Medications for Anxiety Disorders

While Anxiety is a very important subject for many of our patients and clients, we thought it is time to spend a full blog post article about this subject. At Pharmacy XL we have both antidepressants and anxiety drugs. Everyone experiences occasional anxiety at one point or another in their lifetime. It could be while writing a test or during a presentation in class. Heck it could even be in the few minutes preceding sex. However, anxiety disorders are a group of mental illnesses which interfere with everyday life. People with anxiety disorders usually experience intense, excessive and persistent worry and fear about everyday situations. Usually anxiety disorders are accompanied with sequential episodes of sudden feelings of intense anxiety and fear or terror that reach a pinnacle within minutes (panic attacks). Anxiety disorders are so common that they affect up to about 30 percent of all adults at one point in their life. It is also possible to have more than one anxiety disorder concurrently. It is more likely for women to experience anxiety disorders than men.

Various anxiety disorders include generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism but let’s continue.

Symptoms may start during childhood or the teen years and continue into adulthood. These symptoms are likely to remain until treatment is initiated and completed. Usually they can occur concurrently with other mental disorders particularly major depressive disorder, personality disorder, and substance use disorder.

According to the American Psychiatric Organization, the estimated percent of U.S. adults in any given year with various anxiety disorders are:

• 7 to 9 percent: specific phobia
• 7 percent: social anxiety disorder
• 2 to 3 percent: panic disorder
• 2 percent: agoraphobia
• 2 percent: generalized anxiety disorder
• 1 to 2 percent: separation anxiety disorder

The good news I am here to tell you, the reader, is that whatever form of anxiety you have, treatment is possible. There are drugs to help in its treatment and alternatives include lifestyle changes and psychotherapy

No clear evidence exists as to which of therapy or drugs is more effective. The patient chooses one of the two based on convenience and preference. The other choice of treatment is only initiated when symptoms are not adequately controlled by the first choice.

Types of Anti-anxiety Medications

There are different classes of anxiolytic medications. Each class is associated with peculiar risks and benefits. Hence it is very vital to be able to distinguish anxiolytics based on classes. Also there is the potential for drug-drug, drug-food interactions when on these medications. This is of extra relevance in patients with other mental disorders apart from anxiety. For example, some medications often used for anxiety may affect the effectiveness of antipsychotics administered at the same time.

Below are the main classes of medications usually used in the treatment of anxiety along with their associated risks and benefits, along with some examples of specific medications within each class.

First-line Options

Selective Serotonin Reuptake Inhibitors (SSRIs)

This class of drugs are one of the most commonly used types of medication for anxiety. They elicit their action by increasing the levels of the neurotransmitter, serotonin, in the brain. Examples include citalopram, escitalopram, fluoxetine, paroxetine, sertraline. They are usually a psychiatrist’s first choice when choosing a medication for this purpose. Evidence has shown them to be very effective anxiolytics. They are also non-addictive, have no effect on memory or interfere with psychotherapy, and have minimal side-effects. They however are required to be used for at least 4-6 weeks to reach maximum efficacy and they could cause uncomfortable withdrawal symptoms if they are stopped abruptly such as nausea, headache, dizziness, chills, body aches, paresthesias, insomnia, and electric shock-like sensations.

Paroxetine produces withdrawal symptoms at a greater rate than other SSRIs. Withdrawal symptoms appear to be less severe with fluoxetine, perhaps owing to its long half-life and the natural tapering effect associated with its slow clearance from the body. A strategy for minimizing withdrawal symptoms seen with SSRIs is to switch the patient to fluoxetine and then taper and discontinue the fluoxetine. Also evidence exists that SSRIs may increase the risk of suicide among younger patients.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs do the same thing that SSRIs do. They are monoamine reuptake inhibitors. They inhibit the reuptake of two neurotransmitters in the brain namely serotonin and norepinephrine. The benefits and side effects are practically the same as SSRIs. As such SSRIs or SNRIs are first line choices for generalized anxiety disorder (4).

