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Antianxiety and Antipanic Medications

Anxiety affects as many as 40 million Americans each year. If you are one of the many who is coping with debilitating feelings of anxiety, it is important to evaluate all of the treatment options available to you. In addition to therapy and lifestyle changes, some individuals benefit from taking antianxiety medication prescribed by a healthcare practitioner. Anxiety is often used as a catchall term to describe a state where a person feels discomfort, strong feelings of rejection, apprehension, nervousness, or fear of their surroundings, emotions, or other stimulus. In simple terms, anxiety is our response to any undesirable and problematic situation.

 

Antianxiety medications, also known as anxiolytics, cannot cure your anxiety condition. However, they may help ease symptoms of anxiety such as fear, insomnia, panic, and worry when those symptoms prevent you from doing day-to-day activities. These medications are prescribed by a doctor or psychiatrist and are not available for purchase over-the-counter.

Types of Anxiety

Anxiety does not come in just one form. Getting a proper diagnosis for your anxiety is an important first step before beginning any type of medication.


Mild anxiety is a common phenomenon. This occurs because of any problem that a person faces in daily life such as a test, interview, question, argument, etc. With the removal of the problem, this anxiety fades away. Severe or chronic anxiety persists for a longer period of time and often produces more severe symptoms, such as:

  • A general lack of interest
  • Sadness
  • Panic
  • Tachycardia (increased heart rate)
  • Palpitations (irregular heartbeat)
  • Dyspnea (shortness of breath)
  • Hypertension (increased blood pressure)
  • Gastrointestinal distress (indigestion, ulcers, diarrhea)

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  • Loss of appetite
  • Localized or generalized pain
  • Sweating
  • Trembling
  • Fatigue

A trained mental health professional or psychiatrist can diagnose your anxiety. Professionals typically make their diagnoses based on the Diagnostic and Statistic Manual (DSM-5). Some of the anxiety diagnosis outlined in the DSM includes:

  • Generalized Anxiety (GAD): Anxiety about common life problems, such as a financial crisis, performance issues, or work that lasts longer than six months.
  • Panic Disorder (PD): Small episodes of fear, tension, or discomfort that occur repeatedly.
  • Social Anxiety: Fear to face, socialize, and interact with people because a person may think people have a negative image of him. It is also the fear of public humiliation due to the harsh reactions of others.
  • Obsessive Compulsion (OCD): Anxiety generated by repetitive thoughts, ideas, concepts, and thinking that often results in the unreasonable actions (compulsions) of a person in a real environment.
  • Posttraumatic Stress (PTSD): Anxiety associated with trauma (injury, rape, fight, accident, etc.).
  • Specific phobias: A phobia is a state of intense fear to a stimulus or an object.

The type, duration, and dosage of your antianxiety prescription will likely vary depending on the nature of your anxiety as well as your treatment goals.

Finding the Right Medication

There are several different medications on the market that may be used to treat the symptoms of anxiety or panic. They include:

These medications work differently and each comes with their own potential side effects and risks. Your doctor or psychiatrist is the best person to discuss the differences between medication options to find the best fit for you. Be sure to discuss your complete health history and current substance use with your doctor before beginning an anti-anxiety or anti-panic medication.

 

In general, these medications work by reducing the overall amount of activity in the brain, leading to a calming effect. Antianxiety medications begin working quickly and have relatively few side effects. Drowsiness, poor coordination, and fuzzy thinking are the most common side effects. Doctors often prescribe the lowest effective dose to help minimize these effects. Still, people taking these medications should refrain from operating a motor vehicle until they know with certainty how the drugs affect them. Some prescriptions may call for a once-daily dose of these medications, while others may simply suggest that a patient take the medication only as necessary to control symptoms.

 

In most cases, antianxiety medications are only used temporarily, as some can be habit-forming. Some medications take effect right away to ease symptoms. For example, in the case of surgery, a person can be given an anxiolytic to soothe his or her fear and worry about the upcoming procedure. Other medications, such as antidepressants, can take several weeks before they reach effectiveness. 

Benzodiazepines

Benzodiazepines are a class of medications used exclusively for the short-term treatment of panic and anxiety issues. They are typically used to treat conditions such as generalized anxiety, obsessive compulsions, panic attacks, social phobia, and posttraumatic stress.

 

Benzodiazepines are classified according to their duration of action. Short-acting agents (oxazepam, trizolam) act for about three to eight hours. Intermediate-acting agents (alprazolam, lorazepam) show their effectiveness for 10 to 20 hours. Long-acting agents (diazepam, quazepam) act for 24 to 72 hours.

