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Not everyone who has anxiety needs medication. Anxiety is complex. If you have anxiety, your doctor or healthcare provider will need to ask detailed questions about what you are experiencing.
The first step to treating anxiety is usually understanding what it is, how it affects you and if possible making lifestyle changes. Your doctor or a therapist may also use psychological therapy. Your doctor might refer you to a psychologist for cognitive behavioural therapy (CBT), which is a type of psychological therapy that can help you change your thoughts and behaviours, or other types of psychological therapies.
If your anxiety is moderate or severe, or you do not feel better with psychological therapy, your doctor might also prescribe medications.
Types of anxiety medications
Medications for anxiety include antidepressants and benzodiazepines. These correct an imbalance of chemicals in the brain that causes anxiety.
There are several kinds of antidepressants, but the ones most commonly used to treat anxiety are selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs). These medicines increase the level of certain chemicals in your brain that can affect your mood.
Most people who take antidepressants will be advised to take them for at least 12 months, if they are tolerating them well.
Benzodiazepines, also known as sedatives, are usually only used to reduce anxiety for a short term (less than a month, and the shorter the safer) as they are addictive. Benzodiazepines are sometimes prescribed to assist sleep.
Important information about anxiety medication
Medication often takes longer to treat anxiety than it does to treat depression. It might take several weeks for the medication to take effect. Studies show that anxiety medication works better if someone also has therapy.
Anxiety medication can cause side effects in some people. These may include:
- more anxiety
- weight gain
- dry mouth
- difficulty with sexual drive or arousal
These side effects normally fade away, but if you are experiencing side effects from anxiety, always tell your doctor as they may be able to help.
Some antidepressants can cause a harmful reaction when taken with certain other medications. Talk to your doctor or pharmacist before you take any other medications, including sleeping pills and painkillers.
Take your anxiety medication as prescribed. Do not adjust doses on your own without consulting your doctor. Don’t drink alcohol while taking anti-anxiety medication.
If you are not sure about taking medications to treat anxiety, ask your doctor about the following:
- What are the benefits of the particular medication for anxiety?
- What are the risks of the medication?
- What are the possible side effects?
Looking for more medicine information?
healthdirect’s medicines section allows you to search for medicines by brand name or active ingredient. It provides useful information about medicines such as their use, whether they are available on the Pharmaceutical Benefits Scheme and product recalls.
How Do I Know If I Have Generalized Anxiety Disorder?
The first step is to rule out the possibility that your symptoms are being caused by a medical condition that is not psychiatric. Among the conditions that produce symptoms similar to those of anxiety are hyperthyroidism or other endocrine problems, too much or too little calcium, low blood sugar, and certain heart problems. Certain medicines also can sometimes cause anxiety. A thorough evaluation by your health care provider will determine if any of these conditions are the cause of your symptoms.
If no other medical culprit can be found and the symptoms seem out of proportion to any situation you are facing, you may be diagnosed with an anxiety disorder.
What Are the Treatments for Generalized Anxiety Disorder?
Medication for Anxiety
Medication is useful for alleviating the symptoms of generalized anxiety disorder and is often prescribed in conjunction with other therapies. Some types of anxiety drugs can be habit-forming and are usually prescribed on a short-term or as-needed basis.
Different anxiety disorders have different medication regimens. Some are preventive and some are designed to cure the problem.
Antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), are widely used to treat and prevent a variety of anxiety disorders. Examples of SSRIs that are commonly used to treat chronic anxiety include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). The antidepressants duloxetine (Cymbalta) and venlafaxine (Effexor), SNRIs (serotonin and norepinephrine reuptake inhibitors) which act on the brain chemicals serotonin and norephinephrine, and some of the tricyclic antidepressants like imipramine (Tofranil), may also help. Novel antidepressants such as mirtazepine (Remeron) are also prescribed at times.
