A variety of medications have been found helpful in treating anxiety disorders, but none of them work for every person. While selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered the first-line treatment for many anxiety disorders,2 each individual needs to work with his or her physician to identify the best approach.
What are You Using Medication for?
An important issue you should discuss is whether you’re using medication for long-term change or short-term relief. Some medications aren’t intended to be used for more than several weeks. Other medications must be taken for a long time to maintain their results.4 And when some anti-anxiety medications are discontinued, problems with anxiety often return. Some medications cannot be stopped abruptly and must be tapered off to prevent severe withdrawal symptoms. In some cases, such as with the long-term use of benzodiazepines, anxiety and other problems may actually worsen after the medication is discontinued.5 So, it’s important to discuss:
- How long a medication can be safely used
- When and if you are expected to stop taking it
- What will happen when you stop taking the medication
Another important consideration is the effect of medication on therapy. Some medications have been shown to increase or decrease the effectiveness of various therapeutic approaches, like Cognitive Behavioral Therapy.1 The right combination of medication and treatment can also vary depending on what phase of treatment you’re in. If you are in therapy, or plan to seek therapy, be sure to discuss all of this with your doctor (and/or therapist) to ensure you achieve the most beneficial outcome.
Medication Side Effects
No discussion of medication with your doctor is complete unless you address side effects. Side effects are unintended adverse consequences associated with taking medication. In the case of anti-anxiety medications, side effects can range from an upset stomach to confusion, and from muscle weakness to sexual dysfunction. There are logical reasons for side effects. First, keep in mind that brain functions rely on neurotransmitters, chemicals that allow neurons to communicate with each other. The brain and the rest of the body uses a limited number of neurotransmitters in multiple neurological processes. Just as you can use baking soda for a variety of purposes (for leavening, as a cleaning agent or toothpaste, to deodorize your refrigerator, and so on), the human body uses most neurotransmitters in a variety of different systems.
Therefore, medications designed to influence a neurotransmitter’s activity in one set of brain circuits may also have a side effect of influencing completely unrelated processes. Consider serotonin, a neurotransmitter often thought to be involved in various areas of the brain that create anxiety. Medications used to increase serotonin levels in the brain may also affect intestinal processes because serotonin plays a key role in coordinating muscle contraction in the intestines. This results in side effects that can include constipation or diarrhea.
Because it’s very difficult to impact levels of a neurotransmitter in a specific location without influencing other parts of the nervous system, side effects are expected when people take medications for anxiety. Furthermore, levels of one neurotransmitter in the brain may shift in response to changes in levels of other neurotransmitters. Therefore, it’s difficult to use medication to make one change in the brain without affecting other systems.
Finally, because no two brains or bodies are exactly alike, medications frequently have different effects on different people. So a medication that’s helpful for one person may have only negative effects for another person. No one can predict the response a specific individual will have to a specific anti-anxiety medication. Under a doctor’s supervision, a person may have to try a few different medications before finding the one that works best.
Furthermore, new side effects can develop after long-term use of a medication. The brain is a responsive and adaptive system, and it adjusts to changes in its chemistry in complex and sometimes unexpected ways. It can change its structure or reduce its production of specific chemicals in response to the continued presence of certain medications. Long-term impacts on the brain other than those intended for treatment can occur. However, we know very little about these effects because they’re rarely studied. Pharmaceutical companies that design and evaluate medications tend to focus primarily on their short-term benefits and safety, and clinical trials of the effects of a medication rarely last more than one year.
Categories of Anti-anxiety Medications
As we noted, the most commonly prescribed anti-anxiety medications fall into four categories:
Each kind of medication attempts to reduce anxiety in a different way and has different influences on the process of rewiring the brain. You will be more likely to benefit from a medication if you know what to expect from it and use it in a way that promotes the changes you hope to produce.
Review Your Medications
So, before you read the next article in this series, it will be helpful if you know what kind of medication you are taking or considering taking. On a blank piece of paper, list the medications you’ve taken, or are considering taking, to treat your anxiety and identify what category each falls into. Use RxList and MedlinePlus to help you categorize your medication. If you have already tried medications, describe the effects each medication has had on you—both positive and negative. The next installments of this series will explain to you what to expect and what not to expect from each category of medication.
Other articles in this series include:
Part 3: SSRI Fact Sheet
Part 4: SNRI Fact Sheet
1.Addis, Michael E., Christina Hatgis, Esteban Cardemil, Karen Jacob, Aaron D. Krasnow, and Abigail Mansfield. “Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.” Journal of consulting and clinical psychology 74, no. 2 (2006): 377.
2.Bandelow, Borwin, Leo Sher, Robertas Bunevicius, Eric Hollander, Siegfried Kasper, Joseph Zohar, and Hans-Jürgen Möller. “Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care.” International journal of psychiatry in clinical practice 16, no. 2 (2012): 77-84.
3.Hoffman, Ellen J., and Sanjay J. Mathew. “Anxiety disorders: a comprehensive review of pharmacotherapies.” Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 75, no. 3 (2008): 248-262.
4.Koen, Nastassja, and Dan J. Stein. “Pharmacotherapy of anxiety disorders: a critical review.” Dialogues Clin Neurosci 13, no. 4 (2011): 423-437.
5.Vicens, Caterina, Isabel Socias, Catalina Mateu, Alfonso Leiva, Ferran Bejarano, Ermengol Sempere, Josep Basora et al. “Comparative efficacy of two primary care interventions to assist withdrawal from long term benzodiazepine use: A protocol for a clustered, randomized clinical trial.” BMC family practice 12, no. 1 (2011): 23.
Catherine Pittman, Ph.D., is a clinical psychologist and Chair of the Psychology Department at Saint Mary’s College in Indiana. With expertise in anxiety disorders, she teaches Abnormal and Clinical Psychology courses and supervises senior theses. Dr. Pittman runs a private practice at Roseland Counseling, assisting clients with anxiety, depression, bipolar disorder, brain injury, and post-traumatic stress disorder. Her research on the neurological basis of anxiety aims to enhance understanding through classes, presentations, articles, and books like "Rewiring the Anxious Brain."