 

Valium (diazepam), Xanax (alprazolam), and Ativan (lorazepam) are the most frequently prescribed benzodiazepine anti-anxiety medications. These drugs act on gamma-aminobutryric acid (GABA) receptors present in the brain. GABA is a neurotransmitter that promotes inhibitory responses in the brain. Activation of GABA receptors induces relaxation and sleep.

 

Even when prescribed for legitimate reasons, benzodiazepines can be habit forming if a person takes too much of the drug too often. Unpleasant withdrawal symptoms are possible if a person suddenly stops taking anti-anxiety medications. Doctors usually instruct people to taper off of these medications gradually rather than all at once.

Antidepressants for Anxiety

In some cases, doctors may prescribe antidepressant medications to treat anxiety because these medications are often effective for long periods and can have other benefits. Antidepressants are divided into various classes including SSRIs, SNRIs, TCAs, atypical antidepressants, and MAOIs. Usually, selective serotonin reuptake inhibitors—SSRIs (Prozac, Zoloft)—and selective norepinephrine reuptake inhibitors— SNRIs (Effexor XR)—are preferred over tricyclic antidepressants— TCAs (Tofranil)—because of their better results.

 

Antidepressants modulate the reuptake of serotonin (5-HT), norepinephrine, and/or dopamine. These are the neurotransmitters that trigger the responses of excitement, happiness, and pleasure. These are normally taken back from the synaptic cleft to the neurons, but antidepressants prohibit this process.

 

People using these drugs sometimes report a sense of euphoria, but more common adverse reactions may include constipation, mood elevation, mania, anger, anxiety, hypertension, insomnia, and sexual dysfunction. Children, teens, and young adults who take antidepressants may be at increased risk for suicidal thoughts or behavior.

Alternative Treatments for Anxiety

As with most mental health issues, non-pharmacologic therapies, such as talk therapy or counseling, can be an effective treatment strategy to treat symptoms and address the underlying factors contributing to one's anxiety. Identifying the underlying emotional or behavioral reasons for anxiety can help a person understand his or her triggers for it, what they can do to cope with it, and how they can potentially overcome it. If you are experiencing anxiety, consider finding a qualified therapist before or after speaking to a doctor to see if therapy can help your situation. Many types of therapy, such as cognitive behavioral therapy, have helped people completely relieve their anxiety. Counseling can be a stand-alone treatment or done in conjunction with taking medication. 

 

Possible alternative substances that are under investigation for the treatment of anxiety include Hydroxyzine, kava kava, and pregabalin. Barbiturates are also sometimes used to treat anxiety, but their use is limited now with the availability of many benzodiazepines. Antihistamines can also be used to promote relaxation; however, their use is also limited and should only be used when a person is allergic to benzodiazepines.

 

Alternative body therapies such as massage, nutritional therapy, and breathing exercises have also produced positive results for alleviating anxiety. Yoga and meditation may also help a person who is experiencing anxiety find relief for his or her mild or chronic symptoms.


References: 

  1. Allgulander, C., Bandelow, B., Hollander, E., et al. (2003). WCA recommendations for the long-term treatment of generalized anxiety disorder. CNS Spectrum, 8(8 suppl. 1), 53−61.
  2. Anxiety Disorders. (n.d.). National Institute of Mental Health. Retrieved January 12, 2015, from http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml?rf=53414
  3. Ballanger, J.C., Davidson, J.R., Lecrubier, Y., et al. (2001). Consensus statement on generalized anxiety disorder from the international consensus group on depression and anxiety. Journal of Clinical Psychiatry, 62 (suppl. 11), 53–58.
  4. Bandelow, B., Zohar, J., Hollander, E., et al. (2002). Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World Journal of Biological Psychiatry, 3, 171–199.
  5. NIMH · Mental Health Medications. (n.d.). NIMH · Home. Retrieved April 23, 2012, from
    http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml#pub8 
  6. Panic disorder: MedlinePlus Medical Encyclopedia. (n.d.). National Library of Medicine - National Institutes of Health. Retrieved April 25, 2012, from
    http://www.nlm.nih.gov/medlineplus/ency/article/000924.htm
  7. Rickels, R., and Ryan, M. (2002). Pharmacotherapy of generalized anxiety disorder. Journal of Clinical Psychiatry, 63(suppl. 14), 9–16.

 

Last Update: 02-02-2015

 

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