid drugs or alcohol.
Beta-Blockers:
Beta-blockers side effects are :
Depression, cold hands and feet, fatigue, dizziness, drowsiness tiredness, dyspnea, low blood pressure, sleep problems, weight gain, dry mouth, nausea shortness of breath.
Beta-blockers are contradicted in asthma. People with diabetes should take them with caution and talk to a doctor to avoid possible risks.
Buspirone
Side effects of buspirone mean blurred vision, diarrhea, dizziness, fatigue, dry mouth, headache, muscle pains, nausea, poor concentration, restlessness, nervousness, sleep problems, strange dreams, sweating, weakness.
Monoamine oxidase inhibitors
Diarrhea, constipation, difficulty urinating, dizziness, drowsiness, dry mouth, nausea, headache, low blood pressure, sexual dysfunction, sleep problems, sweating, weight gain.
These medications interact with many other drugs as well as some foods and drinks.
People who are under this Medication should consult their doctor about the foods, medicines, and drinks to be avoided.
Suicide Risk
People under 25years of age will experience an increase in suicidal thoughts and behavior while taking anti-depressants particularly within the first weeks of use.
Risks with SSRI’s :
Related to increased risk of suicidal behavior in children and adults.
- United States food and drug administration (FDA) requires all anti-depressants to carry a black box warning relating to risks of suicide in children and young adults.
- It is advisable not to stop taking medication without consulting a doctor as it may lead to withdrawal symptoms.
Have a word with your physician
It’s better to discuss with your physician while choosing the best medication for your anxiety disorder. If the medications are unable to control your disorder then he may suggest you take alternative treatments such as massage therapy, and psychotherapy.
Follow your physician’s instructions carefully while taking anxiety drugs. Also, never stop taking anxiety medications and antidepressants abruptly and make sure to consult your doctor before you would like to stop taking them. If you are experiencing any side effects when you are on medication talk to your physician immediately.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
- https://www.sciencedirect.com/science/article/abs/pii/S0887618512000977
Sirisha B