Anxiety treatment drugs / medication - what are they?
If you have anxiety, you may think that drugs are the only option. However the UK's National Institute for Clinical Excellence has recently advised doctors that medication should not be the first course of action for most people suffering from symptoms of anxiety. And counselling should be considered as a treatment for anxiety before drugs.
This is great news, because the drug option does not work for everyone. Only one in three people will find relief from their symptoms and many will suffer unpleasant side effects. They can cause sexual dysfunction, weight gain, gastric upset, disrupted sleep and anxiety symptoms. Especially when you first start taking them.
If you and your doctor conclude that the drug option is best for you, look at visiting a counsellor as well. Leave no stone unturned on your path back to feeling well again.
Looking at the options: Drugs and talking therapies
Commonly prescribed drugs for anxiety
Benzodiazepines Diazepam, valium, alprazolam and lorazepam Are drugs prescribed for a short time to relieve anxiety. Doctors are reluctant to offer them for more than two to four weeks as they are addictive and have many side effects such as:
- Sleepiness, lethargy
- Memory problems
- Dry mouth
- Blurred vision
All benzodiazepines relieve anxiety (anxiolytic) but some act as sleeping agents too. They are put into categories according to whether they are long or short acting. This is dependant on how quickly the body breaks down and eliminates the medication.
Some people will be really surprised when their doctor prescribes an antidepressant for symptoms of anxiety. But the neurotransmitters that are responsible for anxiety also influence depressive conditions, so it makes sense that they can be used for both.
Developed in the 1950's these drugs all work in different ways to affect the amount of neurotransmitter serotonin available in between the synaptic nerves in the brain. The drugs are now divided into three main categories
Selective serotonin reuptake inhibitors SSRI'S paroxitine
(Paxil) fluroxetine, sertraline, citralopram and fluvoxamine. Widely prescribed because they are a 'safer.'
Selective Norepinephrine Reuptake Inhibitors
SNRI'SVeneflaine (Effexior) Regular medical monitoring will be required
Monoamine Oxidase Inhibitors MOI'S Phenelzine tranylaypromine.
These are the oldest class of antidepressants and have more side effects than the above, so a doctor will most likely try one of the above in the first instance
Busprone Buspar (Azapirone) This is usually prescribed for a short period. You will not become dependant on it as you might a benzodiazepine but can take at least six weeks before you notice any improvement. It has a sedative effect, so will not be prescribed when sedation or impairment of the psychomotor movements would be dangerous. Side effects are normally found at the beginning of the course of treatment and are generally alleviated by lowering the dose or as treatment goes on.
Hydroxyzine is an antihistamine and as such can make people sleepy. So it is used as a short term prescriptive drug for anxiety around specific events like an operation.
Used for the treatment of high blood pressure and a racing heart, they can be effective for anxiety over something specific. For instance if you were anxious over a future presentation or exam
Talking therapies for anxiety
Drug companies spend billions promoting the view that depression and anxiety are biological illnesses and can only effectively be treated with drugs. All independent research indicates that the right psychotherapeutic intervention relieves symptoms more quickly and is more likely to prevent relapse.
A meta analysis by three leading researchers (The Therapist. Volume 4, No 3 - 1997) showed that psychological interventions, particularly cognitive behavioural therapy, are at least as effective as medication in treating depression. Depression rides on the back of anxiety so it makes sense that this finding would apply to someone who has anxiety issues.
'Drug therapies are less robust and effective than psychological intervention in the long-term treatment of anxiety.'
Effective psychotherapy that enables someone to feel more optimistic and calm, will change the brain chemistry just as well as any treatment from drugs.
Not all therapies are equal
Some therapies that concentrate on reflecting on the past can be damaging for some one who is anxious. Constant rumination on events and negative perceptions can exacerbate uncomfortable feelings and strengthen the emotional patterns that trigger anxiety.
It can be really interesting to explore why you feel or react in a certain way. but this rarely provides the tools to feel better. So what should you look for in a therapy?
- Therapies that work towards specific goals rather than perambulating around any thoughts that pops up. Typical goals might be that you want to be able to feel relaxed when talking to people sleep better or be calm when travelling on public transport.
- There are endless pages being written on positive psychology, and for good reason. Concentrating on what is wrong makes a person feel rotten, yet looking at what has or is working can break down the rigid thinking styles that hold anxiety in place.
- Be cautious of a therapist who says that you have to build a good relationship with them and that you will be in therapy for several years. You should expect to see some results almost immediately.
Counselling and Psychotherapy
There are many different types. A therapist that specialises in Short Term Solution Focused therapy or Cognitive Behavioural Therapy is likely to be more effective in helping you change uncomfortable anxiety patterns.
Brief therapy or short term solution focused therapy
An increasingly popular therapy that helps clients to change by consolidating solutions to the problem rather than dwelling on them. You will be helped to focus on what you want to achieve rather than what the therapist thinks that you ought to be doing. Clients can expect beneficial change from the first session. Milton Erikson was the pioneer of solution focused therapy. His valuable work has been carried on by Bill O'Hanlon at the Brief therapy family centre in Milwaukee Winconsin, Steve de Shazer and Insoo Kin Berg.
Hypnosis and Neural linguistic programming (NLP)
Again some of the roots can be traced back to the work of Milton Ericson. Today practitioners are equipped with sets of skills that help you to change the way that you think about things. They help you to structure the way that the brain reacts to situations so to maximise comfort and effectiveness in many situations.
Cognitive Behavioural Therapy (CBT)
Actively helps you to change the way that you think about certain things therefore effecting subsequent behaviour. Great for many anxiety based conditions.
Psychoanalysis can involve having to commit to years of reflective therapy. There is often a lot of time spent analysing childhood years and in our experience clients rarely feel more relaxed afterwards.
A doctor friend of mine recently said that most doctors shrink when someone with anxiety or depression comes to their practise. 'They have little training or time and most of our knowledge comes from personal research and drug companies.'
Many doctors in the UK are now being trained in basic Cognitive Behavioural Therapy skills. It is a helpful step forward which can produce good results but most people will need more time than a doctor can give. So look for a good counsellor as drugs are not your only option when looking for the right treatment for anxiety.
If you want more information on alternative treatments to drugs take a look at our non-drug treatment for anxiety and panic attacks.