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For those suffering from anxiety, medication can prove extremely helpful. However, anxiety disorders are complex problems that cannot be solved simply. Medication needs to be used as part of a holistic and systemic approach to healing.

For those suffering from anxiety, medication can prove extremely helpful. However, anxiety disorders are complex problems that cannot be solved simply. Many people seek a fast and easy cure through medication but there is no “magic pill”. For some anxious people, medication can prove beneficial but rarely in isolation. It needs to be used as part of a holistic and systemic approach to healing which looks at changing dysfunctional thoughts and beliefs and building resources to enable people to feel able to face their fears.

The essence of successful anxiety treatment is rooted in the individual and their beliefs about their own abilities to confront difficult situations and develop a sense of mastery and control – an internal locus of control, if you will. All professional interventions, whether individual or group therapies, medications, behavioral or psychosocial approaches have one purpose: to establish and secure the sense that belief that you can have control over yourself and your body.

Medications need to be taken within this context. They can be beneficial in the short term and as an adjunct to psychological therapies but in themselves they are not the solution, even when very effective at temporarily removing discomfort. The dominant medical model in society today sadly promotes the idea that medication is the solution and people often find themselves putting all their faith in pharmacotherapy. This reinforces an external rather than internal locus of control.

Different medications can help manage different disorders in different ways. In the case of panic attacks, medications can serve to enhance motivation and help speed up progress. For pharmacotherapy to be effective, it must target at least one of the two stages of panic: anticipatory anxiety and the symptoms of the panic attack itself. For those experiencing obsessive-compulsive disorder (OCD), medications can have an impact upon frequency and intensity of worries and the associated distress. Medication cannot stop obsessions from occurring but if it is able to dampen the worries slightly, then self-help skills can be applied. For those with simple phobias, pharmacotherapy can assist with some of the physical sensations associated with entering the fearful situation and reduce anticipatory anxiety. Likewise, with social anxiety, tensions allied with entering the feared situation (such as a racing heart or excessive perspiration) can be reduced, alongside reducing inhibitions which can impact upon shyness.

It is important to remember that medications are not compulsory and not necessary to treat an anxiety disorder. However, if you do decide to use a medication, it is important to give it time to evaluate its benefit as often it can take time to achieve therapeutic effect. Often in the early stages there are side effects which can, on occasion, worsen the very symptoms they are designed to ameliorate. Once treatment has begun, it must never be stopped abruptly but reduced gradually in order to avoid possible side effects.

What kind of medications are offered for anxiety disorders?

  • Antidepressants. Current good practice and research has led to selective serotonin reuptake inhibitors (SSRIs) being the first treatment choice, although they often bring side effects which are among the very issues the person is experiencing. These medications work by preventing the reuptake of the neurotransmitter serotonin by certain brain nerve cells, which leads to more serotonin being available. This leads to enhanced neurotransmission (the sending of nerve impulses) which in turn improves mood. Some SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, and sertraline.

These SSRIs may be used for the following conditions:

  • Fluoxetine - OCD, depression, panic, social anxiety, PTSD, generalized anxiety
  • Fluvoxamine - OCD, social anxiety, panic, PTSD, and generalized anxiety

  • Sertraline - OCD, social anxiety, panic, PTSD, and generalized anxiety

  • Paroxetine OCD, social anxiety, panic, PTSD, and generalized anxiety

  • Escitalopram oxalate - OCD, social anxiety, panic, PTSD, and generalized anxiety

  • Citalopram - OCD, panic, PTSD, generalized anxiety

  • If SSRI's don't work or are unsuitable, people are sometimes offered a tricyclic antidepressant, although they are often avoided owing to greater associated side effects. These work by inhibiting the reabsorption of both serotonin and norepinephrine. Some tricyclic antidepressants include amitriptyline, imipramine, and nortriptyline.

    • Imipramine - panic, PTSD and generalized anxiety

    • Desipramine - panic, PTSD and generalized anxiety

    • Nortriptyline - panic, PTSD and generalized anxiety

    • Amitriptyline - panic, PTSD and generalized anxiety

    • Doxepin - panic

    • Clomipramine – panic and OCD

  • SNRIs (serotonin-norepinephrine reuptake inhibitors) work by increasing serotonin and norepinephrine levels through the mechanism of preventing reuptake. Some SNRIs include venlafaxine and duloxetine. ​

    • Venlafaxine - OCD, social anxiety, panic and generalized anxiety

    • Venlafaxine XR - OCD, social anxiety, panic and generalized anxiety

    • Duloxetine - OCD, social anxiety, panic and generalized anxiety

  • Serotonin Enhancers such as Buspirone. As this has a mild sedating effect it has the potential to be habit-forming.
  • Other anti-depressants such as Trazodone may be used for generalized anxiety
  • Monoamine Oxidase inhibitors (MAOIs). These work by reducing the amount of monoamine oxidase, the substance that breaks down the neurotransmitters in the brain. They are not usually prescribed for anxiety, owing to serious side effects when combined with certain foods and medicines.
  • Phenelzine - panic, social anxiety, OCD, generalized anxiety and PTSD

  • Tranylcypromine - panic, social anxiety, OCD, generalized anxiety and PTSD

  • Anticonvulsant medication. In some cases, anti-convulsants may be prescribed for anxiety. These are normally used to treat seizure disorders such as epilepsy but are also licensed to treat anxiety.
    • Sodium valproate - panic

    • Pregabalin - generalized anxiety disorder

    • Gabapentin - social anxiety and generalized anxiety

  • Beta-blockers. Beta-blockers are sometimes prescribed to treat the physical symptoms of anxiety, especially the autonomic nervous system ones such as tremors or palpitations, for example.
  • Propranolol - social anxiety

  • Atenolol - social anxiety

  • Benzodiazepine tranquillisers. On occasions, very severe anxiety that is causing significant disability may warrant the use of a benzodiazepine tranquilliser in a low dose for a very short-term period only. These drugs unfortunately have serious side effects and are extremely addictive as well as being dangerous therefore they are generally avoided in modern prescribing. They work by promoting relaxation, alleviating muscular tension, and managing other physical symptoms of anxiety. Some well known tranquillizers include alprazolam, clonazepam, diazepam, lorazepam.

    • Alprazolam - OCD, social anxiety, panic, phobias and generalized anxiety

    • Alonazepam - social anxiety, panic, phobias and generalized anxiety

    • Diazepam – panic, phobias and generalized anxiety

    • Lorazepam - panic, phobias and generalized anxiety

    • Oxazepam – phobias and generalized anxiety

    • Chlordiazepoxide – phobias and generalized anxiety

Unfortunately a substantial number of patients are resistant to SSRIs or other recommended first-line of treatments or may still experience residual symptoms. On occasion, therefore, antipsychotics may be prescribed in very small doses for short periods for treatment resistant anxiety but they are typically regarded as a last resort. Atypical antipsychotics such as quetiapine, olanzapine, and risperidone have been found to help some people with anxiety symptoms although fatigue and sedation are commonly experienced as side effects.

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