Treatment of anxiety does not always require medication. The use of anti-anxiety drugs depends in part on whether the person can tolerate his or her symptoms while learning to manage them. Coping measures include psychotherapy and stress-reducing therapies such as progressive muscle relaxation, biofeedback, or, less commonly, yoga, self-hypnosis, or meditation. In general, these approaches are designed to give people with anxiety a feeling of control over their symptoms.
If you suffer from anxiety, you can help yourself by getting adequate sleep, exercising (which aids sleep and improves self-esteem), and avoiding caffeine and alcohol.
Often a person has more than one anxiety disorder; determining exactly which disorders are present can lead to better treatment. As with mood disorders, a careful evaluation by a health professional is the first step in treatment. Depending on the severity of anxiety symptoms, treatment can be managed by your primary care physician or a specialist.
General Medication Treatment for Anxiety
Although benzodiazepines are still commonly used to treat anxiety, two classes of antidepressant drugs —SSRIs and tricyclics —have become the first line of treatment. The serotonin and norepinephrine reuptake inhibitors and tetracyclics also are used to treat these conditions. These drugs are not habit forming and can be effective in low doses. Clearly, antidepressants are indicated when a person with anxiety is also depressed. Tricyclics and SSRIs take several weeks to work, making them slower acting than benzodiazepines, but they do bring a fast-acting benefit to people with anxiety by promoting better sleep, which quickly improves daily functioning.
Benzodiazepines for Anxiety
It is thought that benzodiazepines relieve anxiety by enhancing the effects of the neurotransmitter GABA. The mechanism of action is not fully understood, however. The side effects of benzodiazepines are generally minor. They include mild disturbances of thinking and, in rare instances, slowed breathing. Two side effects of benzodiazepines, drowsiness and clumsiness, may lead to an increased risk of accidents while driving. A study from Quebec found that users of benzodiazepines had a 26% greater chance of having a car accident than nonusers. The increased risk for those using benzodiazepines was highest (45%) during the first week of therapy.
The most troublesome issues with benzodiazepine treatment are the development of tolerance (decreased effectiveness of a given dose with continued use) and both physical and psychological dependence, especially with long-term use of a drug at high doses. Physical dependence is defined by the development of a specific set of physical symptoms upon withdrawal of a drug. Psychological dependence refers to a persistent desire for the drug after it has been discontinued.
Tolerance may cause a person to request, and at times receive, increasingly larger doses to maintain benefits. In this instance, the person may be switched to an SSRI or a tricyclic drug instead of higher doses of a benzodiazepine. The risk of side effects, such as drowsiness and confused thinking, rises with increased doses of benzodiazepines.
When a person is physically or psychologically dependent on benzodiazepines, he or she can experience serious symptoms during withdrawal, including irritability, agitation, restlessness, insomnia, loss of appetite, tremor, muscle aches, and, in some people, confusion or seizures. The danger of severe withdrawal symptoms can be diminished by using the smallest effective dose of a benzodiazepine for the shortest possible time and by slowly tapering the drug dose as it is discontinued.
Buspirone for Anxiety
The antianxiety drug buspirone (BuSpar) has fewer adverse effects than benzodiazepines, but it may be less effective, particularly for panic disorder. Common side effects of BuSpar are dizziness, headache, nervousness, and nausea. However, BuSpar causes less drowsiness than other drugs, and abuse is unlikely because it does not lead to tolerance or dependence. In switching from benzodiazepines to BuSpar, a person may be able to minimize anxiety symptoms by starting immediately on BuSpar while tapering the dose of a benzodiazepine.
Herbs for Anxiety?
Kava kava, which is prepared from the crushed root of Piper methysticum (a shrublike pepper plant), is marketed as a natural remedy for anxiety and stress. However, the FDA has issued a warning that the supplement can damage the liver. In addition, long-term use of kava kava may result in allergic reactions, visual disturbances, or difficulties maintaining balance. Kava kava should not be used if you are pregnant, breastfeeding, or taking antidepressants.
Valerian also is sold as a natural anti-anxiety remedy. Most research on the herb, which is prepared from the dried root of the plant Valeriana officinalis, has focused on people with insomnia. Less is known about its effectiveness in treating anxiety.
As with all herbal products, kava kava and valerian aren't regulated by the FDA, and there's no guarantee of their purity or effectiveness. Drug-herb interactions are also a concern. It is important to discuss all herbal remedies with your doctor before trying them.
