8 Things You Should Know About Anxiety Medicine

Anxiety disorders are common. Here’s what you need to know about medications.

Most everyone feels anxious at some point — especially during a pandemic — but also in “normal” times. Usually, that anxiety goes away with time. When it doesn’t, it could signal a clinical anxiety disorder.

Anxiety disorders are the most common form of mental illness, according to the National Institutes of Health. They affect more than 25 million Americans. There are five major types of anxiety disorders:

— Generalized anxiety disorder.

Obsessive-compulsive disorder.

— Panic disorder.

Post-traumatic stress disorder.

— Social phobia (or social anxiety disorder).

While each is different, they share many symptoms and methods of treatment, including medication. Here are eight things you should know about anxiety medications.

There are four common types of anxiety medications.

There are four main classifications, or types, of medication that doctors prescribe for anxiety. You may recognize some as treatments for depression as well:

— Selective serotonin reuptake inhibitors, or SSRIs.

— Serotonin-norepinephrine reuptake inhibitors, or SNRIs.

— Benzodiazepines.

— Tricyclics.

Anxiety medications help you control your symptoms and allow you to function better in your daily life. But they cannot cure the cause of anxiety.

Anxiety medications are usually safe and effective when prescribed and monitored by your doctor. These meds may be prescribed for short- or long-term relief.

They work by affecting brain chemicals.

Both depression and anxiety are thought to relate to chemicals in the brain called neurotransmitters that affect attention span, sleep and, especially, mood. These medications regulate neurotransmitters, leaving more “happy” chemicals available to the brain, but they do so in different ways.

— SSRIs slow the reuptake of serotonin.

— SNRIs inhibit serotonin and norepinephrine reuptake.

— Benzodiazepines increase the effectiveness of the neurotransmitter gamma-aminobutyric acid, or GABA, which slows down an anxious brain and nervous system.

— Tricyclic antidepressants prevent serotonin and norepinephrine from binding with receptors on the nerves, leaving more for the brain.

There are also other medication options.

Along with those four main classes, there are a few others that your doctor may try to treat anxiety.

Anxiolytics. These drugs work on regulating brain chemicals that may cause anxiety; Buspirone is a popular example of an anxiolytic.

Monoamine oxidase inhibitors, or MAOIs. These drugs are Food and Drug Administration-approved to treat depression, but many doctors also use them for anxiety, specifically panic disorder and social phobia. Examples of MAOIs include phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate) and selegiline (Emsam).

Beta blockers. Known better for treating high blood pressure and other cardiovascular conditions, beta blockers may be prescribed for social anxiety. They block the effects of norepinephrine, a brain chemical associated with high arousal, and are good at relieving physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling and blushing, the NIH says.

It takes time to find the right medication.

Patients respond differently to these different medications. And each may be better suited to a different issue.

For example, if anxiety is due to a specific, short-term event, like flying in an airplane or giving a big speech, the best choice might be a benzodiazepine, according to Dr. Michael Thase, professor of psychiatry and chief of the Division of Mood and Anxiety Disorders Treatment and Research Program at the University of Pennsylvania.

Long-term anxiety may be better treated with one of the antidepressants in the SSRI and SNRI classes, Thase says. Even within these classes, each patient might respond better to one medication over another. So it’s not unusual for a patient to try more than one drug before finding the best treatment.

Medications work best with psychotherapy.

For most long-term or chronic anxiety, providers will prescribe psychotherapy along with medication, to help treat the cause of your illness.

The NIH lists the following types of psychotherapy for anxiety:

Cognitive behavioral therapy, which helps people think and behave differently when faced with a triggering situation.

Cognitive therapy, which helps people notice and combat unhealthy or distorted thinking.

Exposure therapy, which helps people face their fears and get past them so they can pursue activities they have avoided.

Some medications may be habit-forming.

SSRI and SNRI antidepressants may be taken long term if needed, without risk of dependence. This isn’t the case with a benzodiazepine.

“You should try to avoid staying on a benzodiazepine for longer than a few weeks if you can. After that, there is a small risk of dependence and tolerance,” Thase warns. “Benzodiazepines also may inhibit the progress of some kinds of psychotherapy.” Some research has found that these meds, for unclear reasons, reduce the effectiveness of therapy for PTSD patients.

Stopping too quickly is dangerous.

Medications prescribed for anxiety (and depression) should be taken exactly as prescribed. That includes when you’re trying to wean off them. Stopping too quickly can cause withdrawal symptoms and serious health risks, among them suicidality, which is having thoughts of self-harm.

With an SSRI, for example, “withdrawal feels like electrical tingling in the hands and arms — ‘zaps’ as they call them,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University.

Other symptoms include dizziness or vertigo when moving your head, he says. These symptoms usually pass in one to two weeks, but you should contact your doctor when you experience any side effects of these medications.

The best medication may be no medication.

While moderate to severe anxiety most likely benefits from interventions like medication and psychotherapy, mild or occasional anxiety may be better treated with lifestyle changes:

Diet. Avoiding stimulants like caffeine, depressants like alcohol and high-sugar, high-fat foods can reduce anxiety, says Ramsey, founder of the Brain Food Clinic and author of the book “Eat to Beat Anxiety and Depression: Nourish Your Way to Better Mental Health in Six Weeks.” Chamomile, in either tea or supplement form, also has been shown to help reduce generalized anxiety.

Exercise. The Anxiety and Depression Association of America reports that exercising for just 10 minutes can elevate your mood.

Sleep. While anxiety can interfere with sleep, the opposite is also true: Poor sleep can contribute to anxiety. Improving sleep habits can improve mental well-being.

Mindfulness. Meditation, yoga, deep breathing exercises and other relaxation techniques help calm the worried mind.

Aromatherapy. Essential oils like lavender also can help reduce anxiety, according to a study published in Evidence-Based Complementary and Alternative Medicine journal.

Here are eight things to know about anxiety medications.

— There are four common types of anxiety medications.

— They work by affecting brain chemicals.

— There are also other medication options.s

— It takes time to find the right medication.

— Medications work best with psychotherapy.

— Some medications may be habit-forming.

— Stopping too quickly is dangerous.

— The best medication may be no medication.