Traditionally, anxiety disorders have been perceived as emotional problems that require psychological treatment. In the past two decades, a lot of progress has been made in the development of potent antianxiety medications. However, while medication can effectively relieve anxiety symptoms, it doesn’t necessarily change a person’s thought and behavioral pattern, nor does it address challenges of the present or past, which may have caused the onset of the anxiety. Therefore, psychotherapy and cognitive behavioral therapy remain important cornerstones in the treatment of anxiety disorders.
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Since there are several different classes of commonly used medications to treat anxiety disorders, it is important to discuss with your doctor the benefits, side effects and potential risks of each of them.
Selective serotonin reuptake inhibitors (SSRIs) are a class of antianxiety medication that is the first choice for pharmaceutical treatment of anxiety disorders for most doctors. This class of medication includes sertraline (Zoloft), citalopram (Celexa) and fluoxetine (Prozac). SSRIs block the reabsorption of the neurotransmitter serotonin, increasing serotonin levels in the brain leading to an improvement in the patient’s mood and feelings of well-being.
A second class of antidepressants, the serotonin norepinephrine reuptake inhibitors (SNRIs), is also frequently used in cases where the SSRIs were not effective. Examples of SNRIs are desvenlafaxine (Pristiq) and duloxetine (Cymbalta). Similar to SSRIs, these drugs inhibit the reuptake of the neurotransmitter serotonin in the brain, but also inhibit the reuptake of the neurotransmitter norepinephrine.
The most common side effects for these antidepressants are nausea, dry mouth, nervousness, dizziness and reduced sex drive. Most side effects disappear during the first month of treatment. For both types of antidepressants it can take up to several weeks for them to become fully effective.
Benzodiazepines increase the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain and the peripheral nervous system. GABA inhibits the signaling between neurons and thus has a calming effect on the nervous system. While benzodiazepines used to be first-line therapies for anxiety disorders, due to their side effects and addictive potential, they are now mainly used to treat acute forms of anxiety. Treatment with benzodiazepines, such as alprazolam (Niravam, Xanax), diazepam (Valium) and lorazepam (Ativan), is not recommended for people who have been dealing with drug or alcohol abuse.
Frequently, doctors prescribe antiseizure medications as alternatives to benzodiazepines. Drugs like gabapentin (Neurontin) and pregabalin (Lyrica) work quickly and effectively without as many side-effects as benzodiazepines. Some of the problems associated with antiseizure drugs are withdrawal symptoms and severe drowsiness.
For all antianxiety medications, close supervision by a medical doctor is important, given the potential for serious side effects.
There are also many non-drug treatment options for anxiety called psychological therapies.
Psychotherapy, also known as “talk therapy,” helps patients uncover and resolve the potential root causes of their anxiety, such as traumas during childhood, major illness, the death of a loved one, loss of a job or divorce. During the therapy the patient talks about current and past experiences with the goal being to understand and cope better with their anxiety and to regain a sense of control. This form of therapy may take months to become effective and can last several years.
Cognitive-behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is considered the first-line of treatment for generalized anxiety disorder. It usually takes only a few months to achieve significant improvements. The goal of CBT is for the patient to learn specific skills on how to change anxiety-triggering thought patterns and behavior. In contrast to psychotherapy, CBT doesn’t address the issues of the past, but focuses entirely on the current problems by teaching practical, confidence-building strategies to gradually return to the activities a patient avoided due to anxiety.
There are many effective treatment options for anxiety. While antianxiety medication taken correctly can help alleviate anxiety symptoms, it is widely agreed that for long-term results patients should also undergo non-drug therapies, such as psychotherapy and cognitive behavioral therapy.