Antihistamines (such as hydroxyzine) and beta-blockers (such as propranolol) can help mild cases of anxiety as well as performance anxiety, a type of social anxiety disorder. Antidepressants such as SSRIs or SNRIs or tricyclics need to be taken daily whether or not you have anxiety on that particular day, as prescribed by your health care provider. Antihistamines or beta-blockers are usually taken only when needed for anxiety, or immediately before an anxiety-provoking event (for example, taking propranolol shortly before giving a speech). Finally, certain anticonvulsant medicines, such as gabapentin (Neurontin) and pregabalin (Lyrica), are also beginning to show value in treating some forms of anxiety in initial research studies
If you have acute anxiety (panic attack), you will likely need to take an anti-anxiety medicine as well. The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan). They have drawbacks: Benzodiazepines sometimes cause drowsiness, irritability, dizziness, memory and attention problems, and physical dependence. Nonetheless, in recent decades they have largely replaced barbiturates because they tend to be safer if taken in large doses.
Another anti-anxiety drug is busprirone (Buspar). It has fewer side effects than the benzodiazepines and is not associated with dependence. Buspar, however, can have its own side effects and may not always be as effective when a person has taken benzodiazepines in the past.
Therapy for Anxiety
Psychotherapy, with or without medication, is often considered a fundamental aspect of treatment for generalized anxiety disorder.
Several specific forms of psychotherapy have been described in research studies as helpful for alleviating the symptoms of GAD. Two — psychodynamic psychotherapy and supportive-expressive therapy — focus on anxiety as an outgrowth of feelings about important relationships. Another form of psychotherapy, called cognitive-behavioral therapy, involves learning behavioral relaxation techniques as well as restructuring patterns of thinking that foster anxiety.
Biofeedback is another helpful tool. In a series of sessions with a therapist, you watch your own brain-wave patterns on an electroencephalograph and gradually learns to control the waves. This teaches you to achieve a more relaxed state at will. Practitioners estimate that after about a dozen sessions, you will be able to exert control over mental activity without the help of the therapist or monitoring instrument.
Lifestyle Modifications to Alleviate Anxiety
Daily exercise can be another helpful treatment for anxiety symptoms. If you find that exercise works for you, push yourself to go for brisk walks or undertake an active sport that you enjoy. Get your heart rate into the target range for your age for at least 30 minutes each time you exercise.
Since anxiety is often accompanied by shallow breathing, deep breathing exercises can also be helpful. Try the following form of yoga breathing:
- Lie on your back in a comfortable place.
- Breathe in slowly through your nose, using your diaphragm to suck air into your lungs while allowing your abdomen to expand. (Put your hand on your abdomen just below the navel to make sure the abdomen is being pushed up and out by the diaphragm.) After the abdomen is expanded, continue to inhale as deeply as possible.
- When you breathe out, reverse the process: Contract the abdomen while exhaling slowly and completely.
- Repeat several times.
Progressive relaxation is another helpful technique. It begins by tensing and then relaxing one part of the body, usually beginning with the toes. When this part of the body is relaxed, another part of the body is tensed and relaxed until the entire body is free of tension.
Relaxing visualization can also help. A therapist or meditation trainer suggests relaxing images for a person to hold in mind. Once the image is in place, the person imagines soothing sensations such as pleasant scents and sounds. Eventually people can learn to do this themselves when they anticipate — or find themselves in — stressful situations.
Starcevic, V. Anxiety Disorders in Adults: A Clinical Guide, Oxford University Press, 2005.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders4th Edition, 2000.
Journal of Clinical Psychiatry, New Perspectives for Treating GAD, 2004.
Generalised Anxiety Disorder (GAD) can be a long-term condition.
There are different treatments available. Your GP will discuss all the treatment options with you. They will tell you about any possible risks or side effects.
With your GP, you can make a decision on the most suitable treatment.
Your GP may suggest some educational resources about anxiety.
This usually involves working from a book or computer programme. A health professional will support you.
Another option is going on a group course. On these courses you and a few other people with similar problems meet with a therapist every week. You learn ways to tackle your anxiety.
You may need more intensive therapy or medication if initial supports don’t help.
Primary Care Psychology
You don’t need a referral from your GP. You can refer yourself to Primary Care Psychology.
Your GP will be happy to talk it through with you first, if you prefer.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) is one of the most effective treatments for GAD. The benefits may last longer than the benefits from medication.
CBT helps you manage problems by thinking more positively. It frees you from unhelpful patterns of behaviour.
It helps you do things you would usually avoid.