Examples include venlafaxine, duloxetine and desvenlafaxine.

Other Options

Benzodiazepines

This group of drugs exert their anxiolytic effect by increasing action of gamma-aminobutyric acid (GABA) in the brain. Examples include alprazolam, clonazepam, diazepam, lorazepam and in short they also called Benzos. They exert their effect much faster than SSRIs and SNRIs. Side effects associated with these drugs have limited their use in clinical settings.

Like SSRIs they can cause withdrawal symptoms when their usage is stopped abruptly after prolonged use. This can result in seizures and death. Tolerance of the drug can also occur. This means that more of the drug would be needed to elicit the same effect. Addiction Addiction to these medications could also arise in certain individuals. Nevertheless, when used appropriately, they play an important role in the treatment of anxiety disorders. For example, they are sometimes used in combination with an SSRI for the first few weeks of treatment before the SSRI has reached maximum efficacy.

TCAS

The use of TCAs in clinical practice is limited by their less favourable side effect and safety profiles compared to the newer antidepressant agents such as SSRIs and SNRIs. They exert their therapeutic effects by   increasing synaptic serotonin and noradrenaline by blocking the re-uptake of these neurotransmitters. Examples include imipramine, clomipramine and amitriptyline.Side effects associated with these drugs include anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation and confusion in the elderly), alpha-1 blocking effects (postural hypotension and reflex tachycardia) and antihistamine effects (accounting for drowsiness and weight gain). These effects interfere with patient compliance. However they do improve after a few weeks (5)

Other drugs that could be used include Buspirone and Hydroxyzine

Buspirone

Buspirone is a partial agonist for the 5-HT1A receptor thus increasing amount of serotonin available in the brain. It takes several weeks (4 to 6 weeks) before efficacy is seen. Buspirone is generally safe and well tolerated. Side effects include initial nausea and dizziness, restlessness and fatigue.

Hydroxyzine

The antihistamine hydroxyzine is another medication that is sometimes used to treat anxiety. The anxiolytic effects of hydroxyzine are thought to be due to its blocking of the histamine receptor; however, hydroxyzine appears to be more effective for anxiety than other antihistamines (such as Benadryl) and this may be due to its interaction with a subset of serotonin receptors. The effects are seen much quicker than SSRIs and SNRIs. Hydroxyzine is non-habit forming, does not cause tolerance, withdrawal, or memory impairment. The most significant side effect of hydroxyzine is sedation which tends to decrease over time. Hydroxyzine is the active ingredient in the well known anxiety drug called Atarax and of course available at our pharmacy.

Other Anxiety Drugs and Antidepressants

Of course we discussed just the top what is possible to discuss about anxiety and depression as it is a never ending science and every day we know more. Also there are more medications than just described here, for which you simply go to the homepage of our online pharmacy at https://www.pharmacy-xl.org and then check out the antidepressants section as well as Anti-Anxiety section for a full list of meds we can provide to you for a cheap price.

References

1. Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association (5th ed.). Arlington: American Psychiatric Publishing. 2013. pp. 189–195. ISBN 978-0890425558.
2. Craske, MG; Stein, MB (24 June 2016). “Anxiety”. Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358
3. Gelenberg AJ, Freeman MP, Markowitz JC, Rosenbaum JF, Thase ME, Trivedi MH, Van Rhoads RS (October 2010). Practice Guideline for the Treatment of Patients With Major Depressive Disorder(PDF) (third ed.). American Psychiatric Association. ISBN 978-0-89042-338-7
4. Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; Boer, Johan A den; Christmas, David M; Davies, Simon; Fineberg, Naomi (2014-04-08). “Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology” (PDF). Journal of Psychopharmacology. 28 (5): 403–439. doi:10.1177/0269881114525674. PMID 24713617
5. Nutt DJ. Overview of diagnosis and drug treatments of anxiety disorders. CNS Spectr 2005;10(1):49–56