The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American Psychiatric Association defines a number of anxiety disorders, including Acute Stress Disorder, Panic Disorder, Generalized Anxiety Disorder (GAD), Agoraphobia, Social Anxiety Disorder (Social Phobia), Specific Phobia, Post-Traumatic Stress Disorder (PTSD) and Obsessive-Compulsive Disorder (OCD). The physical and emotional symptoms of these disorders, such as heart palpitations, trembling, hyperventilation, fear, obsession and inattention, may be treated effectively with anti-anxiety pills (sometimes called anxiolytics). Because some medications are more effective for some anxiety disorders, it is important to work with a qualified, licensed health care professional to find the medication most targeted to your symptoms.
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Selective serotonin reuptake inhibitors (SSRIs) are typically used as the first course of treatment in anxiety because they can be used safely long-term and have a relatively low risk of serious side effects. SSRIs effective in treating OCD, Panic Disorder and phobias include fluoxetine (Prozac), sertraline (Zoloft)–also approved for PTSD, paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). The serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) is commonly used to treat GAD.
Like SSRIs, tricyclics are antidepressants but are less frequently prescribed because of their risk of more serious side effects. Tricyclics effective for panic include nortriptyline (Aventyl or Pamelor), amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan or Adapin), imipramine (Tofranil) and clomipramine (Anafranil). Imipramine has also shown some efficacy in treating GAD, while clomipramine and venlafaxine (Effexor) may effectively treat OCD.
Like tricyclics, monoamine oxidase inhibitors (MAOIs) are antidepressants that–although effective–come with heightened risks of side effects, such as cardiac arrhythmias, tremors and, rarely, seizures. MAOIs that are particularly suited to treating panic disorders include phenelzine (Nardil), tranylcypromine (Parnate) and isocarboxazid (Marplan). Phenelzine may also be effective in treating Social Phobia.
According to the National Institute of Mental Health, benzodiazepines bring about the onset of symptom relief faster than SSRIs. However, long-term use may result in impaired thinking, confusion, muscle weakness, tolerance, dependency and withdrawal risk. Benzodiazepines that are commonly prescribed for panic, generalized anxiety and phobia symptoms include diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), oxazepam (Serax) and chlordiazepoxide (Librium).
Once primarily used to control seizures among epileptic patients, anticonvulsants have since demonstrated efficacy in reducing symptoms of anxiety as well. Valproate is an anticonvulsant commonly prescribed to treat panic.
According to the results of a critical review published in June of 2007 in the "Journal of Clinical Psychopharmacology," pregabalin (Lyrica) may be most effective for social phobia and GAD symptoms, lamotrigine (Lamictal) is best suited for PTSD and gabapentin (Neurontin) has been effective in treating social anxiety. The study also found that gabapentin (Neurontin) has demonstrated mixed efficacy in the treatment of panic.
Buspirone (BuSpar) is an anxiolytic that is thought to act on serotonin and dopamine levels in the brain, thus altering mood and anxiety. According to the National Alliance on Mental Illness, BuSpar appears to be most effective among patients with mild to moderate generalized anxiety symptoms and may be less effective among patients with Panic Disorder, severe anxiety or OCD.
REFERENCES & RESOURCES
- Center for Substance Abuse Research, University of Maryland: Benzodiazepines
- Journal of Clinical Psychopharmacology; The Role of Anticonvulsant Drugs in Anxiety Disorders: a Critical Review of the Evidence; Marco Mula, M.D., et. al.; June 2007
- National Alliance on Mental Illness: BuSpar
- Healthy Place: Common Medications for Anxiety Disorders