Mindfulness and applied relaxation
Mindfulness and applied relaxation are alternative types of psychological treatment.
Mindfulness focuses your awareness on the present moment. It allows you to acknowledge and accept certain feelings. It can reduce anxiety associated with the fear of actual situations or sensations. It helps to counter the sense of ‘tunnel vision’ that may develop during anxiety.
Applied relaxation focuses on relaxing your muscles in a particular way. A trained therapist teaches the technique which alleviates anxiety and involves:
- learning how to relax your muscles
- relaxing your muscles quickly in response to a trigger
- practising relaxing your muscles in situations that make you anxious
If psychological treatments don’t help, medication might be the next option.
There is a range of medications your GP can prescribe to treat GAD. Your GP can discuss options with you in detail, such as:
- the different types of medication
- the length of treatment
- the side effects and possible interactions with other medicines
You should see your GP regularly while taking medication for GAD.
Tell your GP if you think you may be experiencing side effects from your medication. They may be able to adjust your dose or prescribe an alternative medication.
The main medications for treating GAD are:
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant. They increase the level of a chemical called serotonin in your brain.
Common SSRIs prescribed include:
Like all antidepressants, you take SSRIs on a long-term basis. You’ll start with a low dose and increase as your body adjusts to the medicine.
They can take several weeks to start working.
Common side effects of SSRIs include:
- feeling agitated
- feeling or being sick
- diarrhoea or constipation
- loss of appetite and weight loss
- blurred vision
- dry mouth
- excessive sweating
- problems sleeping or drowsiness
- low sex drive
- difficulty achieving orgasm during sex or masturbation
- in men, difficulty obtaining or maintaining an erection
These side effects should improve over time but some side effects can persist.
If your medication isn’t helping after about two months of treatment, talk to your GP.
When it’s appropriate for you to stop taking your medication, your GP will reduce your dose slowly. This reduces the risk of withdrawal effects. Never stop taking your medication unless your GP advises you to.
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
Serotonin and noradrenaline reuptake inhibitors (SNRIs) are another type of antidepressant. They increase the amount of serotonin and noradrenaline in your brain. SNRIs can also increase your blood pressure.
Examples of SNRIs include:
Common side effects of SNRIs include:
- feeling sick
- dry mouth
As with SSRIs, some of the side effects are more common in the first 1 or 2 weeks of treatment. These usually settle as your body adjusts to the medication.
If SSRIs and SNRIs aren’t suitable for you, pregabalin is an option. This is a medication known as an anticonvulsant. It is used to treat conditions such as epilepsy. It is also beneficial in treating anxiety.
Side effects of pregabalin can include:
- increased appetite and weight gain
- blurred vision
- dry mouth
Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.
Benzodiazepines are a type of sedative, sometimes used as a short-term treatment. They are particularly effective during a severe period of anxiety. They help ease the symptoms within 30 to 90 minutes of taking the medication.
If you’re prescribed a benzodiazepine, it will usually be diazepam.
Benzodiazepines are very effective in treating the symptoms of anxiety. But they can become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.
They are usually not prescribed for any longer than 2 to 4 weeks at a time.
Side effects of benzodiazepines can include:
- difficulty concentrating
- tremor (an uncontrollable shake or tremble in part of the body)
- low sex drive
Referral to a specialist
If the symptoms of GAD persist, talk to your GP about a referral to a community mental health team.
A community mental health team usually has the following:
- psychiatric nurses
- clinical psychologists
- occupational therapists
- social workers
Members of the mental health team will speak to you again about your difficulties. They’ll ask you about your previous treatment and how effective you found it.
They’ll ask about things in your life that may be affecting your condition. How much support you get from family and friends may also be explored.
Your mental health team will then develop an individual care plan with you. This will focus on your goals and how to support you.
This plan may include a treatment you haven’t tried before.
You may need psychological treatment and medication. A combination of two different medications is also an option.
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Anxiety disorders are more than just a case of nerves. They are illnesses, often related to a person's biological makeup and life experiences, and your symptoms can keep you from coping and may even make it hard to maintain your daily activities. Fortunately, there are a number of medications available to treat the symptoms of anxiety disorders.
