Fear and anxiety are normal emotions that everyone experiences at times. However, for some people, fear and anxiety can become excessive, persistent, and disabling. This type of severe, out-of-proportion fear and anxiety is known as an anxiety disorder. There are several different types of anxiety disorders, including generalized anxiety disorder, social anxiety disorder, panic disorder, phobias, and separation anxiety disorder. Anxiety disorders affect around 19% of U.S. adults each year. Thankfully, there are many effective treatments available, including therapy and medications. Medications for anxiety, also known as anxiolytics, work by reducing the symptoms of excessive fear and worry. Some common medications used for anxiety disorders include antidepressants, benzodiazepines, buspirone, and beta-blockers. This article will provide an overview of the different medication options for treating anxiety and fear-related disorders.
What causes excessive fear and anxiety?
Fear and anxiety are natural reactions to stressful or dangerous situations. Anxiety becomes a disorder when the fear or anxiety becomes excessive, persists longer than appropriate, interferes with normal functioning, and is no longer within the person’s control. The exact causes of anxiety disorders are not fully understood, but likely involve a combination of biological and environmental factors. Genetics play a role, as anxiety disorders tend to run in families. Changes in certain brain areas and chemical imbalances in the brain involving neurotransmitters like serotonin, norepinephrine, dopamine, and gamma-aminobutyric acid (GABA) have been associated with anxiety disorders. Environmental factors such as trauma, stress, and learned fear responses can also contribute to the development of anxiety issues. Ultimately, anxiety disorders reflect a dysregulation of normal fear and nervous system responses.
Medications to treat anxiety disorders
There are several types of medications that can be effective in reducing anxiety symptoms. The most common medications used for anxiety include:
Antidepressants
Many antidepressant medications work for treating anxiety disorders, even when a person is not depressed. Antidepressants were developed to treat depression originally, but were found to also alleviate anxiety symptoms. They work by increasing neurotransmitter activity in the brain, namely serotonin and norepinephrine. The increased neurotransmitter activity helps regulate emotion and mood. There are several types of antidepressants used for anxiety:
- Selective serotonin reuptake inhibitors (SSRIs) – fluoxetine (Prozac), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) – venlafaxine (Effexor), duloxetine (Cymbalta)
- Tricyclic antidepressants (TCAs) – imipramine (Tofranil), clomipramine (Anafranil)
- Monoamine oxidase inhibitors (MAOIs) – phenelzine (Nardil), tranylcypromine (Parnate)
SSRIs are usually the first choice medication for anxiety today because they have fewer side effects than other classes of antidepressants. SNRIs and TCAs are also commonly used. MAOIs are generally avoided as first line treatment due to dietary restrictions and side effects.
Benzodiazepines
Benzodiazepines are medications that work by enhancing the effects of GABA in the brain. GABA is an inhibitory neurotransmitter, meaning it has calming effects that counter anxiety and excitement. Benzodiazepines provide rapid relief of anxiety symptoms by slowing down brain activity. Some examples of benzodiazepines used for anxiety include:
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Diazepam (Valium)
While benzodiazepines are very effective for acute anxiety relief, they have risks of dependency and abuse. Therefore, they are usually only prescribed short-term or on an as-needed basis.
Buspirone
Buspirone (Buspar) is an anti-anxiety medication that works differently than benzodiazepines and antidepressants. It binds to serotonin receptors in the brain and helps regulate serotonin and dopamine. Buspirone takes a few weeks to start working but can be good option for long-term management of generalized anxiety symptoms. It has minimal risk of dependency.
Beta-blockers
Beta-blockers are a class of medication used originally for heart conditions like high blood pressure. Beta-blockers work by blocking the effects of adrenaline in the body and have a calming, physically relaxing effect. Beta-blockers can be very effective at quickly relieving the physical symptoms of anxiety, such as shaking, pounding heart, and tremors. Some beta-blockers prescribed for anxiety include:
- Propranolol (Inderal)
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
Beta-blockers are mainly used for short-term relief of performance anxiety or specific phobia symptoms, like fear of public speaking. They are not used as a long-term medication.
How are anxiety medications selected?
There is no definitive way to predict exactly which medication will work best for a particular individual. Choosing the right medication usually involves trying one medication for 4-6 weeks to see if it provides adequate relief of symptoms at an acceptable dose without troublesome side effects. If the first medication trial does not work, another medication can be tried. Response to psychiatric medications can vary a lot between individuals based on factors like genetics, diet, lifestyle, and metabolism. However, there are some general guidelines providers follow when selecting a medication to try first:
- SSRIs are usually the first choice
- Consider SNRIs or TCAs if SSRIs are not effective
- Benzodiazepines used for short-term or episodic symptoms
- Buspirone is an option for generalized anxiety
- Beta-blockers used for specific phobias and performance anxiety
- Avoid medications with dependence risk if past substance abuse
- Start with lower doses and increase slowly as needed
The treatment guidelines for anxiety disorders suggest a stepped approach, starting with safer first-line medications before considering other options with more risks. A prescribing provider will take into account the individual’s symptoms, medical history, risk factors, and preferences when deciding where to start medication-wise. Many people with anxiety respond well to first-line SSRI antidepressants or short-term benzodiazepines.
