Anxiety and Panic: What Medications are Best?

Some individuals with anxiety and panic issues can successfully manage their worry and distress through exercise, dietary changes, relaxation, or professional counseling. That said, many anxiety and panic disorders sufferers can benefit from an anxiety medication. Although only your psychiatrist or physician can help you determine what anxiety medication is right for you, doing your homework can help you arrive at your appointment prepared to make an informed choice.

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Classes of Anxiety Medications

Benzodiazepines

Benzodiazepines are a commonly prescribed class of medications for generalized anxiety, panic disorders, and social anxiety. Common benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam). Benzodiazepines generally work quickly, so they can be an effective at treating panic attacks or suddenly-occurring anxiety. Although this class of drugs can be highly effective, they also can be addictive and have a high potential for abuse. Thus, most doctors regard benzodiazepines as only a short-term treatment for anxiety and panic, although some persons may take them for several months, particularly when dealing with chronically stressful situations, such as divorce or a family death. Further, for some patients, benzodiazepines have a paradoxical effect, which means that they actually create more anxiety. This class of drug also produces a marked sedating effect. Some individuals may find this sedation too debilitating. Despite the risks posed by benzodiazepines, they may be a good solution for persons with occasional anxiety and panic.

Anti-Depressants

For the long-term treatment of anxiety and panic disorders, anti-depressants can be an effective choice. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are two of the most common classes of anti-depressants used in the treatment of anxiety-related conditions.

The following anti-depressants have been found to treat anxiety and panic disorders and their related symptoms:

  • Bupropion (Wellbutrin)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Imipramine (Tofranil)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Venlafaxine (Effexor)

Unlike benzodiazepines, anti-depressants pose relatively little risk for abuse and addiction. That said, anti-depressants often take weeks or months to take effect, so they provide little immediate symptom relief. Additionally, many individuals experience negative side effects from anti-depressants, including weight gain, drowsiness, and sexual dysfunction. Anti-depressants are nonetheless still a good choice for chronic and debilitating anxiety. Anti-depressants are also a good choice for persons who experience depression symptoms that may be difficult to distinguish from anxiety symptoms.

BusPar

BusPar, otherwise known as buspirone, is a unique drug used in the treatment of generalized anxiety disorder. It is different than either anti-depressants or benzodiazepines. Like anti-depressants, BusPar can take a few weeks before it starts to work. Additionally, it is considered non-addictive and has little potential for abuse. Although BusPar is sedating, it does not cause extreme drowsiness like benzodiazepines. Despite the strengths of BusPar, it is only effective at treating generalized anxiety disorder, so it is typically not a good choice for persons who are living with panic attacks or other forms of anxiety. It can also be ineffective in persons who have taken faster-acting drugs such as benzodiazepines previously.

Over-the-Counter Anxiety Medications

Currently, there are no over-the-counter medications approved to treat anxiety or panic. Nonetheless, some herbal supplements such as St. John’s wort, passionflower, kava kava, and valerian are marketed as treatments for anxiety. Although anxiety sufferers might feel tempted to try these natural remedies, it is important to remember that the supplement industry is not well-regulated. Because of the lack of regulations on these drugs, it is impossible to know what dose of herb you are receiving and where these herbs originated. Further, over-the-counter anxiety remedies can interact adversely with other drugs. If you are interested in trying one of these drugs, be sure to talk to your doctor first. Just because a medication is available without a prescription does not mean that it is safe.


Anxiety Medications

Do you take medication for your anxiety?

  • Yes, and it's working well.
  • Yes, but it's not working for me right now.
  • No, I never have but am interested.
  • No, I never have and would not consider it.
  • I do not need one right now.
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More Information on Drugs to Treat Anxiety

Alternatives to Medications for Anxiety

Although the various classes of anxiety drugs are generally effective in treating both short and long-term anxiety, many individuals are apprehensive to try medications. Not only are some of the medications addictive, but many have marked sedative effects. Additionally, SSRIs are not a viable option for some persons with co-occurring bipolar mood disorders. Likewise, SSRIs may cause a range of undesirable side effects, including weight gain, gastrointestinal problems, and sexual side effects.

