Pharmacologic Treatments (Medication)
Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.The use of psychiatric medications for anxiety disorders is somewhat controversial. Some clinicians would argue that medications do not treat the disorder itself. Instead, they would argue that medication only masks the symptoms. If medication is discontinued, the symptoms will generally return if psychotherapy has not been provided. However, other clinicians believe that anxiety symptoms originate from faulty brain chemistry. From this perspective, they conclude that medication does indeed treat the disorder. Further study is required before this debate is resolved. In the meanwhile, medication is frequently offered as an adjunct to psychotherapy.
Psychiatric medications fall into six main categories: 1) antidepressants, 2) stimulants, 3) antipsychotics, 4) mood stabilizers, 5) anxiolytics, and 6) depressants. Anxiety disorders are most commonly treated with antidepressants and anxiolytics. Each of these medication classes impact different neurotransmitters. Neurotransmitters serve as chemical messengers in the brain. They are thought to play a key role in many psychiatric disorders.
The so-called "anti-depressant" medications target two neurotransmitters; serotonin and norepinephrine. These are believed to be involved in both mood disorders (such as depression) and anxiety disorders. This makes a great deal of sense because depression and anxiety commonly co-occur and are thought to share a similar etiology.
Two groups of anti-depressant medications are used to treat anxiety disorders. It generally takes about two weeks for these drugs become effective. The first group is called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are believed to relieve the symptoms of depression and anxiety by blocking (inhibiting) the re-absorption (re-uptake) of serotonin in the brain's receptor cells. This blocking action means there is more serotonin available. Therefore, SSRIs increase serotonin. The SSRIs include drugs such as: Luvox®, Zoloft®, Lexapro®, Celexa®, Prozac®, and Paxil®.
The second group of anti-depressant medications is called Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). The SNRIs block the re-uptake of both serotonin and norepinephrine. This blocking action increases the level of both serotonin and norepinephrine in the brain. These medications are considered more broad-spectrum medications. Since anxiety disorders have been associated with a dysregulation of both serotonin and norepinephrine, these medications effectively target the symptoms of anxiety. Some commonly prescribed SNRIs include: Effexor®, Pristiq®, and Cymbalta®. Both SSRIs and SNRIs are not considered addicting, nor are they believed to create drug dependence. However, some people have reported difficulty when discontinuing these drugs.
Anxiolytics (or anti-anxiety) medications are another type of medication used to treat anxiety disorders. Benzodiazepines are a commonly prescribed type of anxiolytic. Benzodiazepines offer short-term, immediate relief of anxiety symptoms but can result in drug dependence. Therefore, these drugs are prescribed cautiously, and for a shorter duration of time. Because of their immediate effect they are often used until the anti-depressants and/or therapy have a chance to become effective. Benzodiazepines increase the action of gamma aminobutyric acid (GABA) in the brain. GABA is a naturally occurring brain chemical. It slows down brain activity and results in a feeling of calm and relaxation. Commonly prescribed benzodiazepine drugs are: Xanax®, Librium®, Klonopin®, Valium®, and Ativan®. Another anxiolytic, Buspar®, is a non-addicting and non-sedating. It targets the same symptoms as benzodiazepines. Like the antidepressants drugs, Buspar® takes up to 2 weeks to take effect, whereas the benzodiazepines take effect immediately. Buspar is effective for GAD LINK and can be used as an adjunct to the antidepressants.
There are both advantages and disadvantages to using psychiatric medications. Some people's anxiety symptoms make it difficult for them to attend and participate in therapy, or to practice therapy exercises. In these cases, medications can be very helpful by reducing symptoms that interfere with treatment. Medications can also be beneficial when a person has a co-occurring disorder that interferes with treatment, such as depression. For example, a depressed person with Panic Disorder may find it difficult to get out of bed in the morning. As such, they would have trouble attending therapy. In this case, the depressive symptoms might need to be treated first with medication, so the person can benefit from therapy. Medications can also help people to better tolerate the more difficult and anxiety-provoking exposure and response prevention (ERP) exercises.