Medications Used to Treat Anxiety Disorders
Although a variety of categories of medications are used in the treatment of anxiety, here are four major classes of medications that mental health professionals use to treat anxiety disorders.
Each class of medication attempts to reduce anxiety in a different way and has its own benefits and risks. While some may be considered preferred options, the drug selection can vary based on the type of anxiety you have and your symptoms.
Using medications for anxiety disorder is considered safe and effective. It can take several weeks (usually four to six weeks) for most anxiety medications to start working, and can be particularly helpful when used along with psychotherapy.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are currently considered the first-line medication for most forms of anxiety. They work by causing more serotonin to be available in the brain, which can improve both mood and anxiety.
If you have been diagnosed with an anxiety disorder, your doctor may recommend one of the following SSRIs:
(citalopram) (fluvoxamine) (paroxetine) (fluoxetine) (sertraline)
Although SSRIs have fewer side effects than some other antidepressants, they may still cause gastrointestinal distress, sleep difficulties, and sexual dysfunction. Many side effects go away within a couple weeks of beginning the medication, however, so give your body time to adjust.
SSRIs are considered a first-line treatment for all anxiety disorders. The treatment of OCD typically requires a higher dose.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are an option for people who don’t respond to SSRIs. They are called SNRIs because they increase levels of both serotonin and norepinephrine, another neurotransmitter in the brain.
The most commonly prescribed SNRIs for anxiety include:
(duloxetine) (venlafaxine) (desvenlafaxine)
SNRIs are considered just as effective as SSRIs, but they tend to have more side effects. These may include headaches, sexual dysfunction, insomnia, upset stomach, and increased blood pressure.
SNRIs are considered as effective as SSRIs. They are therefore considered a first-line treatment for all anxiety disorders except obsessive compulsive disorder (OCD).
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants (TCAs) were some of the first antidepressants developed. Like SNRIs, TCAs block the reuptake of serotonin and norepinephrine.
The TCAs most commonly prescribed today include:
- Elavil (amitriptyline) (nortriptyline)
- Tofranil (imipramine)
Although they are just as effective as SSRIs in treating anxiety disorders, TCAs tend to cause significant side effects, including dry mouth, constipation, blurry vision, trouble urinating, and hypotension (low blood pressure on standing). For these reasons, TCAs are usually only prescribed when other drugs are unable to provide relief.
Benzodiazepines (sometimes called “benzos”) are the most widely used group of sedative drugs. They are usually prescribed for short-term management of severe or treatment-resistant anxiety.
Benzodiazepines are also prescribed on an as-needed basis to help you relax and reduce muscle tension. Because they are fast-acting, they are very helpful in treating panic attacks. They can also be useful for social anxiety disorder (SAD) and phobias if they are only taken occasionally.
Common benzodiazepines include:
(lorazepam) (clonazepam) (diazepam) (alprazolam)
When used on occasion or daily for a few weeks, benzos have a low risk of addiction. This risk increases when benzodiazepines are taken regularly for more than a few weeks. Benzodiazepines are not considered safe for continuous use, as this can increase risk for dependence and tolerance.
You should abstain from alcohol when taking benzodiazepines because the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. Be sure to tell your doctor about other medications you are taking.
Risks of Anxiety Medications
Anxiety medications have some important risks you should be aware of. These risks differ a bit between the drug classes, with suicidal thoughts a bigger risk with antidepressants and dependence and withdrawal a concern with benzodiazepines.
In 2005, the Food and Drug Administration (FDA) required all antidepressants carry a black-box warning relating to the increased risk of suicidal thinking and behavior in children and young adults up to age 25.
Those younger than 25 should be carefully watched for increased depression, agitation, irritability, suicidality, and unusual changes in behavior, especially at the beginning of treatment or when doses are changed.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Tolerance and Dependence
Long-term use of benzodiazepines is generally not recommended because you can develop tolerance and/or dependence.
Tolerance means you need to take more of the medication in order to make it work. Dependence means that you develop withdrawal symptoms if you stop taking the medication. Some people abuse these medications in order to get high.
Many people who take a medication over a long period of time can become dependent. When they go off the drug, they need to do so gradually, to avoid experiencing withdrawal symptoms.
