How is Anxiety Treated in Conventional Medicine?

Generally, anxiety disorders are treated with medications, specific types of psychotherapy, or both. Treatment choices depend on the symptoms and the preference of the doctor and patient.

Psychotherapy: Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what causes an anxiety disorder and how to deal with its symptoms.

Cognitive-Behavior Therapy (CBT): Many therapists use a combination of cognitive and behavior therapies, this is often referred to as CBT. Cognitive-behavioral therapy is based on the scientific fact that thoughts cause feelings and behaviors, not external things, like people, situations, and events. The benefit of this fact is that an individual can change the way they think to feel and act better even if the situation causing the problem does not change.

Relaxation Techniques: Relaxation Techniques help individuals develop the ability to more effectively cope with the stresses that contribute to anxiety, as well as with some of the physical symptoms of anxiety. The techniques taught include breathing re-training and exercise.

Benzodiazepines: Benzodiazepines are fast-acting sedatives that typically relieve anxiety symptoms within 30 minutes to one hour. The rapid relief when using benzodiazepines makes them very effective when taken during a panic attack or another overwhelming anxiety episode.

Unfortunately, benzodiazepines can be addictive. If taken regularly for more than a couple of weeks, physical and psychological addiction is likely to occur. Benzodiazepine may create tolerance, with larger doses needed to achieve the same effect, and serious withdrawal symptoms can occur when going off the medication, including increased anxiety, depression, and insomnia. Some benzodiazepines, including diazepam (Valium®) have a longer half-life in the body, meaning they stay in the body longer. The addictive potential is why benzodiazepines are usually recommended only for short-term. To minimize the withdrawal reaction, it is important to slowly taper off these medications.

Some examples of benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (Librium®), clonazepam (Klonopin®), clorazepate (Tranxene®), lorazepam (Ativan), oxazepam (Serax), diazepam (Valium). Clonazepam (Klonopin®) is commonly used for social phobia and GAD, lorazepam (Ativan®) is used for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and generalized anxiety disorder (GAD).

Most common side effects include drowsiness, impaired coordination, fatigue, confusion and disorientation, dizziness, decreased concentration, short-term memory problems, dry mouth, blurred vision, and irregular heart beat.

Azapirones: Azapirones were developed more recently than benzodiazepines, and are anti-anxiety drugs prescribed for GAD and obsessive compulsive disorder (OCD). Compared to benzodiazepines, the azapirones are slow acting, taking from two to four weeks to provide anxiety symptom relief. Advantages of these drugs over benzodiazepines include less sedation and effects on coordination, and less memory impairment. Withdrawal effects with azapirones are minimal compared to benzodiazepines. Buspirone (Buspar®) is the only azapirone approved for medical use.

Side effects may include nausea, headaches, dizziness, drowsiness, upset stomach, constipation, diarrhea, and dry mouth. Azapirones are not to be taken with monoamine oxidase inhibitors (MAOIs, a type of antidepressant) due to the increase risk of life-threatening high blood pressure.

Selective serotonin reuptake inhibitors (SSRIs): SSRIs are antidepressants that alter the levels of the neurotransmitter serotonin in the brain. SSRIs have been used to treat panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). They are often prescribed because they have less severe side effects than the older antidepressants.

Some SSRIs used in anxiety disorders include fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) which are commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. SSRIs generally are started at low doses and gradually increased until they have a beneficial effect.

Tricyclic antidepressants (TCAs): TCAs are older antidepressants that may be prescribed for panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). Tricyclics can also be prescribed for anxiety disorders co-occurring with depression. The tricyclics typically take around two weeks to provide symptom relief.

Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.

Monoamine oxidase inhibitors (MAOIs): MAOIs are the oldest class of antidepressant medications.

The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia.

There are several newer atypical antidepressants which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephrine and dopamine.

Venlafaxine (Effexor®), an atypical antidepressant, is used to treat GAD.

Antidepressants take up to four to six weeks to begin relieving symptoms, so they aren't helpful if first taken during a panic attack.

Antidepressants are often prescribed instead of benzodiazepines because the risk for dependency and the abuse is less.

Antidepressant can cause loss of sexual desire, nausea, insomnia, sweating, nervousness, dizziness, weight gain or weight loss, dry mouth, constipation, and blurred vision. MAOIs also have severe interactions with certain foods, drinks, and medications. When an individual takes an MAOI, he or she must carefully monitor what is eaten and what drugs are taken. Items that are restricted include many cheeses, chocolate, wine, and beer.

Beta blockers are type of drug used to treat high blood pressure and heart problems. In anxiety, beta blockers can help control physical symptoms such as nervousness, rapid heart rate, trembling voice, sweating, dizziness, and shaky hands. Beta blockers are prescribed off label for anxiety.

Because they don't affect the emotional symptoms of anxiety such as worry, beta blockers are most helpful for phobias, particularly social phobia and performance anxiety (such as a speech or being in front of an audience).

Examples of beta blockers include propranolol (Inderal®), metoprolol (Lopressor®) and atenolol (Tenormin®).

Side effects include light-headedness, sleepiness, short-term memory loss, unusually slow pulse, fatigue, insomnia, diarrhea, cold hands and feet, and sexual side effects.

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