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HEALTH GUIDE / Prescription Drugs / Anti-Anxiety Medications

Anti-Anxiety Medications

Anxiolytics

About

About anti-anxiety medications

Anti-anxiety medications are drugs used to relieve symptoms of fear and anxiety experienced by some people. They may also be used for other purposes, such as treating transient insomnia and helping patients withdraw from other medications. Anti-anxiety drugs are highly effective and some begin to work in just 30 to 90 minutes.

The benzodiazepines have the potential to become habit-forming and are usually only prescribed on a short-term basis. In addition, patients whose nervous systems have adapted to the use certain anti-anxiety medications may experience symptoms of withdrawal after they stop using the drug. Sudden withdrawal from benzodiazepines can potentially cause death.

Anti-anxiety medications are available in a variety of formulations, including tablets, capsules, oral solutions, suppositories and injections. They include:

Benzodiazepines

Drugs that became popular in the 1960s as an alternative to barbiturates for treating anxiety. Benzodiazepines can relieve anxiety within 30 to 90 minutes in many patients. Because these drugs may be habit-forming, they are usually only prescribed for short periods of time when a patient is highly anxious. Other negative effects include increased depressant effects when taken with central nervous system (CNS) depressants such as alcohol and several medications.

Buspirone

An anti-anxiety drug that is sometimes used as an alternative to benzodiazepines. The amount of time it takes to work varies among patients. A main advantage of busipirone is that it does not create dependency in those who take it.

Antidepressants

These are among the first-line medications used to treat a number of anxiety disorders. Antidepressants most commonly used to treat anxiety include selective serotonin reuptake inhibitors (SSRIs) and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine. Several of the SSRIs and venlafaxine are approved by the U.S. Food and Drug Administration (FDA) for treatment of anxiety disorders.

Patients should be aware that the U.S. FDA has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Beta blockers

These medications block the effects of norepinephrine (a hormone and neurotransmitter) at its receptor and are usually used to treat high blood pressure (hypertension). Although they cannot treat anxiety itself, they are often effective in treating physiological responses to anxiety. These include increased heart rate, sweating and tremors. Beta blockers may also be used to help control performance anxiety that occurs during events such as speaking in public. Because of their side-effects, it is important to monitor heart rate and blood pressure when these drugs are prescribed. These drugs are not FDA approved for the treatment of anxiety disorders.

In addition, some physicians may prescribe other medications such as antihistamines, clonidine and tiagabine, to treat anxiety. However, these drugs are recommended less often than the anti-anxiety medications detailed above and not all physicians support their use for treatment of anxiety. Furthermore, they must be prescribed in an off-label manner (for a purpose other than which they were originally intended) as they have not been approved by the FDA for the treatment of anxiety.

It is important to note that patients should never take an over-the-counter or prescription medication to treat anxiety without first consulting their physician.

Some examples of anti-anxiety medications include:


Type Generic Name Brand Name(s)

Benzodiazepines

diazepam

Valium

chlordiazepoxide

Librium

flurazepam

Dalmane

estazolam

ProSom

Antidepressants

fluoxetine

Prozac

sertraline

Zoloft

escitalopram

Lexapro

paroxetine

Paxil

venlafaxine

Effexor

Beta blockers

propranolol

Inderal

atenolol

Tenormin

Antihistamines

hydroxyzine*

Vistaril, Atarax

diphenhydramine*

Benadryl

Others

buspirone

BuSpar

clonidine*

Catapres

tiagabine*

Gabitril

*Have not been approved by the FDA for treatment of anxiety.
Conditions

Conditions treated

Anti-anxiety medications are effective in treating most types of anxiety, regardless of the underlying cause. However, some experts maintain that these drugs should only be used if other treatment methods such as psychotherapy or relaxation training have proved inadequate by themselves.

Conditions that are treated with anti-anxiety medications include:


  • Phobias. Extremely strong, persistent, irrational fears of things, places, experiences or situations. Patients may react with extreme panic when they come into contact with the stimulus that they fear.
  • Panic disorder. Condition in which a person regularly experiences panic attacks –sudden episodes of fear and anxiety that usually last for between 10 and 30 minutes and cause symptoms such as racing heartbeat, heavy perspiration and shortness of breath.
  • Generalized anxiety disorder (GAD). Condition in which a person worries excessively about all types of life issues, including health, family, money and work. Patients with this disorder may find themselves unable to relax even when there are no signs of trouble in their lives.
  • Obsessive-compulsive disorder (OCD). Condition in which patients have persistent thoughts they cannot control (obsessions) and/or perform certain actions repeatedly (compulsions).
  • Post-traumatic stress disorder (PTSD). Condition that follows an especially traumatic or terrifying event in a person’s life. In severe cases, it can become so debilitating that patients have difficulty working or socializing.

Anti-anxiety medications may occasionally be used to treat transient (short-term) insomnia. However, other medications have proven more effective for this purpose. In some cases, anti-anxiety medications may be prescribed to help patients more comfortably withdraw from using other medications.


Conditions of concern

The dosages of many anti-anxiety medications may have to be adjusted for patients with kidney or liver conditions because these conditions can impair the body’s ability to process (metabolize) and excrete the drug. This raises the risk of a toxic overdose of the medication.

Patients with some forms of glaucoma (disease that damages the optic nerve) should not use benzodiazepines and should use antihistamines with caution because they may increase pressure in the eye. Beta blockers may be affected by many conditions, including emphysema (abnormal increase in the size of the air spaces of the lungs) and diabetes (disorder in the body’s ability to break down blood sugar). Patients should discuss all their medical conditions with their physician before receiving prescribed medications.

