Medications are a quick option to eliminate a problem. But this does not mean that they are the best alternative, much less the only one. In the case of mental problems such as depression, generalized anxiety or phobias, medications help reduce the intensity of the symptoms but do not eradicate the problem. Therefore, one of the most common complaints of those who take anxiety medications is that as soon as they stop taking them, the symptoms return, sometimes with more intensity than before.
Still, the truth is that the use of anxiety medications has increased exponentially in the last decade, both in Europe and the United States. Therefore, it never hurts to take a look at how these types of drugs work.
Types of anxiety medications
Not all anxiety medications are the same or used to treat the same symptoms. In fact, some have many contraindications while others are more “mild”. The most common drugs are listed below:
– Selective Serotonin Reuptake Inhibitors (SSRIs). These are the most commonly used anxiety medications since they are normally the first choice of the family doctor or psychiatrist.
The reason is very simple: SSRIs have proven to be very effective in combating anxiety , they do not create addiction, they do not cause memory problems, they do not interfere with psychotherapy since they do not affect the person’s level of wakefulness and have minimal side effects (when SSRIs cause side effects, they usually go away within the first week).
However, a minority of patients have reported a decrease in libido and sexual sensations, which is why it is used in the treatment of premature ejaculation. Another disadvantage is that they must be taken for 4 to 6 weeks before reaching their maximum effectiveness, and some SSRIs can cause uncomfortable withdrawal symptoms if stopped abruptly. In the case of people with bipolar disorder, SSRIs can trigger a manic episode and for this reason they are prescribed along with a mood stabilizer. There is also evidence that SSRIs may increase the risk of suicide among younger patients.
Very roughly speaking, these drugs work by increasing signaling between neurons that use a chemical called serotonin to communicate with each other. Among the most common SSRIs are: Prozac (fluoxetine), Celexa (citalopram), Lexapro (escitalopram), Zoloft (sertraline), Paxil (paroxetine) and Luvox (fluvoxamine).
– Serotonin and norepinephrine reuptake inhibitors (SNRIs). Basically, these anxiety medications perform the same function as SSRIs but also affect norepinephrine levels. When used to treat anxiety, their benefits and side effects are essentially the same as those of SSRIs and, like SSRIs, they must be taken for 4 to 6 weeks to achieve their maximum effect. Currently available SNRIs are: Effexor (venlafaxine), Cymbalta (duloxetine) and Pristiq (desvenlafaxine).
– Benzodiazepines. This class of medications includes some of the best-known drugs, such as Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). Although benzodiazepines are quite commonly prescribed to treat anxiety symptoms, they are no longer considered a first-line treatment because although they reduce anxiety quickly, they often cause problems when taken long-term.
Benzodiazepines cause intolerance, meaning that doses will need to be increased over time to achieve the same effect. It has also been associated with a particularly strong withdrawal syndrome that can even cause seizures, not to mention that these medications cause addiction.
Benzodiazepines also inhibit the formation of new memories, which can have a negative impact on psychotherapy. Additionally, these medications can be lethal when combined with alcohol or opioids.
However, when used appropriately, benzodiazepines can play an important role in the treatment of anxiety disorder. For example, it is sometimes used in combination with an SSRI to speed healing during the first few weeks of treatment before the SSRIs have reached their maximum effectiveness.
– Buspirone. It is a medication that is sometimes used to treat anxiety. Like SSRIs, buspirone acts at a neuronal level on serotonin levels, but unlike SSRIs that increase the amount of serotonin available to all serotonin receptors, buspirone only affects a specific subtype of serotonin receptor. An advantage of this selectivity is that buspirone does not cause the sexual side effects that have been associated with SSRIs. Like SSRIs and SNRIs, buspirone may take 4 to 6 weeks to reach maximum effectiveness.
– Hydroxycin. Like benzodiazepines, the effects of hydroxyzine occur rapidly, but unlike benzodiazepines, hydroxyzine is not habit-forming and does not produce tolerance, withdrawal, or memory impairment. The most important side effect of hydroxyzine is sedation, but this tends to decrease over time. The anti-anxiety effects of hydroxyzine are due to it blocking the histamine receptor.
– Gabapentin. It is a medication that is primarily used to treat seizures and nerve pain but is also used with some frequency to combat anxiety. Like hydroxyzine, gabapentin works quickly and without many of the problems associated with benzodiazepines. However, a withdrawal syndrome may occur and some people experience significant drowsiness. Like SSRIs, gabapentin has also been associated with an increased risk of suicide.
Because gabapentin has “gaba” in its name, it is often mistakenly believed to directly affect neurons that use a chemical called GABA to communicate with each other. However, the exact mechanism of action of gabapentin is currently unknown, although it is assumed that it affects the movement of calcium across the cell membrane.
Obviously, there are many other medications for anxiety since this is not a complete list and psychiatrists are free to use the most appropriate drug according to the patient’s characteristics. However, we must remember that Cognitive Behavioral Therapy has shown its effectiveness in combating anxiety and is considered the first option among all treatments for anxiety. The main benefit of psychotherapy is that its benefits stand the test of time and that it does not cause adverse effects.
Reference:
Schiffman, JE (2011, November) Anti-Anxiety Medications Explained . In: Psychology Today.
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