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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Generalized anxiety disorder (GAD) has a biological component in that abnormal amounts of certain brain chemicals may play a role in its development and the condition often responds to medication. Anxiolytics (anti-anxiety medications) and antidepressants help ease the symptoms of anxiety. They are often used in combination with counseling, such as cognitive-behavioral therapy .
Depending on your situation, medication may be advised for the short-term or for a lengthy period of time. In general, people who are treated for a longer period of time usually have a lower relapse rate. Medication will likely be recommended if anxiety impairs your ability to function.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .
Common name: Buspirone (BuSpar)
Buspirone is a relatively new anxiolytic drug that is believed to enhance the activity of serotonin, a neurotransmitter involved in regulating anxiety and mood. It takes within two weeks to take effect. For that reason, it is not useful for treating acute anxiety and insomnia . The primary advantages of buspirone are that it is not sedating and it does not result in physical dependence or tolerance as compared with benzodiazepines.
Do not take buspirone with mono-amine oxidase (MAO) inhibitors. Do not take with alcohol or other sedating drugs. Use with caution if you have liver or kidney disease .
Possible side effects include:
Common names include:
Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA), a neurotransmitter thought to be abnormal in people with GAD. These drugs produce a sedative effect, reduce physical symptoms, such as muscle tension, and often cause drowsiness and lethargy.
Benzodiazepines are fast-acting and useful for treating acute anxiety and insomnia. These drugs can be habit-forming when used long-term or in excess. They may cause withdrawal symptoms, such as anxiety, irritability, and insomnia when discontinued. In such cases, you should taper off the medication slowly, over a period of weeks or months under a doctor’s supervision.
Withdrawal from benzodiazepines can be severe at times. It can include restlessness, tremors, delirum tremens , and seizures that can be life threatening. Dangerously high fever, confusion, hallucinations, and dehydration may also occur. Benzodiazepines should not be used for more than four weeks. GAD may return after stopping the drug, but that is often true of any medication or treatment. Talk to your doctor before changing how you take this medication.
Do not take with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate machinery. Benzodiazepines should not be taken in combination with certain oral antifungal medications or by people with certain types of glaucoma .
Possible side effects include:
*** see note above
Common names include:
Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety. Although they are considered antidepressants, SSRIs have been used effectively for the treatment of anxiety disorders. Improvement is usually seen in four to six weeks after beginning treatment. You should not drink alcohol while taking an SSRI. Do not take SSRIs if you are taking MAO inhibitors, thioridazine, or pimozide (Orap). Use with caution if you have liver or kidney disease.
Possible side effects include:
Common names include:
Tricyclic antidepressants are thought to regulate serotonin and norepinephrine in the brain. They have been used effectively for the treatment of depression . Improvement is usually seen in three to six weeks after beginning treatment. These drugs are highly toxic if taken in large doses; therefore, they are often not prescribed for suicidal patients. Tricyclic antidepressants are not addictive. These drugs are infrequently used for the treatment of GAD because of the many side effects, plus the overdose potential.
Possible side effects include:
Common names include:
Atypical antidepressants affect the concentration of serotonin and can be effective in treating GAD. Improvement is usually seen in four to six weeks after beginning treatment.
Possible side effects include:
Consultation with a specially trained mental health professional is recommended if you do not respond to treatment with medications. A mental health professional can help clarify the diagnosis and determine if another psychiatric disorder is present. He can also make recommendations about psychotherapy and changes in medications.
Whenever you are taking a prescription medication, take the following precautions:
Contact your doctor if you have any side effects that are troublesome and persistent.
References:
Anxiety and panic: gaining control over how you're feeling. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/common/mentalhealth/anxiety/013.html . Updated September 2006. Accessed October 29, 2008.
Fricchione G. Generalized anxiety disorder. N Engl J Med . 2004;351:675-682.
Generalized anxiety disorder (GAD). Anxiety Disorders Association of America website. Available at: http://www.adaa.org/GettingHelp/AnxietyDisorders/GAD.asp . Accessed October 29, 2008.
Merck website. Available at: http://www.merck.com/ . Accessed October 29, 2008.
Last reviewed July 2008 by Theodor B. Rais, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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