Everyone feels anxious at some point in their life. It can be something small like a twinge when we see traffic piling up. It can be felt overnight like when we have a test or a speech in the morning. It can last a week or two, say, if there is a trial coming up. But if the worrying, sweating, shallow breaths, and other symptoms last day after day, week after week, the problem might be chronic, and medication might be recommended. However, while medications are designed to have beneficial effects, many have unintended and unwanted effects that should be considered and observed.
As a family of drugs, the anxiolytics, or anti-anxiety medications, are generally non-addictive and have manageable side effects. Still, for some people there are contraindications. A medical doctor needs to evaluate any other conditions the patient has to determine which medication has the best chance of working with the least side effects.
The general side effects of anti-anxiety medications are loss of coordination and drowsiness. Someone taking these drugs at the proper dosage should not expect these side effects, but should be prepared for them. Every medication affects each individual differently. The time period beginning any new drug should be a cautious one. Until the personal effects of the drug are known, it is prudent to avoid making major decisions as well as avoiding operating machinery such as driving a car.
The side effects vary in severity with the medication and with the specific patient. Some patients may have only a vague awareness of the side effects; others lives will be dominated by them. Here is a partial list of side effects for some drugs used for anxiety.
- Tricyclic antidepressants - low blood pressure, heart problems, GI problems e.g. constipation, feeling dizzy
- Benzodiazepines – drowsiness and dizziness, lack of coordination, sexual problems, memory formation problems
- Barbiturates – drowsiness, dizziness, sluggishness in thought and action, skin problems, bleeding, emotional and respiratory depression, potential for abuse, and overdose
- Selective serotonin reuptake inhibitors (SSRIs) – insomnia, headaches, sexual problems, lowered blood clotting, and in some cases self-destructiveness
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) – anxiety, GI problems, hypertension, sexual problems
- Monoamine oxidase inhibitors (MAOIs) – low blood pressure, dizziness, sexual problems, GI problems, weight gain
Anxiolytics do not combine well with other central nervous system depressants. Breathing can be labored and there can be other dangerous side effects if anxiety medications are combined with antidepressant ones. Drugs that are eliminated by the liver, such as anti-convulsants, antibiotics, cimetidine, and antidepressants can interfere with the elimination of most anti-anxiety drugs. This can result in higher than safe blood levels of the medications. It’s important to check with your doctor or pharmacist for possible interactions with each of your other medications.
Sometimes medication can be affected by other non-drug-related influences such as:
Food/Drink: BuSpar, an MAO inhibitor, is successful at treating anxiety. Unfortunately it negatively interacts with grapefruit, red wine, dairy, beer, and even pickles. Xanax, a benzodiazepine, can adversely interact with grapefruit as well.
Sunlight can be another problem since anti-anxiety drugs tend to be sun sensitizing; meaning, someone using the drugs are more sensitive to the sun. As a result, skin problems could develop if the person taking the medication is exposed to a lot of sunlight.
Alcohol should not be taken with any anti-anxiety medication since the combination will likely have a synergistic reaction; meaning, it will make the person much more tired and drowsy. The combination could also adversely affect the liver, causing future damage.
Side Effects over Time
As a family, anti-anxiety drugs are considered non-addictive, and many people stay on an anxiolytic for years. These newer drugs replaced barbiturates, which had negative side effects and long-lasting consequences. More recently, studies have found that benzodiazepines may have more of a potential for dependence and abuse than previously thought and are not recommended for long-term use.
Thus, while most people taking anti-anxiety medications do not stay on them for years, it is possible to use them on an on-going basis. Psychotherapy is often used in conjunction with medication in order to reduce or replace the need for the medications.
Rebound is when the medication is discontinued and then symptoms come back worse than before the drug treatment was started. The rebound effect can be mitigated by withdrawing from the drug very slowly. Discontinuing a high dose suddenly will surely cause problems. When changing the dosage of a medication or weaning off of it completely, one should always be under a doctor's supervision.
Sometimes a medication is given in good faith to reduce anxiety, and just the opposite occurs. Paradoxical effects of benzodiazepines, for instance, can be aggression, rage, mania, hyperactivity, and twitching. Some studies have found that these symptoms occur in 1/100 of cases for benzodiazepines. Again, a patient should alert his physician of any change in mental attitude, as well as any other symptoms, when on medication.
Making the Decision
The decision of whether drug therapy should be started, which medication to take, and at what dosage must be made through honest discussion with a medical doctor. It is not uncommon for someone undergoing drug therapy to start on one drug at a specific dose and then change either the medication or dosage to ensure a balance between beneficial and detrimental effects.
The effects of the medication on the anxiety, as well as the presence and severity of the side effects, needs to be monitored by a medical doctor. It is usually recommended that psychotherapy be concurrent with the use of anxiety medications.