Anti-anxiety medications

Anxiety disorders and the medications used to treat them:

Resource

Anxiety Disorders Association of America
http://www.adaa.org

Type of medication:

Benzodiazepines

Medications and their commonly used brand names:

Anxiety disorders that benzodiazepines are prescribed for:

• Generalized anxiety disorder (GAD)
• Panic disorder
• Social phobia

How benzodiazepines work:

Benzodiazepines are central nervous system depressants, which means that they slow down the nervous system. They do not eliminate worry, but rather reduce the sensations associated with anxiety. These are fast-acting drugs that help most people feel better in the first week, and many feel the effects the first day of treatment.

Missed dose:

If you are taking this medicine daily, and you miss a dose, take it right away if you remember within the first hour or so of the missed dose. However, if you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Possible side effects:

The side effects listed here are most commonly encountered with at least one type of benzodiazepine, not necessarily all of them. However, since many of the effects of benzodiazepines are similar, these side affects may occur with any one of these medicines, although they may be more common with some than with others. Elderly people are more susceptible to all side effects of these drugs.

The most common side effects are:

• Drowsiness
• Impaired concentration
• Impaired memory of events taking place after the drug is taken

Note: In many patients, these side effects tend to diminish over time. Check with your doctor if these symptoms persist, or if any of the following symptoms occur:

• Anxiety
• Confusion
• Fast, pounding, or irregular heartbeat
• Exacerbation of respiratory problems
• Increased appetite and weight gain
• Clumsiness or unsteadiness
• Dizziness or lightheadedness
• Slurred speech

Signs of dependence
In some patients, benzodiazepine medications lose their effectiveness over time, requiring an increase in dose. Occasionally, patients may become dependent on the drug. Some signs of dependence are:

• A strong desire or need to continue taking the medicine
• A need to increase the dose to receive the effects of the medicine
• Withdrawal effects after the medicine has been stopped: irritability, nervousness, trouble sleeping, stomach cramps, trembling, or shaking

Patients who develop a dependence on benzodiazepines tend to exhibit dependence on other substances, such as alcohol or other drugs.

Signs of overdose
An overdose of this medication or combining it with another central nervous system depressant (e.g., alcohol) may lead to unconsciousness and possibly death. In the case of an overdose, get emergency medical help immediately.

Signs of an overdose include:

• Continuing confusion
• Continuing slurred speech
• Convulsions (seizures)
• Severe drowsiness or coma
• Severe weakness
• Shakiness
• Slow heartbeat
• Slow reflexes
• Staggering
• Trouble breathing

Lingering effects
After you stop taking this medication, your body may need time to adjust. During this time, if you notice any of the following, check with your doctor:

• Irritability
• Nervousness
• Trouble sleeping

Most patients do not experience these withdrawal symptoms if the medication is gradually tapered over time.

Resource

With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. For a complete review of these factors, see the USP Drug Information Database:
Benzodiazepines (Systemic)

Type of medication:

Beta-adrenergic blocking agents (beta blockers)

Medications and their commonly used brand names:

Anxiety disorders that beta blockers are prescribed for:

Social phobias, particularly performance anxiety. They may also be prescribed for panic disorder and post-traumatic stress disorder, particularly in combination with other medications.

How beta blockers work:

Beta blockers interfere with the adrenaline-like effects of the neurotransmitter norepinephrine, causing a reduction in the bodily symptoms associated with anxiety. They work quickly and are not habit forming.

Missed dose:

If you do miss a dose of this medicine, take it as soon as possible. However, if it is within eight hours of your next dose, skip the missed dose and go back to your regular dosing schedule.

Possible side effects:

The side effects listed here are most commonly encountered with at least one type of beta blocker, not necessarily all of them. However, since many of the effects of beta blockers are similar, these side affects may occur with any one of these medicines, although they may be more common with some than with others. Elderly people are more susceptible to all side effects of these drugs.

Beta blockers may produce a number of side effects that often require adjustment of the dose or change of medication. The may include:

• Sadness
• Fatigue
• Drowsiness
• Trouble sleeping
• Decreased blood pressure, leading to unusual weakness or lightheadedness
• Slow heart rate (less than 60 beats per minute)
• Decreased endurance and tolerance to running and exercise
• Decreased sexual ability
• Diarrhea
• Cold hands and feet

Check with your doctor if these symptoms persist or are severe. Also, check with your doctor immediately if any of the following occur:

• Depression
• Shortness of breath
• Heart rate less than 50 beats per minute
• Swelling of ankles, feet, and/or lower legs

Resource

With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. For a complete review of these factors, see the USP Drug Information Database:
Beta-adrenergic blocking agents (Systemic)

Type of medication:

Buspirone

Commonly used brand name:

BuSpar

Anxiety disorder that buspirone is prescribed for:

• Generalized anxiety disorder; may be especially useful for people with GAD and alcoholism.