While medications have many advantages, there are also some disadvantages. Newer medications have fewer side-effects than earlier drugs. Nonetheless, some people continue to experience uncomfortable side-effects from medication. Others do not respond as expected to medications, experiencing minimal benefit. The potential for drug dependence, and overuse with the benzodiazepines is also a concern. Sometimes drugs can actually interfere with the therapeutic process. From a theoretical perspective, exposure and response prevention (ERP) works most effectively when people fully experience their anxiety so that habituation and extinction can occur. The excessive use of anti-anxiety medications interferes with that process. If overly sedated by anxiolytic drugs, the therapy participant may not experience anxiety during ERP sessions. Many cognitive-behavioral therapists recommend a conservative use of psychiatric medications. This is particularly true when cognitive-behavioral therapy is leading to less than desired improvement; or, when symptoms are severe enough to interfere with many areas of daily life.
People with anxiety disorders are encouraged to discuss medications with their healthcare professionals. Psychiatrists, psychopharmacologists, neurologists, and psychiatric nurse practitioners are all good choices. These discussions enable people to make well-informed decisions about the pros and cons of medication. When a person is participating in therapy with a non-prescribing practitioner such as a psychologist or social worker, they should discuss their interest in medication with these providers as well. As mentioned, some therapies are less effective when medications are used. However, in general, the combination of medication and cognitive-behavioral therapy complement each other quite well. Both have proven to be successful in improving people's symptoms and the quality of their lives.
Resources
-
Articles
- What is Anxiety?
-
The Biopsychosocial Model of Anxiety
- The Biopsychosocial Model: Causes of Pathological Anxiety
- Biological Explanations of Anxiety Disorders
- Biological Explanations of Anxiety: Part II
- Biological Explanations of Anxiety: Part III
- Biological Explanations of Anxiety: Part IV
- Psychological Explanations of Anxiety Disorders
- Psychological Explanations: Part II
- Social Explanations of Anxiety Disorders
- Development & Maintenance of Anxiety Disorders
-
Classification & Diagnosis of Anxiety Disorders
- The Classification and Diagnosis of Anxiety Disorders
- Panic Attacks: A Classic Symptom of Several Anxiety Disorders
- Panic Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Agoraphobia
- Specific Phobias and Social Anxiety Disorder (Social Phobia)
- Generalized Anxiety Disorder (GAD)
- Other Anxiety-Related Disorders
- Anxiety and Other Psychiatric Disorders
-
Anxiety Disorder Theories and Therapies
- Anxiety Disorders: Theories and Therapies
- Behavioral Learning Theory and Associated Therapies
- Operant Conditioning
- Operant Conditioning and Avoidance Learning
- Contemporary Views of Behavioral Learning Theory
- Behavioral Therapies for Anxiety Disorders
- Cognitive Theory and Associated Therapies
- Cognitive Therapy
- Cognitive-Behavioral Therapy
- Adjunct Therapies
- Pharmacologic Treatments (Medication)
-
Treatment of Anxiety Disorders
- Treatment for Separation Anxiety Disorder
- Treatment for Selective Mutism
- Treatment for Panic Disorder
- Treatment for Specific Phobias and Treatment for Social Anxiety Disorder (Social Phobia)
- Treatment for Generalized Anxiety Disorder (GAD)
- Treatment for Obsessive-Compulsive Spectrum Disorders (OCSDs)
- Conclusion
- Anxiety Disorder References & Additonal Resources
-
News
-
Questions and Answers
- Anxious About Opinions
- Possible OCD and Anxiety issues
- Fear
- Stay in Therapy Because I Like it?
- Is My Anxiety a Normal Reaction?
- What am I Supposed to do With a Hypochondriac Step Daughter?
- Need Help
- Husband Continually Annoyed/Angry With Me
- How Can I Overcome my Debilitating Shyness and Fear of Life?
- Really Desperate..Please Help
-
111 more
- OCD and Trauma?
- Depression
- I Don't Care For Anything, I Feel as Though I'm Wasting my Life.
