Anxiety, an uncomfortable state that every person experiences occasionally, can be so severe or so prolonged that medication is used to help alleviate it. According to the "Diagnostic and Statistical Manual of Mental Disorders," anxiety disorders include generalized anxiety disorder, panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder. There are several commonly used classes of anxiolytics--a word that literally means "medications that melt anxiety." Treatment of different conditions varies somewhat, but some medications are useful for several types of anxiety.
Benzodiazepines
Benzodiazepines, widely prescribed medications for the treatment of acute and chronic anxiety, include alprazolam, diazepam and clonazepam. They can be taken on a regular schedule, several times a day, or used occasionally, as needed. All benzodiazepines can be addictive, can cause confusion and memory impairment and shouldn't be used during pregnancy.
Alprazolam, a very potent anxiolytic with a short half-life, is especially useful for treatment of panic attacks, including those due to performance anxiety and fear of flying. The medication should be taken about half an hour before the stressful event. Alprazolam is considered the most addictive of the benzodiazepines.
Diazepam, with its longer half-life, can be used for chronic anxiety, though it's not the drug of choice for this condition in 2010. Side effects include depression.
Clonazepam is used for treatment of panic attacks, post-traumatic stress disorder and generalized anxiety.
Serotonin Specific Reuptake Inhibitors
Serotonin specific reuptake inhibitors, or SSRIs, are used on a long-term basis and can take several weeks to achieve their full effect. Medications from this class include sertraline, fluoxetine and paroxetine. They're used to treat generalized anxiety disorder and panic disorder, a condition in which there are recurrent panic attacks with no clear precipitant. They can exacerbate anxiety initially and are therefore started at low doses and increased very gradually. Benzodiazepines are often used at the beginning of treatment, until the anxiolytic effect of SSRIs takes hold. Fluvoxamine, another SSRI, has an anti-obsessional effect and is used to treat obsessive-compulsive disorder, or OCD.
Antihistamines
Antihistamines such as hydroxyzine are often used to treat nonspecific anxiety that doesn't fall into any particular category. They're useful in patients who have a history of addiction, since unlike benzodiazepines, they're not addictive. They can cause sedation and should be used with caution before driving or operating heavy machinery.
Beta-Blockers
Beta-blockers such as propranolol, a medication usually used to treat high blood pressure, can be used in the treatment of performance anxiety. Propranolol should be taken about half an hour before the performance. Beta-blockers block the outward manifestations of anxiety--tremor, shaky voice and rapid heart rate. They don't relieve the internal feeling of anxiety. Their advantages include their lack of a sedating effect, allowing the performer to reach his full potential during the performance. Propranolol can exacerbate asthma and certain cardiac conditions.
References
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz, editors; 2009
- "Harrison's Principles of Internal Medicine"; Anthony Fauci et al.; 2008
- "Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition"; American Psychiatric Association; 2000