Many studies have shown that non-medication based therapies can be just as effective as drugs when treating certain anxiety disorders, such as panic disorder and phobias. In particular, cognitive behavior therapy (CBT) can help persons with anxiety notice marked improvements in as little as 12 weeks of counseling. This approach to therapy challenges anxiety sufferers to look at their worries and change their perceptions of the subject of concern. Likewise, CBT often involves learning relaxation strategies, such as deep breathing exercises and meditation or prayer. CBT will ultimately look different for each individual and will draw on your specific symptoms, preferences, beliefs, and coping mechanisms. Because CBT requires work and practice to help you overcome your anxiety, some counselors may refer you for short-term medication management until you master some of the relaxation and self-soothing strategies you will learn in therapy. In many cases, the combination of short-term medication and counseling can help persons overcome their anxiety permanently, or reduce the level of distress so significantly that they no longer need professional treatment after 4-6 months.

Anxiety disorders can be debilitating and have complex causes, however, so do not feel discouraged if CBT or other types of talk therapy do not work for you right away. If you find that you anxiety medication is not working after six weeks, talk to you doctor about alternative treatments. Many anxiety sufferers try out several medications before they find the right treatment.

Note: This information is for informational purposes only and is not intended to be a substitute for medical advice. Always talk to your doctor before beginning or stopping any prescription or over-the-counter medication. If your anxiety is causing you to experience suicidal thoughts, call 911 or go to your local emergency room.

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Comments 4 comments

meloncauli profile image

meloncauli 4 years ago from UK

Good hub. Although often only sticking plaster solutions, medication has it's uses. For interim help whilst someone is addressing the issues and to relieve if only for a few months but as a long term solution these drugs should be avoided in my opinion.


MsBizPro profile image

MsBizPro 4 years ago from North Carolina Author

That is definitely a good point, particularly for persons who are experiencing situation anxiety issues. Also, it warrants mentioning that psychotherapy is highly effective in treating these conditions in some individuals. That said, for individuals with chronic and debilitating anxiety disorders, long-term medication is often necessary. There are several drugs available that can be taken safely for years. Of course, that needs to be a decision made between the patient and the doctor.


parwatisingari 4 years ago

Meloncauli,and MsBizPro are both right, medication should be the last option, and gentleman definitely not advertised for all and sundry it could lead to abuse.

Psychotherapy is definitely more useful.

This is my take both as a person who suffered from Anxiety attacks and now who treats them.


MsBizPro profile image

MsBizPro 4 years ago from North Carolina Author

@parwatisingari Like you, I both live with anxiety and treat it (actually, I will not start practicing as a therapist for another three months). Although my anxiety is not debilitating, it is chronic. (Indeed, I cannot remember a time in my life when I did not have generalized anxiety.) Thanks to cognitive-behavioral therapy, I have decreased much of my irrational worry and have the tools I need to cope with the anxiety. That said, psychotherapy alone is not enough for me. I require long-term medication--of the non-addictive variety. It has made a world of difference in my life. Most people in my life couldn't see it, but most days, I was miserable inside. With medication, that misery is virtually gone.

Until entering graduate school, like you, I believed that medication should only be a last resort. That said, in one of my courses, I expressed this opinion to a wise professor who has been a practicing psychotherapist for almost 50 years. He argued that treating medication as "last resort" in cases where patients are suffering or unstable is unethical because it is essentially withholding a viable and safe treatment. I agree with him. Psychotherapy can take time to work and I see little sense in letting an individual suffer unnecessarily. That said, I do think that primary care physicians often over-prescribe psychotropic drugs. Most anxiety sufferers (that is, those with subthreshold symptoms) do not need medication--but there are many persons who can benefit from a medication regimen. For most diagnosed mental health issues, a combination of psychotherapy and medication is the most effective treatment approach, so I don't see one as being better than the other, in any fundamental sense. They serve different needs.

This topic also brings to mind the question of why psychotropic medications are so controversial. I think part of it could be the perception that they are overprescribed, but I think stigma plays a role, too. Ultimately, I think there is still a widespread perception that if an individual tries hard enough, he or she can overcome their anxiety or depression. While this is true in some cases, many mental health issues are rooted in biology and brain chemistry and cannot be treated fully through psychotherapy alone.

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