Psychotherapy is recommended for treatment of anxiety, but when psychotherapy alone is not sufficient to quell the worry, racing heart, shaking and other symptoms of anxiety disorder, then medication can be effective.
There are several different types of anxiety disorder and while they all stem from basically the same disorder, each may be affected by medications differently. Benzodiazipines are the class of drugs most popular in today’s market to treat anxiety. They work by making the neurotransmitter GABA more effective, producing a calming effect. This group of drugs includes Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam) and Valium (diazepam). Generally these drugs are well tolerated, but they share key side effects such as drowsiness, dizziness, GI problems, and irritability.
Xanax (i.e., Niravam) is often given in pill form to be taken orally. It might be started at a low dose and the dose is increased until the desired effect is reached. Over a long period usage there may be some problems such as reduced effectiveness and drug seeking behavior (addiction). Going off the drug suddenly is dangerous. There are a number of symptoms associated with stopping the drug suddenly, some of the most severe are seizures, shortness of breath and hallucinations.
Xanax is especially good at decreasing panic disorder. It is also used to treat depression and, another form of anxiety disorder, agoraphobia. It can also be described for premenstrual syndrome.
Report all other medications and herbal preparations being taken to the prescribing physician. Xanax should not be combined with itraconazole (Sporanox) or ketoconazole (Nizoral) and may interact with St. John’s Wort. It may interact with grapefruit juice.
Ativan also is useful for anxiety. It can also be prescribed to treat irritable bowel syndrome, epilepsy, insomnia, and is sometimes used to reduce nausea from cancer treatment. An anxiety patient with any of these other conditions would most likely be prescribed Ativan over Xanax.
Ativan is also habit forming. The problems from withdrawal are not as bad as Xanax, but they are still significant: irritability, sleeplessness and more anxiety.
Drowsiness is one of the most likely side effects. It can be dangerous if operating machinery such as an automobile. Less common side effects might be shuffling walk, motor stimulation, and the rash and skin yellowing possible with other benzodiazepines.
Klonopin (aka Ceberclon/ Valpax) is used to relieve panic attacks. It is also used as an anti-seizure medication. Dosing is tricky for persons above the mid sixties. It may not be compatible with glaucoma or liver disease.
It shares a lot of the side effects of the other benzodiazepines, but it is noted that thoughts of suicide in those that are taking this drug should be keenly observed. Rash and hives may be more common side effects with this anxiolytic than others.
Valium (i.e., Valrelease) was one of the first benzodiazepam-type drugs. It was originally on the market to relax muscles. It is also sometimes used in alcohol withdrawal and irritable bowel syndrome. It is used for general anxiety and panic disorder.
The use of tobacco may reduce the effectiveness of Valium and, like other benzodiazepines, alcohol should be avoided.
Side effects are the same as other benzodiazepines. There is an addictive potential with this drug. Dry mouth is a common side effect.
This medication may cause false results for diabetes testing, so may not be the best choice for diabetics. It also is contraindicated if the patient has myasthenia gravis.
Other classes of drugs are still used for anxiety. Sometimes the anxiety sufferer also has depression or the physician prescribes an antidepressant for anxiety. The most common antidepressant is selective serotonin reuptake inhibitors (SSRIs). This group includes Prozac.
If the condition is generalized anxiety disorder or obsessive compulsive disorder then an SSRI is likely to be prescribed. The SSRIs manipulate serotonin, a different neurotransmitter in the brain than the GABA the benzodiazepines influence.
SSRIs share many of the physical side effects of the benzodiazepines. Watch also for sexual problems as a result of the SSRIs. There is controversy about this class of drugs inciting suicide, especially in adolescents.
Post-traumatic stress disorder might be treated with antipsychotics, but it also might be treated with SSRIs such as Zoloft (sertraline) or Paxil (paroxetine). Minipress (prazosin) might be prescribed if the main problems are insomnia and nightmares.
For all these drugs, be sure to inform the doctor if you have glaucoma, seizures, or diseases of the lung, heart, liver. Special consideration should be taken if you are pregnant.
All medications have contraindications and side effects. For the most part, the medications can be adjusted to minimize the negative effects. Good results have been gotten by all the drugs listed above. But each course of medication needs careful monitoring by a medical doctor.