What are the benefits of anxiety medications?
When used properly, medications for anxiety can provide many benefits:
- Significant reduction of anxiety and fear
- Fewer panic attacks
- Increased ability to function normally
- Improved sleep
- Increased focus and concentration
- Regulated fight-or-flight response
- Prevention of future anxiety episodes
- Improved response to therapy
Medications help rebalance brain chemistry to keep anxiety at normal, manageable levels. This allows the person to function optimally in relationships, at work or school, and in day-to-day activities without being limited by anxiety symptoms. Medications make a huge difference in quality of life for many people struggling with excessive anxiety.
What are the risks and side effects?
All medications have potential risks and side effects, even over-the-counter drugs like pain relievers. The most common side effects of anxiety medications include:
Antidepressants
- Headache
- Nausea
- Insomnia or drowsiness
- Dry mouth
- Sexual dysfunction
- Weight changes
Side effects are usually worst when first starting an antidepressant but improve with time. Sexual side effects may persist and need to be addressed.
Benzodiazepines
- Drowsiness
- Lightheadedness
- Confusion
- Lack of coordination
- Dependence and withdrawal reactions
Benzodiazepines carry a risk of physical and psychological dependence if used long-term. Stopping abruptly can cause dangerous withdrawal effects.
Buspirone
- Dizziness
- Headache
- Nausea
- Restlessness
Buspirone has fewer side effects than other anti-anxiety medications but can take up to 6 weeks to start working.
Beta-blockers
- Fatigue
- Dizziness
- Cold hands and feet
- Weakness
- Nausea
- Poor sleep
Beta-blockers can worsen symptoms in people with asthma or certain heart conditions.
Most medication side effects are mild at appropriate doses and can be managed by adjusting the dose or switching medications. The benefits of anxiety relief usually outweigh the disadvantages of medication side effects for most people.
What about risks like dependence and abuse?
There are legitimate concerns about the risks of dependence and abuse potential with certain psychiatric medications, especially benzodiazepines. Anyone taking anxiety medication should be aware of these risks:
- Benzodiazepines have significant abuse potential
- Taking high doses or combining benzodiazepines with other drugs or alcohol dangerously increases overdose risk
- Using benzodiazepines daily for more than 2-4 weeks can lead to dependence where stopping the drug causes withdrawal symptoms
- Withdrawing from benzodiazepines too rapidly can cause life-threatening effects like seizures
- Antidepressants generally do not have abuse potential but stopping them suddenly can cause intolerable side effects
- Prescription stimulants for ADHD like Adderall have some abuse risk
To keep risks low:
- Use the lowest effective dose
- Avoid combining medications unless medically supervised
- Do not drink alcohol or use illegal drugs
- Store medication securely
- Taper off cautiously with medical guidance
- Follow prescribing instructions carefully
The risks of addiction and dependence need to be balanced with the risks of not treating severe anxiety effectively. With responsible prescribing and appropriate monitoring, the benefits of anxiety medications far outweigh the risks for most patients.
Are medications enough for treating anxiety disorders?
Medications are very helpful for controlling anxiety symptoms, but additional therapy is recommended for most people with an anxiety disorder diagnosis. Medication alone is often not enough. Cognitive behavioral therapy (CBT) in particular is effective for learning coping strategies and new ways of thinking to manage anxiety long-term. A combination approach using CBT and medication together has consistently been shown to be more effective than either treatment alone. Other supportive therapies like mindfulness practices, yoga, exercise, and stress management can enhance anxiety treatment effectiveness as well. For milder anxiety, therapy without medication may be attempted first. But for moderate to severe anxiety symptoms, combining medication and therapy has the best results. This combined approach provides both immediate symptom relief through medication and skill building for preventing future anxiety episodes using CBT techniques. Working closely with a psychiatrist or mental health provider is important to monitor progress and adjust treatment as needed. Ongoing communication between patient, prescriber, and therapist is key.
Conclusion
Excessive, debilitating anxiety is highly treatable with a range of medication options. The most commonly prescribed anti-anxiety medications include SSRIs, benzodiazepines, buspirone, and beta-blockers. These medications work through different mechanisms but share the common goal of decreasing fear and worry. There is no one right medication that works for everyone, so finding the most effective option usually takes some trial and error. Side effects vary but can often be managed by making dosage adjustments. While medications do carry risks, they can be used responsibly and safely under medical supervision. The benefits of relief from anxiety symptoms, prevention of anxiety attacks, and improved functioning for most people outweigh the risks when taken as prescribed. The most successful approach to treating anxiety disorders long-term usually involves medications to control symptoms along with therapy to develop coping skills. With today’s treatment options, people suffering from excessive fear and anxiety can find real relief and return to living their lives to the fullest.