When faced with debilitating anxiety, characterized by intense panic, immobilizing fear, or persistent sleepless nights due to worry, the desire for relief can be overwhelming. Undeniably, medication can provide assistance when anxiety becomes disabling. However, it is essential to consider whether pharmaceutical interventions are always the optimal solution.
A variety of medications are employed to manage anxiety disorders, encompassing both conventional anti-anxiety drugs and more recent alternatives. Benzodiazepines, often prescribed for short-term usage, have been traditionally utilized to alleviate anxiety. In contrast, selective serotonin reuptake inhibitor (SSRI) antidepressants have emerged as a recommended long-term approach to anxiety management.
Benzodiazepines for Anxiety
Benzodiazepines, commonly referred to as tranquilizers, represent a prevalent class of medications prescribed for managing anxiety. Examples of these drugs include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). These medications are known for their rapid onset of action, often providing relief within 30 minutes to an hour, making them particularly effective during acute anxiety episodes, such as panic attacks. However, due to their potential for physical dependence, they are not advised for extended periods of treatment.
These medications function by dampening the activity of the nervous system, promoting both physical and mental relaxation. Despite their efficacy, benzodiazepines may also cause undesirable side effects.
- Fatigue
- Lightheadedness
- Impaired equilibrium or motor skills
- Incoherent speech
- Difficulty focusing
- Memory disturbances
- Disorientation
- Gastrointestinal discomfort
- Head pain
- Diminished visual clarity
SSRI Antidepressants For Anxiety
Many medications initially approved for addressing depression are also prescribed for anxiety disorders. In comparison with benzodiazepines, the likelihood of dependency and abuse is significantly lower. However, antidepressants require a 4 to 6-week period before they start alleviating anxiety symptoms, so they are not suitable for “as-needed” use. Their application is primarily for persistent anxiety issues that necessitate ongoing treatment.
The most commonly prescribed antidepressants for anxiety include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), and citalopram (Celexa). SSRIs have been utilized in the treatment of various anxiety disorders, including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD).
Typical side effects of SSRIs encompass:
- Tiredness
- Upset stomach
- Restlessness
- Drowsiness
- Weight fluctuations
- Diarrhea
- Sleep disturbances
- Sexual dysfunction
- Anxiousness
- Headaches
- Dryness in the mouth
- Excessive perspiration
Alternative Medications for Anxiety
Some other medications, such as buspirone, beta-blockers, and bupropion, can be utilized in the management of anxiety.
Buspirone (BuSpar)
Buspirone, also known under the brand name BuSpar, is a newer anti-anxiety medication that acts as a mild tranquilizer. It alleviates anxiety by increasing serotonin levels in the brain, similar to SSRIs, and decreasing dopamine. Buspirone takes approximately two weeks to begin working, which is slower than benzodiazepines. However, it is less sedating, does not impair memory and coordination, and has minimal withdrawal effects.
Due to its low risk of dependence and minimal drug interactions, buspirone is a more suitable option for older adults and those with a history of substance abuse. Nonetheless, its effectiveness is limited, as it is only beneficial for generalized anxiety disorder (GAD) and not other types of anxiety disorders.
Common side effects of buspirone include:
- Nausea
- Headaches
- Dizziness
- Drowsiness
- Weight gain
- Upset stomach
- Constipation
- Nervousness
- Diarrhea
- Dry mouth
Beta-blockers
Beta-blockers, such as propranolol (Inderal) and atenolol (Tenormin), are medications primarily used for treating high blood pressure and heart-related issues. However, they can also be prescribed off-label for anxiety. By blocking the effects of norepinephrine, a stress hormone involved in the fight-or-flight response, beta-blockers help manage physical symptoms of anxiety, such as rapid heart rate, trembling voice, sweating, dizziness, and shaky hands.
Since beta-blockers do not address emotional symptoms of anxiety, such as worry, they are most effective for phobias, particularly social phobia and performance anxiety. Taking a beta-blocker before an anxiety-provoking situation (e.g., giving a speech) can help alleviate nervousness.
Common side effects of beta-blockers include:
- Dizziness
- Sleepiness
- Weakness
- Fatigue
- Nausea
- Headache
- Constipation
- Diarrhea
Bupropion
Bupropion, sold under brand names such as Wellbutrin, Forfivo, and Zyban, is an antidepressant. There is some evidence suggesting its potential usefulness in treating anxiety and panic disorders.
In some individuals, bupropion may exacerbate anxiety depending on the dosage, as can other antidepressants. However, it can also help manage generalized anxiety and co-occurring anxiety symptoms with depression in others. Some studies indicate that it may be as effective as SSRIs in treating depression accompanied by anxiety.
Common side effects of bupropion include:
- Dizziness
- Nausea
- Dry mouth
- Drowsiness
- Anxiety
- Insomnia
- Loss of appetite
- Headache
Hydroxyzine
Hydroxyzine is an antihistamine commonly used to alleviate allergic reactions. It can also be employed to manage anxiety symptoms such as tension and nervousness. Hydroxyzine works by altering the body’s histamine and serotonin levels, leading to mood changes. It is typically prescribed as a short-term solution, meaning it is used only when anxiety symptoms arise.
Common side effects of hydroxyzine include:
- Dry mouth
- Dizziness and confusion
- Headache
- Constipation
- Drowsiness
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