Anxiety is a reaction to stress characterized by feelings of uneasiness, fear, worry and apprehension. Anxiety manifests physically as heart palpitations, fatigue, chest pain, nausea and shortness of breath. Symptoms of anxiety range from mild to severe, and several treatment options are available. Therapy and relaxation techniques are helpful in reducing anxiety in individuals with mild to moderate anxiety, but medication may be necessary in individuals with severe anxiety. Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines and tricyclic antidepressants are effective in reducing anxiety and improving quality of life.
Benzodiazepines
Benzodiazepines work by increasing the effectiveness of GABA, a neurotransmitter in the brain, but should be prescribed only for short periods of time because of their addiction potential. Alprazolam, clonazepam, lorazepam and diazepam are fast-acting drugs that are very effective in treating the physical symptoms of anxiety and panic. Side effects include blurred vision, depression, drowsiness, confusion and dizziness. Tolerance can develop within two weeks and larger doses may be required to achieve the same effect as the initial dose.
These drugs are often abused and should never be combined with alcohol or opiates because of increased respiratory depression and potential for overdose. When withdrawing from benzodiazepines, the patient should be monitored closely by a doctor and a slow taper should be prescribed. Benzodiazepine withdrawal can cause seizures, delirium and death if not done correctly.
Selective Serotonin Reuptake Inhibitors
SSRIs inhibit the reuptake of the neurotransmitter serotonin by nerve cells in the brain, causing more serotonin to be available. Increased serotonin is associated with an increase in mood and a decrease in anxiety. Unlike benzodiazepines, SSRIs are not addictive and with a slow taper do not produce any withdrawal effects. SSRIs have been known to cause some agitation and anxiety when first initiated, but this side effect usually go away within two to four weeks. Sexual problems and a decreased libido are common side effects. Other side effects include nausea, weight gain, insomnia and drowsiness. Examples in this class of medication include fluoxetine, escitalopram oxalate, citalopram, paroxetine and sertraline.
Tricyclic Antidepressents
Tricyclic antidepressants block the reuptake of the neurotransmitters serotonin, norepinephrine and dopamine, which can decrease anxiety and improve mood. Tricyclics can cause significant side effects including dry mouth, constipation, dizziness, drowsiness, confusion, increased heart rate, low blood pressure upon standing, urinary retention and weight gain. Medications in this class include amitriptyline, amoxapine, imipramine and desipramine.