Withdrawal symptoms usually appear within three days of stopping a medication and last one to two weeks. Ironically, many withdrawal symptoms are similar to the anxiety symptoms that you may have initially sought treatment for:
- Difficulty concentrating
Some drugs cause more severe withdrawal symptoms than others. For instance, discontinuing benzodiazepines can lead to severe or life-threatening withdrawal symptoms, such as seizures.
Be sure to talk with the doctor before discontinuing any medication. To avoid these symptoms your doctor will probably taper your medication dose gradually.
A Word From Verywell
Be sure to take your medications exactly as prescribed by your doctor. If you are having serious side effects, consult your doctor, but do not stop your medication without your doctor's approval as this can cause serious health issues.
Anxiety is the most common mental health condition in Australia.
One in four Australians have experienced some form of clinical anxiety in their life — that's the same percentage of people in this country who were born overseas.
Counselling from a psychologist is widely accepted as the most effective treatment option for people struggling with anxiety, but medication can play an important role if the symptoms are more severe.
"Medication can be extremely helpful for anxiety, especially if you are talking about anxiety at the pointier end," says Ahona Guha, a clinical and forensic psychologist in Melbourne.
"Think about it a little bit like a crutch for a broken leg, it really just helps us move through life while we are learning to walk again."
Medications are pretty readily available for Australians, however there is increasing concern about how difficult it is to wean yourself off them.
Known formally as discontinuation syndrome, withdrawal symptoms vary from person to person.
They can include flu-like symptoms such as headaches, chills, dizziness, body aches, nausea or sweating, as well as insomnia, gastrointestinal issues and electric-shock-like sensations or a rushing noise in the head.
They can also look like symptoms of depression or anxiety.
But for many people, antidepressants can really help them deal with anxiety and mental health conditions.
Let's take a look at the most commonly prescribed medications and how they can ease anxiety.
Some types of antidepressants are very effective in managing anxiety, even in people who do not have depression.
In fact, the use of antidepressants in managing a range of mental health concerns in Australia has more than doubled over the past 20 years.
Conditions like anxiety and depression can affect the chemical balance of your brain and affect your mood. Medications can help address this.
They won't work for everyone, but they can be very effective when they do.
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Selective Serotonin Reuptake Inhibitors (SSRIs) are an extremely common form of antidepressant prescribed to people with anxiety.
It will often be a doctor's first choice of medication because most people tolerate it pretty well without side effects.
Types of anxiety
Here's how to tell the difference between the common types of anxiety.
SSRIs manage the brain's levels of serotonin, which is a chemical that regulates anxiety, happiness and mood.
SSRIs are among the most frequently sold drugs in Australia. Sertraline (sold under the brand name Zoloft) and escitalopram (Cipralex and Lexapro) are both among Australia's 10 most commonly prescribed medications.
Fellow of the Royal Australian and New Zealand College of psychiatrists, Professor Valsamma Eapen, says SSRIs take a while to start to take effect.
"They will at least take two weeks to begin to act, and then it takes six, eight, 12 weeks to really have the levels built up sufficiently to show you the benefits," she says.
Doctors are likely to prescribe SSRIs as a first medication for anxiety because they have a good history of research behind them, she adds.
"We have more evidence, more studies and more clinical experience with SSRIs."
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs) manage serotonin levels, like SSRIs, but also manage noradrenaline.
You asked, we answered your questions about anxiety
Three experts answer your questions about living with anxiety.
Noradrenaline is a chemical that plays a vital role in the fight or flight response, and impacts on blood pressure and heart rate.
Venlafaxine, sold as Effexor, is the most common SNRI prescribed by doctors in Australia.
Medications managing two chemicals in the brain, as SNRIs do, are more likely to come with side effects, Dr Eapen says.
"SNRIs are relatively new," she explains.
"Some of the side effects that you get are from that noradrenaline effect, as opposed to the fewer serotonin side effects."
Benzodiazepines are a type of sedative commonly prescribed for short-term treatment of anxiety symptoms.
They reduce tension and promote relaxation, but can affect coordination and alertness, and are known to be addictive and grow less effective with longer term use.
Valium and Xanax are among the most well-known brands of benzodiazepines.
