Choosing the Proper Anti-Anxiety Medication
DSM-IV identifies several types of anxiety disorders. Generalized Anxiety Disorder (GAD) is characterized by physical complaints ranging from excessive sweating to upset stomach, and also the psychological markers of nervousness, worrying, and fear, symptoms that usually persist for most of the day, for weeks, months, or years at a time. Obsessive Compulsive Disorder (OCD) causes one to tirelessly fixate on intrusive thoughts for more than one hour a day, every day; the person may also adopt compulsions such as counting or systematically tapping one’s foot to ease the obsessions. Feelings of impending doom coupled with marked physical complaints, such as a rapid heartbeat, typifies Panic Disorder. Post Traumatic Stress Disorder triggers intense, disturbing flashbacks in a patient. Other anxiety disorders include Social Phobia, when one is generally nervous around people for most of the time, and specific phobias, such as a fear of spiders. With different symptoms, the anxiety disorders respond best to different types of medications.
Anxiolytics, or anti-anxiety medications, differ in their potency. The most powerful class of anxiolytics is the barbiturates. These medications are rarely prescribed for any of the aforementioned disorders. Rather, they are used primarily for patients with extreme and immediate concerns with anxiety. If barbiturates are prescribed, however, their quantity is usually limited to one to two pills at a time because of their toxicity; their potential for addiction and overdose is high.
In terms of strength, a few steps down from the barbiturates are the benzodiazepines, also known as sedatives or minor tranquilizers. The brands Valium and Xanax are examples of “benzos”. Benzodiazepines have a short half-life; therefore, even though they act quickly in the body, they only remain in effect for a few hours, about four to eight hours depending on the dose. These drugs are usually prescribed for patients who have acute, sporadic symptoms of anxiety. For instance, patients with panic disorder may be prescribed a benzodiazepine to take when a panic attack surfaces. Some patients may have a fear of flying, and therefore may take a benzodiazepine before takeoff; the effects of these pills will last throughout the flight, but will abate after a few hours.
Benzodiazepines are therefore not generally prescribed for long-term maintenance of anxiety for several reasons. For one, they can cause marked drowsiness in patients. More importantly, with long-term use, the body builds a tolerance, becomes addicted to these drugs, and can experience sharp withdrawal symptoms when the drug is halted. Of significant concern is the possibility of experiencing a seizure, a consequence of withdrawal. Benzodiazepines are also anti-seizure drugs by nature, and if one stops taking the drug suddenly, their seizure threshold is immediately lowered, increasing the possibility of this serious side effect. When taken minimally and periodically, benzos can be a safe and effective treatment for acute symptoms of anxiety.
The most common class of anxiolytic drugs is also used to treat clinical depression. Antidepressant is a slight misnomer, since this class of drugs has been found to be effective not only for depression, but also for anxiety. Antidepressants are broken up into three classes. The first two, Monamine oxidase inhibitors (MAOIs) and trycyclics are the older yet effective classes, but they have stronger side effects than the newest class of antidepressants, the Selective Serotonin Reuptake Inhibitors (SSRIs). The SSRIs are actually the most commonly prescribed antidepressant to date. What makes them so attractive is their low incidence of side effects, their inability to promote tolerance or addiction, their widespread effectiveness for several psychological disorders, and of course, their high success rate. Prozac became the first SSRI introduced to the American market in the 1980s. Since then, pharmaceutical companies have created SSRIs such as Zoloft, Paxil, and Celexa. SSRIs act by maximizing one’s natural level of Serotonin in the brain. Serotonin is a neurotransmitter that affects mood among other processes such as sleep. A drug such as Zoloft prevents the reabsorption of Serotonin into the firing cell; in turn, more serotonin is available to enter the receiving cell. A distinct feature of the SSRIs is that they take from two to six weeks to generally start having a desired effect.
SSRIs possess several features that make them the drug of choice for many anxiety disorders. Specifically, SSRIs are a safe and very effective treatment for those with GAD. Since GAD is generally a chronic condition, the SSRIs are favorable because they offer long-term use given that they have no addiction potential. Side effects are slight, such as dry mouth or drowsiness. SSRIs are also effective for PTSD, Panic Disorder, and OCD. In fact, Zoloft at higher doses has been found very effective in preventing OCD symptoms. Disorders such as OCD, Panic Disorder, and GAD seem to persist and pervade throughout one’s life. However, SSRIs are appealing for treating these disorders in that they can be used effectively for an indefinite duration with minimal consequences.
Two other classes of drugs exist that also combat anxiety. For one, there are the dopamine agonists, which increase dopamine in the brain. Wellbutrin is an example of a dopamine agonist. Like the SSRIs, drugs such as Wellbutrin take a few weeks to build up in the bloodstream before its therapeutic effects are felt and can also be used for long-term treatment maintenance. However, Wellbutrin differs in its side effects from the SSRIs. Whereas the SSRIs are known to produce mild drowsiness, Wellbutrin actually is a stimulant and therefore can cause excitability in some patients. A common complaint from those taking Wellbutrin is insomnia. Of course, not all side effects apply to all individuals. In addition, another class of anxiolytics includes Buspar, part of the azapirones. Buspar is a mild anxiolytic, taking a few weeks to reach therapeutic effectiveness, and has no addiction potential. Since it is relatively mild, it is suitable for long term use in those patients with mild to moderate anxiety.
There are several types of medications from which to choose for those faced with an anxiety disorder. Barbiturates are the most potent and rarely prescribed. Benzodiazepines, such as Valium or Xanax, are practical for short term, episodic relief of anxiety. They may be suitable for Panic Disorder or a specific phobia. Since they have addiction potential and serious side effects, they are usually not prescribed for long periods. Antidepressants by name, drugs such as MAOIs, trycyclics, and SSRIs, relieve both depression and anxiety. SSRIs are the most common antidepressants, and because of their few side effects and lack of addiction potential, they are preferable for long term maintenance of anxiety disorders such as GAD and OCD. Alternative classes of drugs remain, such as those which products include Wellbutrin and Buspar. When deciding to take a medication for an anxiety disorder, it is best to take into consideration the nature of the disorder, the desired length of treatment, and the side effects of potential medications.