Patients with a history of substance abuse are at higher risk for developing dependence on benzodiazepines.

Side effects

Potential side effects

Patients who take benzodiazepines often experience drowsiness and impaired motor function. In addition, gastrointestinal discomfort may occur that results in constipation, diarrhea, vomiting and changes in appetite.

Patients who take buspirone may experience drowsiness, dizziness, lightheadedness or nervousness. In addition, they may experience blurred vision and many of the gastrointestinal side effects associated with benzodiazepines.

Drowsiness and impaired motor function may result from taking antihistamines. Bradycardia (slowness of heart rate), fatigue and dizziness may result from taking beta blockers. Drowsiness, constipation and orthostatic hypertension (sudden fall in blood pressure upon standing) may result from taking clonidine. Asthenia (loss of body strength), vasodilation (dilation of blood vessels) and abdominal pain may result from taking tiagabine.

Other general side effects associated with anti-anxiety medications include:


  • Balance problems and dizziness
  • Drowsiness
  • Long-term memory problems
  • Nausea
  • Reduced muscle coordination

Patients whose nervous systems adapt to the presence of certain anti-anxiety medications such as benzodiazepines may experience withdrawal symptoms if they try to quit using a drug too quickly. In addition, patients who have tapered off a medication without experiencing side effects sometimes suddenly experience side effects once they reach the last dosage level before quitting the drug. The reason for this remains unknown.

Mild to moderate withdrawal symptoms may include anxiety, restlessness, insomnia or nightmares. More serious symptoms associated with the benzodiazepines can include seizures, high fever, psychosis and even death. For this reason, patients should closely follow a physician’s recommendations when quitting use of these medications.

Symptoms that appear to be related to a mild case of withdrawal may instead be signs of a re-emergence of the anxiety that previously had been blunted by the medication. Patients who experience withdrawal symptoms for more than two weeks should consult their physician about this possibility.

Interactions

Drug or other interactions

Patients taking anti-anxiety medications should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.

Of particular concern to individuals taking anti-anxiety medications are alcohol and other central nervous system (CNS) depressants such as antihistamines, analgesics and barbiturates. Taking anti-anxiety medications with these drugs may increase sedation. This is especially true of benzodiazepines, although it also can be true of buspirone and other medications in some patients.

Lifestyle

Lifestyle considerations

Patients who are taking anti-anxiety drugs should avoid activities that require alertness or good psychomotor function until the effect of the drug on the patient’s nervous system response has become clear.
Patients should avoid smoking, because this can decrease the effectiveness of some anti-anxiety medications such as benzodiazepines.

Overdose

Symptoms of overdose

Patients who overdose on the anti-anxiety drug buspirone are likely to experience severe dizziness, drowsiness, abnormal constriction of pupils and stomach upset that may include nausea and vomiting.

Overdoses of antihistamines may produce sedation, reduced mental alertness, apnea (temporary absence of breathing), cardiovascular collapse, hallucinations, seizures and dry mouth. Overdoses of beta blockers may trigger severe hypotension (abnormally low blood pressure), bradycardia (slowness of heart rate), heart failure or bronchospasm.

Overdoses of clonidine may cause bradycardia, central nervous system depression and respiratory depression. Overdoses of tiagabine may result in drowsiness, impaired consciousness or speech, or agitation and confusion.

Very rarely, benzodiazepine overdoses may cause hypotension (low blood pressure).

How to use

Pregnancy use issues

Women should not take benzodiazepines during pregnancy or while breastfeeding. Women who take benzodiazepines during pregnancy increase the risk of having a newborn who exhibits signs of withdrawal from the drug. In addition, benzodiazepines may cause neonatal flaccidity. Breastfeeding while taking benzodiazepines may increase the risk of infant sedation, feeding difficulties and weight loss.

Although the effects of buspirone on pregnancy and breastfeeding are not well known, women are generally advised to avoid the drug during these periods.

Antihistamines, clonidine and tigabine either should not be used or should be used only with great caution by women who are pregnant or breastfeeding.

All women should consult their physician before taking any medication during pregnancy or while breastfeeding.


Elderly use issues

Elderly patients may need to take lower doses of anti-anxiety medications such as benzodiazepines, because they are more sensitive to the effects of these drugs on the central nervous system. In addition, intravenous administration of benzodiazepines is more likely to result in apnea (temporary absence of breathing), hypotension (abnormally low blood pressure), bradycardia (slowness of heart rate) and cardiac arrest. There is a strong association between the use of benzodiazepines and hip fractures among the elderly because these medications can have a detrimental effect on cognitive functioning.
Elderly patients may also be more sensitive to the side effects of medications such as antihistamines and clonidine. The effect of tiagabine on elderly patients is largely unstudied.

Questions for your doctor

Patients may wish to ask their doctor the following questions related to anti-anxiety medications:
  1. Are anti-anxiety medications appropriate for me?
  2. Which type of anti-anxiety medication do you recommend for me?
  3. What are the potential dangers and side effects associated with anti-anxiety medications?
  4. Which side effects, if any, should I report immediately to you?
  5. Do I have any medical conditions that prohibit the use of anti-anxiety medications?
  6. I’ve heard that pregnant or breastfeeding women should avoid using these drugs. Is this true?
  7. How quickly will these medications help reduce my anxiety?
  8. If one type of anti-anxiety medication does not work for me, are there other options?
  9. I am taking medications for high blood pressure. Can I still take an anti-anxiety medication?
  10. Should I talk to a therapist in addition to taking medication for my anxiety?

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