A doctor will ordinarily prescribe benzodiazepines for just a couple of weeks, or intermittently as part of a broader treatment plan.
Dr Eapen says they come in handy when someone is experiencing extreme symptoms that can't wait for the adjustment period of other medications.
"When someone is experiencing acute grief or acute panic — something where you need to see an effect straight away — with benzodiazepine you get the benefit straight away," she says.
"When you can see that this is an acute situation and not chronic anxiety where you can use the SSRI and grin and bear those two weeks — you know that this is an acute stress reaction and you can't wait that long.
"The main disadvantage is because it acts so quickly it's addictive, so you get used to it and won't learn any coping strategies."
Beta blockers work by inhibiting adrenaline, the other chemical that runs the fight or flight response.
Like benzodiazepines, beta blockers don't treat the anxiety itself, but can help ease symptoms such as shaking, sweating, dizziness and heart racing.
"Beta blockers are helpful when the symptoms of anxiety are physical," Dr Eapen says.
"It's the arousal system that you are blocking, but it won't help with the cognitive symptoms of anxiety like the worry."
Some common beta blockers include atenolol (Tenormin) and metoprolol (Lopresor).
How are medications prescribed?
The first step in seeking help for anxiety, whether it be for starting therapy or a medication routine, is to see a GP.
"The GP will assess you to ensure it's not due to something else, because sometimes other things can present like anxiety," Dr Eapen says.
The anxiety puzzle
It's one of the most common medical conditions on the planet so why are the causes of anxiety still such a mystery?
If a GP concludes that medication would help, they can prescribe some medications directly, or give a referral to a psychiatrist.
Psychiatrists often prescribe antidepressants, but the vast majority (86 per cent) in Australia are prescribed and managed by GPs.
All of the types of medications discussed in this article are covered by the Pharmaceutical Benefits Scheme (PBS), which makes them more affordable.
Situational anxiety causes a feeling of fear or apprehension in certain situations, that can range from mild to extremely strong. It’s common to have worries about different things in life such as sitting an exam or having a medical test, but when those worries begin to affect your ability to live a normal life, it could indicate that you are living with situational anxiety, and in some cases treatment may be recommended.
You may find that some everyday situations are triggering for your anxiety, such as walking through a crowded street or getting onto a packed bus. Alternatively, a major life change like moving house or getting married could trigger symptoms.
Fortunately, there are lots of ways to treat situational anxiety. Becoming mindful of your triggers and symptoms is the first step towards managing them so you can live a less stressful life.
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What are the symptoms of situational anxiety?
Symptoms of situational anxiety are similar to those of other anxiety disorders. The main difference is that situational anxiety is triggered by a specific event or situation. Symptoms can vary widely from person to person and depend on the severity of the anxiety itself.
Symptoms you may experience include, but aren't limited to: feeling nervous and/or tense, tiredness and exhaustion often combined with difficulties in falling asleep, sweating, nausea, experiencing chest pains, and feeling irritable.
In some cases, people may even experience a panic attack in response to a specific situation. A panic attack is a period of intense anxiety or fear. In order to prevent these symptoms, people may sometimes begin avoiding situations that they know will trigger an anxiety response.
What is the difference between situational anxiety and generalised anxiety?
It is important to identify the differences between situational anxiety and generalized anxiety disorder (GAD). Where GAD involves an often constant state of generalised worry, situational anxiety occurs in response to a specific situation.
Please note, the Pharmacy2U online doctor service is only appropriate for people with situational anxiety. We will not prescribe medication specifically indicated for generalised anxiety such as SSRIs, SNRIs or benzodiazepines.
How can situational anxiety be managed?
For many people, it can simply be a case of avoiding the situation that causes anxiety or panic attacks. However, this may not always be possible as the situation that is causing the problem is part of normal life and it cannot be avoided, and so a little help is needed.
In general, there are a number of self-help approaches that can reduce feelings of anxiety. Regular exercise, learning to relax, avoiding caffeine, techniques such as cognitive behavioural therapy (CBT), and joining a support group are all approaches that can be effective. It’s also helpful in the long term to stop smoking, and cut down your alcohol consumption – it might feel like these give you short term relief from anxiety, but in the longer term they’re likely to make it worse, and they are detrimental to your general health too.
