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Anticonvulsants are sometimes prescribed to those suffering from anxiety who do not respond to other treatments. While data is limited as to success and they have many side effects, they may be of benefit when all other options fail.

Anxiety can be an unbearable condition for those who suffer with it. People often reach a stage where they will try anything not to be in that constant state of fear, dread and anticipation. The physical side effects are exhausting and the intrusive thoughts and constant rumination all-consuming. In the long term, psychotherapy and other holistic approaches are the only way people can rid themselves of anxiety for good, but what do people do in the short-term to give them some much-needed respite?

In such cases medication can prove extremely helpful for people. They can be beneficial in the short term and as an adjunct to psychological therapies but in themselves they are not the solution in the long-run, even when very effective at temporarily removing discomfort. Anxiety disorders are complex problems that cannot be solved easily and medications need to be taken within this context. Medication works at a superficial level by dampening down the physiological (or in some cases, depending on the medication, cognitive) symptoms of anxiety, but they don’t deal with the underlying emotional issue which needs to be otherwise addressed.

The current gold standard for the treatment anxiety and depression are selective serotonin reuptake inhibitors, despite generally only being about 50 percent successful and having significant side effects. Therefore, there has been a continual search for additional medications to add to the armory in the battle with anxiety. Many medications are discovered by accident when they are given for one thing and seem to also relieve another and many medications used in anxiety have been discovered this way.

Depression and anxiety are common in epilepsy sufferers, and it was noted that the medication used to relieve seizures could either relieve or worsen these symptoms. Anticonvulsants then began to be used as mood stabilizers following their introduction as anti-epileptics, and in turn, their use in anxiety was also considered.

The rationale for using anticonvulsant drugs for anxiety is to do with the main cerebral structures involved in the fear process; namely the amygdala and the hippocampus. The amygdala is involved in the process of experiencing fear and avoidance behaviors, and the hippocampus in the cognitive aspects of fear and anxiety and the re-experiencing of fear emotions. Reducing output from the neurons in these regions is therefore thought to have an impact upon anxiety symptoms; not least as anticonvulsant medications reduce seizure activity by reducing the outbursts from epileptic neurons. In short, anticonvulsants calm brain activity and this can reduce anxiety.

Gamma-aminobutyric acid or GABA (along with serotonin and noradrenalin), is one of most important neurotransmitters that appear to be involved in the development of anxiety. GABA is an amino acid which is naturally occurring in humans in the brain and acts as a neurotransmitter, enabling brain cells to communicate. It is an inhibitory transmitter and its key role in the body is to reduce neuronal activity both in the brain and central nervous system; this leads to increased relaxation, a reduction in stress levels, a more stable mood, pain reduction, and improved sleep. Medications that that stimulate GABA receptors in particular, such as benzodiazepines, barbiturates (sleeping pills), anesthesia, and anti-depressants, all have an impact upon inhibiting neural activity which in turn regulates and balances the brain. This in turn appears to have an impact upon fear arousal mechanisms, such as anxiety, panic, and acute stress responses.

Valproic Acid (Depakote)

Valproic acid is an anti-epileptic that is also used in panic attack treatment, although often in conjunction with other medication. This medication can cause bruising or bleeding if aspirin is taken at the same time and can cause problems with the liver and so three-monthly liver function tests (and platelet counts) are carried out when on this medication. It can make people excessively sleepy if taken with alcohol and certain medications. It can cause stomach complaints such as nausea and vomiting or diarrhea, and headaches and a confused state can also occur on occasion, as can drowsiness.

Gabapentin (Neurontin)

Gabapentin is believed to be useful in the treatment of social anxiety and generalized anxiety disorder. It may work better by adding it to a primary medication that is not completely effective. Dizziness, dry mouth, drowsiness, nausea, flatulence, and decreased libido are all possible side effects.

Pregabalin (Lyrica)

This has been used in the treatment of panic disorder, obsessive compulsive disorder, generalized anxiety disorder and also social phobia. Dizziness, drowsiness, and swelling due to fluid retention edema are all possible side effects.

Topiramate

This drug appears to have some success in treating PTSD and social phobia. It causes many of the same side effects as other anticonvulsants but can also cause numbness or tingling in the extremities and loss of appetite.

Lacosamide

This is a new drug which a recent multi-center study found to have positive effects on anxiety disorders; and importantly, unlike other anticonvulsants, did not cause a deterioration in symptoms where there was no significant improvement.

The rationale for using anticonvulsants to treat anxiety disorders is underpinned by neurobiological theory which indicates that they may be a possible option for short-term treatment in those who do not respond to other treatments or who cannot take certain medications owing to contraindications, for example. However, the data is scanty, and the only fairly robust evidence seems to be for pregabalin in patients with GAD; however, there have also been concerns about the potential for abuse as well as withdrawal symptoms if stopped abruptly.

Paradoxically, anticonvulsants can reportedly also cause anxiety and depression in those taking them, as much as they can alleviate it, therefore it may be a bit of a lottery whether it helps or hinders. However for those for whom all other avenues have explored and come to a dead end, this may be one of the few options left to pursue, and it may just be the one that works for them.

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