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What medications are used to treat anxiety disorders?
Medication treatment of anxiety is generally safe and effective. But it often takes time and patience to find the drug that works best for you.
The first line of treatment for an anxiety disorder is often cognitive-behavioral therapy, or CBT. This is a well-established, highly effective, and lasting treatment. Some people find that excessively high levels of anxiety make them unable to get the most out of such treatment, however. In this case, medication may allow full participation in CBT. Those without access to CBT or those who have not had a satisfactory response to it may benefit from medication treatment, too.
Things to Consider
Have a discussion with your doctor about medication if you are suffering from significant insomnia, which is frequently associated with generalized anxiety disorder, or GAD. Distressed by repetitive and excessive worry, people with GAD usually focus on the day’s activities, such as what was left undone, what went wrong, what needs to be done tomorrow, and the like. People with this condition describe it as a difficulty turning their mind off, and they often have difficulty falling asleep. Improving sleep has been shown to reduce anxiety and depressive symptoms, and it can often be achieved with medication treatment.
Depression often complicates chronic anxiety. Don’t ignore a sad mood, bouts of tearfulness, low self-esteem, feelings of guilt or hopelessness, and other depressive symptoms. Medication is often helpful in reducing symptoms of anxiety and alleviating those of depression. Most drugs used to treat anxiety come from the antidepressant class of medication, so they can be used to treat both conditions effectively.
Variety of Medications
Four major classes of medications are used to treat anxiety disorders.
| Medication class | Generic names | How it works |
| SSRI (selective serotonin reuptake inhibitor) | citalopram, escitalopram, fluoxetine, paroxetine, sertraline | Relieves symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which enhances neurotransmission—the sending of nerve impulses—and improves mood. SSRIs are “selective” because they affect only serotonin and not other neurotransmitters. |
| SNRI (serotonin-norepinephrine reuptake inhibitor) | venlafaxine, duloxetine | Increases the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain. |
| Tricyclic antidepressant | amitriptyline, imipramine, nortriptyline | Inhibits the reabsorption of the neurotransmitters serotonin and norepinephrine. (Has been increasingly replaced by SSRIs.) |
| Benzodiazepine | alprazolam, clonazepam, diazepam, lorazepam | Promotes relaxation and reducing muscular tension and other physical symptoms of anxiety. Frequently used for short-term management of anxiety, such as for minor medical procedures. |
Other medications may also be used to treat anxiety disorders, including MAOI's (monoamine oxidase inhibitors), anticonvulsants, beta blockers, and atypical antipsychotics (also known as second-generation antipsychotics).
If you experience a side effect of any medication, contact your physician. Do not stop taking a medication abruptly because it may create other health risks.
Making a Decision
If you and your doctor have decided on medication as a treatment option, you have many choices. Work with your doctor to find the medication that’s right for you. With patience and persistence, you will find a treatment that will help alleviate your anxiety symptoms.
Justine Kent, MD, is a psychiatrist in New Jersey.
How can I tell if I’m having a panic attack or a heart attack?
Panic attacks and heart attacks can feel frighteningly similar: shortness of breath, palpitations, chest pain, dizziness, vertigo, feelings of unreality, numbness of hands and feet, sweating, fainting, and trembling. Some people describe this experience as feeling as if they’re losing control or going to die.
A panic attack occurs spontaneously or a stressful event can trigger it, but it poses no immediate danger. A heart attack is dangerous, and it requires prompt medical attention. In women, though, heart disease symptoms are sometimes mistaken for a panic attack.
Panic disorder is diagnosed in people who experience panic attacks and are preoccupied with the fear of a recurring attack. Like all anxiety disorders, this one is treatable.
Reid Wilson, PhD, offers this advice:
For someone who has had a heart attack and also has panic attacks, together we identify, along with their physician, the symptoms that should trigger an immediate trip to the emergency room. Whether it turns out to be another panic attack or not, this person should treat those symptoms as a possible heart attack. He or she is to treat all other symptoms as signs of anxiety or a panic attack, even though they may feel like a heart attack.