Situational anxiety can be greatly assisted by the occasional or short-term use of medication that can help control the symptoms that may be experienced.
What medicines are available to treat situational anxiety?
Propranolol is a beta blocker which can be very helpful in controlling symptoms such as heart palpitations, excessive sweating and trembling. By stopping these symptoms, it can be of great help in stopping the anxiety from taking hold and controlling you. It can be used when you know that the situation that causes your anxiety will be faced, or it can be taken on a more regular basis if needed.
Propranolol Propranolol Hydrochloride
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Anxiety disorders are the most common mental illness in the United States, affecting approximately 40 million adults ages 18 and older each year. Fortunately, anxiety disorders are highly treatable through a combination of medication, therapy, and alternative treatments such as Transcranial Magnetic Stimulation, but only for those who seek help. At Family Care Center, we specialize in outpatient behavioral health services for all ages who are struggling with their mental health.
We offer comprehensive medication management services, including anti-anxiety medications, sometimes known as anxiolytics. Discover more about anxiety disorders and anti-anxiety medications below, then get in touch with one of our clinics today to schedule an initial appointment.
Types of Anti-Anxiety Medications
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Transcranial Magnetic Stimulation (TMS)
The 5 Major Types of Anxiety Disorders
While many mental health conditions have anxiety as a symptom, most psychiatrists recognize five major types of anxiety disorders: Anxiety disorders involve more than just temporary worry and fear. Unlike someone who may be anxious because of an upcoming test or a problem at work, anxiety does not go away once the issue is dealt with, but rather is a chronic condition that can get worse over time, negatively affecting nearly all aspects of a person’s life.
Antidepressants trump all others as the most effective evidence-based choice
John T. Walkup, MD
What You'll Learn
- What is the best way to treat anxiety in kids?
- What medications are prescribed for children’s anxiety?
- What medications work best for children’s anxiety?
- Quick Read
- Full Article
- Anxiety medication combined with therapy
Finding the right medication can help kids with anxiety worry less. The best anxiety medications for children are antidepressants called SSRIs. Antidepressants work very well for most children. And they work pretty quickly — most kids start to feel better after the first week or two. Usually, antidepressants can give kids long-term relief with barely any side effects. And they work even better when they’re combined with therapy. The very best way to treat anxiety is with a combination of antidepressant medication and cognitive behavioral therapy.
Unfortunately, it’s common for kids to be prescribed the wrong anxiety medications.
Because kids with anxiety are constantly worrying, they often have a hard time paying attention. Sometimes, adults only notice the trouble paying attention, so the child is misdiagnosed with ADHD. These children are often given stimulant medications, which can help them concentrate. But stimulant medications might also cause them to have stomachaches or trouble sleeping. Plus, they could actually make kids’ anxiety a little bit worse.
Kids with anxiety may also be given clonidine or guanfacine. While these medicines can make kids a bit calmer, they don’t really treat anxiety. Some doctors even prescribe antipsychotic medication, but there is no evidence that these medications help anxious children.
Some doctors prescribe benzodiazepines to anxious children. These give the most relief to children who are really suffering, but they should only be used for a short period of time. While benzodiazepines can help a child feel better quickly, they often don’t work as well after a month or two. In order for the medication to continue working, the doctor would need to keep increasing the dose.
We see a lot of the wrong medications being given to anxious kids because people who are treating them don’t really understand what these children are experiencing, and they don’t know what the evidence-based treatments are.
Anxious kids have a hard time paying attention. It’s not because they have attention deficit, it’s because their heads are full of worry. But their parents and teachers may only notice that they’re having trouble paying attention, and so they get misdiagnosed as having the inattentive subtype of ADHD and put on stimulants. Stimulants will help anybody feel a little bit more attentive, so they will help these kids concentrate better, but they might also have more stomachaches, and often they’re not happy, they’re not comfortable. The stimulants may actually make the anxiety a little bit worse. Plus anxious kids have trouble sleeping, and sometimes the stimulants makes sleeping even harder.
Another type of medicine some practitioners use, because they’re comfortable with it, is clonidine or guanfacine. These are alpha-two agonists; they calm, they lower arousal levels, but they don’t really treat anxiety.
