How to Choose an Anti‐Anxiety Medication

Five Parts:Exploring Treatment with a Mental Health ProfessionalTreating Short-term Anxiety with BenzodiazepinesUsing Antidepressant Medication for Long-term TreatmentTaking Buspirone (BuSpar)Trying Beta Blockers

There are many options to choose from when making the decision to take medication for anxiety. While medications do not treat underlying causes of disorders, they can help manage symptoms. Prior to taking medications, recognize that you have options in treating anxiety outside of medication such as therapy, relaxation skills, and adjusting your thoughts to be more positive.[1] Always consult with a medication expert prior to starting a course of treatment with anti-anxiety medications.

Part 1
Exploring Treatment with a Mental Health Professional

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    Discuss medication with your provider. Once you are diagnosed with anxiety, you may wish to seek treatment soon after. Treatment often includes therapy and/or medication. Taking medication is a big decision to make. Carefully consider your options and discuss your concerns with your prescriber.
    • Some questions to ask may include, “How will the medication help me? What side-effects should I look out for? Should I avoid any foods? Are drug interactions with other prescriptions or supplements a possibility? How will this medication interact with any other medications I take?”[2]
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    Select a medication with your provider. Some medications are more suitable for one kind of anxiety than another. Make sure you have a clear diagnosis prior to obtaining medication, as some medications are more effective at treating certain diagnoses better than others. Let your provider know what you want to treat and how often you want to take medication. For instance, benzodiazepines are best used for short-term use, whereas SSRIs and other medications are more suitable for long-term use.
    • It’s important to communicate to your provider any medications you currently take. Drug interactions can occur with anxiety medications, so speak up about any prescription or nonprescription drugs you take. Also note any supplements or herbs you take regularly.[3]
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    Know that medications come with risks. Many medications come with risks and side-effects. Talk to your provider about possible side-effects you may encounter. Share any medical or psychological diagnoses you have and that you take medication to treat. Bring up any possibility that you are pregnant, want to get pregnant, or are breastfeeding.[4]
    • Some people experience serious side-effects or allergic reactions. Others may feel no effect of the medication at all and may need to change medications.
    • Some medications come with the risk of abuse. Some medications may come with the risk of withdrawal symptoms when terminating use. Discuss these risks ahead of time with your provider.
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    See a therapist. Medications do not cure psychological conditions, they aim to ease symptoms. Therapy is an effective way of identifying negative thought and behavior patterns in your life and learning more adaptive and positive coping skills.[5]
    • If you wish to avoid negative side-effects or interactions, consider choosing therapy before obtaining medication. For many individuals, therapy alone is the best course of treatment.[6]
    • Choosing medication and therapy can be beneficial in treating severe anxiety. Medication can help ease symptoms while therapy can help you learn skills to approach life differently.
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    Use medications as directed. If you do obtain medications, use as directed. Do not combine doses or take more or less than your prescriber intended. Do not double dose or skip doses. If you do, notify your prescriber.
    • Do not share medication with others. Do not use prescription medications as recreational drugs.[7]
    • Make regular appointments with your prescriber to monitor benefits, side-effects, and proper dosage.