How buspirone works:

Buspirone affects the activity of the brain chemical serotonin. Unlike other treatments for anxiety disorders, buspirone primarily reduces the sense of worry, rather than the bodily symptoms associated with anxiety. It can take several days to weeks to be fully effective, and it does not lead to dependency.

Missed dose:

If you miss a dose of buspirone, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Possible side effects:

Buspirone is most commonly associated with:

• Dizziness or lightheadedness
• Nausea
• Nervousness or restlessness
• Unusual excitement

These side effects are often mild and improve with time. Check with your doctor as soon as possible, however, if they are severe or persistent, or if any of the following side effects occur:

• Chest pain
• Confusion
• Fast or pounding heartbeat
• Fever
• Incoordination
• Depression
• Stiff or weak muscles
• Vomiting
• Numbness, tingling, pain, or weakness in hands or feet
• Sore throat
• Uncontrolled movements of the body

Signs of overdose
If you think you or someone else may have taken an overdose of buspirone, get emergency medical help immediately.

Signs of an overdose include:

• Severe dizziness or lightheadedness
• Severe drowsiness or loss of consciousness
• Stomach upset, including nausea or vomiting
• Very small pupils of the eyes

Resource

With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. For a complete review of these factors, see the USP Drug Information Database:
Buspirone (Systemic)

Type of medication:

Monoamine oxidase inhibitors (MAOIs)

Medications and their commonly used brand names:

Anxiety disorders that MAOIs are prescribed for:

• Panic disorder
• Social phobia
• Obsessive-compulsive disorder (rarely)

How MAOIs work:

These medications block the action of a chemical substance known as monoamine oxidase (MAO) in the nervous system. It can take 2-6 weeks until improvement occurs.

Proper use:

Avoid certain foods and beverages
When MAOIs are combined with foods or beverages that contain the amino acid tyramine, dangerous reactions can occur, including high blood pressure. Avoid the following:

• Cheese
• Alcoholic beverages, alcohol-free, and reduced-alcohol beer and wine
• Dried, smoked, or pickled meat, poultry, and fish
• Fermented sausage (bologna, pepperoni, salami, summer sausage) and other meat
• Sauerkraut
• Overripe fruit
• Canned figs
• Fava beans and broad bean pods
• Large amounts of caffeine-containing foods and beverages such as coffee, tea, cola, and chocolate

Allow time between certain medications
MAOIs can not be taken at the same time or within two weeks of an SSRI or TCA. In the case of Prozac, there should be a five-week break between taking Prozac and an MAOI.

Missed dose:

If you miss a dose of this medicine, take it as soon as possible. However, if it is within two hours of your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Possible side effects:

Due to the dietary and medication restrictions associated with MAOIs, they are rarely, if ever, considered first-line treatment, but may be useful if other, safer medications are ineffective. The side effects listed here are most commonly encountered with at least one type of MAOI, not necessarily all of them. However, since many of the effects of MAOIs are similar, these side affects may occur with any one of these medicines, although they may be more common with some than with others.

Stop taking this medicine and get emergency help immediately if any of the following side effects occur:

Symptoms of unusually high blood pressure (called hypertensive crisis):

• Severe chest pain
• Enlarged pupils
• Fast or slow heartbeat
• Severe headache
• Increased sensitivity of eyes to light
• Increased sweating (possibly with fever or cold, clammy skin)
• Nausea and vomiting
• Stiff or sore neck

Hypertensive crises occurs when MAOIs are mixed with certain medications and foods containing tyramine. Less severe and more common MAOI side effects include:

• Moderate weight gain
• Decreased sexual response
• Insomnia
• Drowsiness
• Dizziness

These side effects may improve with time. Check with your doctor as soon as possible, however, if they are severe or persistent, or if any of the following side effects occur:

• Severe dizziness or lightheadedness, especially when getting up from a lying or sitting position
• Diarrhea
• Fast or pounding heart
• Swelling of feet or lower legs
• Unusual excitement or nervousness

Resource

With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. For a complete review of these factors, see the USP Drug Information Database:
Antidepressants, monoamine oxidase (MAO) inhibitor (Systemic)

Type of medication:

Selective serotonin reuptake inhibitors (SSRIs)

Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there�s an increase or decrease in the dose. The medications of concern�mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)�are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants

Medications and their commonly used brand names:

Note: Venlafaxine (Effexor) is an SSRI-like medication that is also used to treat generalized anxiety disorder.