The third group of medicines that we see people using are, believe it or not, antipsychotics. With the scare a few years ago about suicidal behavior on antidepressants, people moved away from the antidepressants and now they’re treating anxious kids with antipsychotics. Now, in someone’s mind that may be safe, but from an evidence-based point of view it’s terrible care.
The clear medications of choice for treating anxiety in children are the serotonin reuptake inhibitors, the antidepressants. Study after study shows those are the medicines that are effective, and they can be extremely effective. With the right assessment, with the right youngster, the use of antidepressants for anxiety can be transformative. And it can happen relatively quickly; in our studies we often see kids better by the first week or two of treatment. They’re not completely well but they’re moving in the right direction, and that kind of response early on generates confidence in the anxiety treatment, makes moms and dads feel a little bit better and makes the kids feel pretty good.
Anxiety medication combined with therapy
The other evidence-based treatment for anxiety is cognitive behavioral treatment and it’s important to understand that in our big study, where we compared combination treatment of cognitive behavioral therapy and medication with either one of those treatments alone, that the combination beat them all handily. So when you’re thinking about the very best treatment you’ve got to be thinking in terms of medication plus a psychological intervention.
Finally, the benzodiazepines are the other treatment that I commonly see being used in kids with anxiety disorders. They are short-term, they can be extremely effective in reducing intense anxiety in youngsters who are really suffering and in distress. But the data supporting their long-term usefulness is very thin, even in adults.
There are kids who are so anxious and uncomfortable and are on the verge of school failure or disruption of the home or something like that where you just really need an acute way to bring down everybody’s anxiety, and in those cases the benzodiazepines can be very helpful. But sometimes they’re a little too helpful, because people begin to like how they feel on them and don’t really shift focus from those medicines onto the antidepressants, which really offer long-term, durable anxiety reduction without really any side effects or problems.
With benzodiazepines you can actually develop tolerance to them, so they might work the first month or two, but to keep them working in the long haul you often have to increase the dose. They manage anxiety, they offer anxiety relief, but they don’t really seem to have that kind of almost curative property that the antidepressants seem to have.
Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants. Benzodiazepines are a type of sedative and are usually a short-term treatment. You should not take benzodiazepines for longer than a month as they are highly addictive.
Benzodiazepines used to treat anxiety disorders include:
Short half-life (or short-acting) benzodiazepines (such as Lorazepam) and beta-blockers are used to treat the short-term symptoms of anxiety. Beta-blockers help manage physical symptoms of anxiety, such as trembling, rapid heartbeat, and sweating that people with phobias (an overwhelming and unreasonable fear of an object or situation, such as public speaking) experience in difficult situations. Taking these medications for a short period of time can help the person keep physical symptoms under control and can be used “as needed” to reduce acute anxiety.
Buspirone (which is unrelated to the benzodiazepines) is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. It is not useful on an “as-needed” basis.
How do people respond to anti-anxiety medications?
Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may even become dependent on them. To avoid these problems, doctors usually prescribe benzodiazepines for short periods (4-6 weeks), a practice that is especially helpful for older adults (read the NIMH article: Despite Risks, Benzodiazepine Use Highest in Older People), people who have substance abuse problems and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly.
What are the possible side effects of anti-anxiety medications?
Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:
- Blurred vision
Tell your doctor if any of these symptoms are severe or do not go away:
- Problems with coordination
- Difficulty thinking or remembering
- Increased saliva
- Muscle or joint pain
- Frequent urination
- Blurred vision
- Changes in sex drive or ability (The American Society of Health-System Pharmacists, Inc, 2010)
If you experience any of the symptoms below, call your doctor immediately:
- Swelling of the eyes, face, lips, tongue, or throat
- Difficulty breathing or swallowing
- Yellowing of the skin or eyes
- Difficulty speaking
- Thoughts of suicide or harming yourself
Common side effects of beta-blockers include:
- Cold hands
- Dizziness or light-headedness
Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both.
Possible side effects from buspirone include:
- Trouble sleeping
Anti-anxiety medications may cause other side effects that are not included in the lists above. For more information about the risks and side effects for each medication, please see [email protected]