Part 2
Treating Short-term Anxiety with Benzodiazepines

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    Identify uses of benzodiazepines. Benzodiazepines (benzos) are by far the most commonly prescribed anti-anxiety medications. Benzos are used to slow down the central nervous system and can be beneficial for anxiety disorders such as panic attacks or other overwhelming anxiety episodes. Benzos work quickly (within 30-60 minutes), making them useful for dealing with specific stressors.[8]
    • Benzos can be most helpful in short-term situations such as relieving a panic attack, dealing with a specific stressor, or helping to calm the mind and body for a specific event.
    • Some common benzos include lorazepam (Ativan), alprazolam (Xanax), midazolam (Versed), oxazepam (Serax), and clonazepam (Klonopin).[9]
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    Discuss treatment and side-effects with your prescriber. Contact your prescriber with any serious side-effects. Common side effects include drowsiness and dizziness, nausea, stomach upset, blurred vision, headache, confusion, depression, trembling, weakness, grogginess, or memory loss.[10] If side-effects are too severe, your prescriber may change medications or alter the dose.
    • Notify a medical professional if you develop chest pains, changes in heart rate, vision changes, or yellowing in the eyes or of the skin.
    • Few people develop an allergic reaction to benzodiazepines. If you do develop a reaction, watch out for rash, itching, swelling, dizziness, or difficulty breathing.
    • Any major impacts such as hallucinations, confusion, or major health upsets should be reported to your prescriber right away.
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    Know the risks of addiction and abuse. Benzos are a schedule IV controlled substance, meaning there is a high risk for addiction, abuse, and use for diversion.[11] Benzos can become highly addictive, which is why they are recommended only for short-term use.
    • If you are at-risk for abusing benzos or for using them recreationally, do not take them.
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    Avoid long-term use. Tolerance, dependence, and withdrawal can occur with long-term use of benzodiazepines. For this reason, benzos are best used for short-term problems or intermittently. Long-term treatment of anxiety should not include the use of benzos. It’s best to use benzos for a matter of weeks (up to 4 weeks) and no more.[12]
    • If you wish to treat long-term anxiety, stay away from benzos. Ask about other options that are safe for long-term use.
    • Unpleasant withdrawal symptoms can occur with prolonged use of benzos. Do not stop benzos “cold turkey.” Follow the protocol given to you by your prescriber to safely stop using benzos.
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    Consider medical risks. Those with liver problems, kidney disease, or drug allergies should communicate the diagnosis and any medication used to treat these conditions to the prescriber prior to obtaining medication. Benzos can negatively interact with other prescription and nonprescription drugs, so be sure to bring up any medications you currently take with your prescriber.[13]
    • During your appointment with your prescriber, discuss any medications you are currently taking. This includes vitamins, herbs, supplements, and recreational drugs. Note any allergies or adverse effects you’ve encountered with other medications, or that family members have encountered.[14]
    • Benzos are not recommended for elderly patients as side effects can be more severe.[15]
    • Discuss any plans to get pregnant with your provider, as benzos can be associated with birth defects when taken during pregnancy.[16]
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    Weigh lifestyle risks. If you take benzos, avoid eating or drinking grapefruit and taking Kava or St. John’s Wort.[17] Some interactions can lead to severe sedation and be deadly, such as interaction with alcohol, barbiturates, narcotics, and tranquilizers.[18]
    • If you regularly drink alcohol, benzos may not be the right medication for you as it can be unsafe to consume alcohol and take benzos.[19] Talk to your prescriber.