Those who have never had a heart attack—but have been diagnosed with panic disorder and are fearful of a heart attack—should get a thorough physical evaluation to determine their heart health. If they are not at risk of a heart attack, then we begin the psychological work: They must be willing to be uncertain whether they are having a panic attack or a heart attack.
Their first goal is to respond to their typical anxiety or panic symptoms as anxiety or panic. Their position should be to say, ‘I want to recover from panic disorder strongly enough that I am willing to have a heart attack and miss it.’ That is how they will confront their need to be 100 percent certain.
Recent research suggests that people who have received a diagnosis of panic attacks or panic disorder under age 50 have an increased risk of developing heart disease or suffering a heart attack. The conclusions in this study are not definitive, and reasons for the increase in heart disease and heart attack were not established. More studies must be conducted to find out whether panic disorder is a risk factor for developing heart disease.
Mark Pollack, MD, says the findings of this research offer some value. He adds, “The study does suggest the possibility that, like other modifiable cardiac risk factors such as poor diet, sedentary lifestyle, or hypertension, treatment of panic and anxiety may have a beneficial effect on reducing the likelihood of developing heart disease.”
Whenever you’re in doubt about your symptoms, seek care without delay. Only medical tests can rule out the possibility of a heart attack. Once a heart attack is ruled out, seek effective treatment such as talk therapy and medication.
Find a therapist with experience treating panic disorder to learn how to manage panic attacks in the future.
Learn seven steps to break the cycle of panic in Facing Panic, Self-Help for People with Panic Attacks.
Reid Wilson, PhD, is the Director of the Anxiety Disorders Treatment Center, Chapel Hill, North Carolina, and the Associate Clinical Professor of Psychiatry at the University of North Carolina School of Medicine
Mark H. Pollack, MD, is the Director of the Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, and Professor of Psychiatry, Harvard Medical School
What is hoarding, and how do I know if I’m a hoarder? What is the difference between hoarding and collecting?
Hoarding is the compulsive purchasing, acquiring, searching, and saving of items that have little or no value. The behavior usually has deleterious effects—emotional, physical, social, financial, and even legal—for a hoarder and family members.
The descriptions below are typical of someone who hoards:
- Avoids throwing away possessions (common hoarded items are newspapers, magazines, paper and plastic bags, cardboard boxes, photographs, household supplies, food, and clothing)
- Experiences severe anxiety about discarding possessions
- Has trouble making decisions about organizing possessions
- Feels overwhelmed or embarrassed by possessions
- Is suspicious of other people touching possessions
- Has obsessive thoughts about possessions:
- Fear of running out of an item and needing it later
- Checks the garbage to see if an item was accidentally discarded - May have functional impairments:
- Loss of living space inside the home (no place to eat, sleep, or cook)
- Social isolation
- Family or marital problems
- Financial difficulties
- Health hazards
People hoard for many reasons, among them the belief that their possessions will be useful or valuable in the future, have sentimental value, are unique and irreplaceable, or because they can’t decide where something goes, it’s better just to keep it.
Hoarding vs. Collecting
Hoarding is not the same as collecting. In general, collectors have a sense of pride about their possessions, and they experience joy in displaying and talking about their possessions and conversing. They keep their collection organized, feel satisfaction adding to it, and budget their time and money.
Hoarders generally experience embarrassment about their possessions and feel uncomfortable when others see them. Their clutter often takes over functional living space, and they feel sad or ashamed after acquiring additional items. Also, they often incur great debt, sometimes extreme.
Effective treatment is available from qualified mental health professionals, who can also help the affected family members.
Listen to a podcast about hoarding.
Find a therapist in your area who can treat hoarding.
Fugen Neziroglu, PhD, ABBP, ABPP, is the Clinical Director and Co-Founder of the Bio-Behavioral Institute, Great Neck, New York.