Anxiety disorders that SSRIs are prescribed for:

• Panic disorder
• Obsessive-compulsive disorder
• Social phobia
• Generalized anxiety disorder
• Post-traumatic stress disorder

How SSRIs work:

These medications increase the activity of serotonin, a brain chemical linked to changes in mood.

It may take 2-6 weeks for you to notice the effects of an SSRI, and they are not associated with dependency.

Missed dose:

Citalopram, sertraline: Check with your doctor on how to deal with a missed dose, since citalopram and sertraline may be given to different patients at different times of day.

Fluoxetine: If you miss a dose it is not necessary to make up the missed dose. Skip the missed dose and continue with your next scheduled dose. Do not double doses.

Fluvoxamine, venlafaxine: What to do when you miss a dose of fluvoxamine depends on your dosing schedule:

One time a day - take the missed dose as soon as possible if you remember the same day and go back to your regular dosing schedule. Do not double doses.

Two times a day - skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Paroxetine: If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Possible side effects:

The side effects listed here have been reported for at least one of the SSRIs, not necessarily all of them. However, since many of the effects of SSRIs are similar, it is possible that these side affects may occur with any one of these medicines, although they may be more common with some than with others.

SSRIs are commonly associated with:

• Decreased sexual drive or ability
• Drowsiness
• Restlessness, agitation, anxiety, or nervousness
• Skin rash, hives, or itching
• Decreased appetite or weight loss
• Nausea, diarrhea, or constipation
• Insomnia

Other side effects that are less common include:

• Blurred vision
• Changes in, or pain during urinating
• Chills or fever
• Confusion
• Dizziness
• Dryness of mouth
• Fast or irregular heartbeat
• Headache
• Increased sweating
• Joint or muscle pain
• Lack of emotion
• Loss of memory
• Menstrual changes
• Muscle pain or weakness
• Stomach or abdominal cramps, gas, or pain
• Trouble breathing
• Unusual tiredness or weakness

These side effects may be mild and improve with time, but check with your doctor if they are severe or persistent.

After you stop taking an SSRI, your body may need time to adjust. During this time, check with your doctor if you notice any of the following side effects:

• Agitation
• Anxiety
• Confusion
• Dizziness or lightheadedness
• Feeling of constant movement of self or surroundings
• Headache
• Increased sweating
• Nausea or vomiting
• Trembling or shaking
• Trouble sleeping
• Unusual tiredness or weakness

Resource:

With every medication, there are important precautions to consider. These include allergies, interactions with other drugs and medical conditions, and safety during pregnancy, lactation, and other stages of life. For a complete review of these factors, see the USP Drug Information Database:

Citalopram

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

Venlafaxine

Type of medication:

Tricyclic antidepressants (TCAs)

Medications and their commonly used brand names:

Anxiety disorders that TCAs are prescribed for:

• Panic disorder
• Obsessive-compulsive disorder

How TCAs work:

These medications affect the brain chemicals serotonin and norepinephrine. It usually takes 2-6 weeks to see improvement.

Missed dose:

What to do if you miss a dose depends on your regular dosing schedule:

• One dose a day at bedtime�do not take the missed dose in the morning since it may cause disturbing side effects during waking hours. Instead, check with your doctor.
• More than one dose a day�take the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose, and go back to your regular dosing schedule. Do not double doses.

Possible side effects:

The side effects listed here have been reported for at least one of the TCAs, not necessarily all of them. However, since many of the effects of TCAs are similar, it is possible that these side affects may occur with any one of these medicines, although they may be more common with some than with others.

Check with your doctor if any of the following side effects occur frequently and/or become bothersome:

TCAs are most commonly associated with:

• Blurred vision
• Constipation
• Difficulty urinating
• Dizziness
• Drowsiness
• Dry mouth
• Nervousness or restlessness

Other side effects that are less common include:

• Decreased sexual ability
• Difficulty speaking or swallowing
• Skin sensitivity to sunlight
• Shuffling walk
• Shakiness or trembling
• Slowed movements
• Stiffness of arms and legs
• Weight gain

These side effects are often mild and improve with time. Check with your doctor as soon as possible, however, if they are severe or persistent, or if any of the following occur:

• Confusion or delirium (especially common in elderly people)
• Eye pain
• Fainting or near-fainting
• Fast or irregular heartbeat
• Hallucinations
• Loss of balance control

Patients with heart rhythm problems or taking cardiac medications may be at increased health risk when taking TCAs and should discuss this issue with their doctors.

To lessen stomach upset, take this medicine with food, unless your doctor has told you to take it on an empty stomach.