Part 3
Using Antidepressant Medication for Long-term Treatment

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    Identify when to use antidepressant medication. Although considered antidepressants, some medications can be used to treat anxiety effectively. Unlike anti-anxiety medication, antidepressants are safe for long term use.[20] Antidepressant medication may be most beneficial for individuals who suffer from long-term anxiety symptoms.
    • Some medications used to treat anxiety include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants.[21]
    • SSRIs are most typically prescribed for treating anxiety. SSRI medications include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), Sertraline, (Zoloft), and Paxil CR.[22]
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    Watch for suicidal thoughts. The Food and Drug Administration (FDA) of the United States of America requires that all antidepressant medication receive a “black box label,” the most severe warning for prescription drugs. Children, teenagers, and young adults (up to age 25) are warned to be at increased risk for suicidal thoughts and behaviors while taking antidepressant medication.[23]
    • Suicide risk is highest in the first weeks and months of taking medications as well as when changes are made in your dose.
    • If you experience suicidal thoughts or behaviors seek help immediately. Contact your therapist and psychiatrist. Go to the Emergency Department, call a hotline, or call a friend to help you.
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    Recognize if antidepressants are unsafe for you. Do not take antidepressants if there is a risk you may be allergic to the medication. Inquire about family history with antidepressants. Be careful in mixing or overlapping antidepressant medication with other prescription drugs. Avoid SSRIs if you have taken the following medications within the past two weeks: thioridazine (Mellaril), pimozide (Orap), or monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil) and tranylcypromine (Parnate).[24]
    • Take extra precaution if you have one of the following diagnoses: a heart condition, prostate enlargement, glaucoma, hyperthyroidism, epilepsy, liver problems, or bipolar disorder.[25]
    • Do not take antidepressants and St John’s Wort at the same time. This can fill your body with too much serotonin and lead to Serotonin Syndrome.[26] If you take St John’s Wort, let your prescriber know prior to obtaining a prescription.
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    Inform yourself of the side-effects. Some common side-effects of antidepressants include insomnia/sleepiness, nausea, dry mouth, dizziness, sexual dysfunction, and weight gain.[27] Side-effects are likely to increase when first starting medication or when changes to your dose are made.[28] Contact your provider if you experience negative side-effects. He or she may adjust your dose or provide a different medication.
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    Note the risks of withdrawal. If you do take antidepressant medication, do not stop taking medication without notifying your prescriber. You may experience withdrawal symptoms such as nausea, dizziness, anxiety, stomach upset, or flu-like symptoms.[29]
    • You will likely slowly taper your doses over several weeks or months. Use as directed.

Part 4
Taking Buspirone (BuSpar)

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    Identify uses of BuSpar. BuSpar is a newer anti-anxiety medication that is slower acting than other anti-anxiety medications. Unlike other anti-anxiety medications, BuSpar is less sedating, does not impair memory and coordination, it’s not very addictive, and the withdrawal effects are minimal.[30]
    • BuSpar is recommended for older adults and those with a history of substance abuse, as it is not addictive.
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    Note side-effects. BuSpar can cause nausea, headaches, dizziness, drowsiness, diarrhea, dry mouth, and upset stomach. The side-effects of BuSpar appear to be less pronounced than other medication side effects. Withdrawal appears to be less pronounced as well.[31]
    • Talk to your prescriber regarding any negative side-effects you experience. He or she may adjust the dosage or change medications.
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    Watch out for drug interactions. Alert your provider to any medications you currently take, including prescription medications, herbs, supplements, or recreational drugs. BuSpar can negatively interact with monoamine oxidase inhibitors(MAOIs) such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) and trazodone (Desyrel).[32] Talk with your provider if you take any of these medications
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    Recognize limitations of BuSpar. BuSpar appears to only effectively treat generalized anxiety disorder (GAD). It does not seem to effectively treat severe anxiety or other anxiety disorders such as phobias, panic attacks, or obsessive-compulsive disorder (OCD).[33]
    • Talk to your prescriber whether BuSpar is a good option for you.

Part 5
Trying Beta Blockers

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    Identify uses for beta blockers. Although typically prescribed for high blood pressure, beta blockers can be used to treat symptoms of anxiety. They are most useful for treating phobias like social phobia and performance anxiety.[34] Beta blockers do not address emotional symptoms of anxiety, and therefore do not effectively treat worry.
    • Beta blockers used to treat anxiety include the drugs propranolol (Inderal) and atenolol (Tenormin).
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    Be alert to medical interactions. Tell your provider if you have a history of asthma or lung disease, heart disease, kidney disease, diabetes, or allergies to any medications. This may influence whether beta blockers are right for you or if they may negatively impact your condition or interact with medications.[35]
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    Note common side-effects. Beta blockers can include side-effects such as nausea, drowsiness, slow pulse, cold hands, and light-headedness. Less common side-effects include shortness of breath, trouble sleeping, loss of sex drive, and depression.[36] Alert your provider if you experience negative side-effects. He or she may change your dose or put you on a new medication.

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