- Unwanted Thoughts
- Anxiety Has Taken Over My Life...
- CBT Therapy and Transference
- Transference II
- OCD
- 19 Yr Old Naive Daughter
- Fear of Choking
- Help
- Should I be Worried?
- Too Much Time doing Homework
- Falling Apart
- Can't Stand Noise
- What Is Intimacy, Exactly?
- Is She Ill?
- Social Anxiety, Depression and More...
- Do I Have Just Social Anxiety or Other Diagnoses Combined with SA?
- Need To Ask Someone
- False Memories
- Help! Please!
- Two Year Old Son Wandered
- Infections and The Brain
- Are Personality Disorders For Life?
- I am Terrified of Death.
- Anhedonia
- Our 23 Year Old Son Refuses to Get Help for His Anxiety Attacks and Depression.
- Anxiety
- Anxiety Disorder vs. Personality Disorder: Differences?
- Restroom Phobia
- I'm Afraid I'm Going Crazy
- Post Brain Surgery Mental Problems
- Would Medication Help?
- obsessive strange thoughts about life and existentialism
- Am I Crazy?
- Is it Anxiety? Is it Normal to Be Like That?
- Depressed 19 year old college student
- Depression helps to contribute to my unemployment! - Paula
- Relationship Anxiety
- Disconnected
- I'm Scared
- Please help fix my mom. - Kenny
- OCD?
- Saving my Son
- Scary thoughts, dark feelings, help?
- Swallowing fear
- Is there something wrong with me?
- I have PTSD and I feel nothing
- OCD Cure
- Repressed Memory
- I have OCD. Will this increase my child's chance of developing Autism?
- Crazy Thoughts
- 20 Year Old Female: no friends, depressed, what should I do?
- unwanted thoughts!
- crazy thoughts... all the time
- A very low threshold for stress tolerance
- Why can't I get gross images out of my head?
- fear of expiration
- SPECIFIC PHOBIA
- anxiety or going crazy?
- OCB
- visions of what could have been
- about depersonalization
- obsessive compulsive disorder
- OCD/ANXIETY while pregnant
- Amnesia
- Social Phobia
- Constant Counting Disorder
- Anxiety
- Is this OCD?
- Worried about my therapist
- No Friends
- Teenager...angst vs. mental health issue
- phobia regarding uncertainty
- Obsessed with running out of things
- Do I Have OCD?
- Do environmental factors hold a person back?
- Never Had a Relationship
- Shy Rural Student
- Nursing Student's Anxiety
- I'm Afraid They Are Judging Me
- Part Time Work and Stress
- Anxiety
- Panic
- Bathroom Phobia
- Anxiety?
- Mastery Of Anxiety And Panic
- Very Determined Panicker In The South
- Panicking Boyfriend
- Alternatives For Anxiety Treatment
- Is Anxiety A Hereditary Factor?
- Unable To Keep Eye Contact
- Is It Really Panic? And How Do We Get Help
- A Cure For Claustrophobia?
- Panic Attacks
- Shyness And The Post Partum Blues
- Klonopin
- Alternative Treatment
- Can't Afford Therapy
- Driving Phobia
- Indecisive
- Agoraphobia?
- Social Fear
- A Cure For Anxiety?
- Panic Attacks
- Fear of Driving
- Shy Guy
- Anxiety?
- Social Anxiety
- Linda writes:
-
Book & Media Reviews
- 8 Keys to Stress Management
- A Brief History of Anxiety
- Anxiety
- Anxiety
- Anxiety Disorders
- Anxiety, Phobias, and Panic
- Been There, Done That? DO THIS!
- Calm Beneath the Waves
- Elsewhere
- Exercise for Mood and Anxiety
-
31 more
- Getting Control
- Helping Students Overcome Depression and Anxiety
- Just Checking
- Mind-Body Workbook for Anxiety
- Monkey Mind
- My Age of Anxiety
- Overcoming School Anxiety
- Panic Disorder
- Passing for Normal
- Phobic and Anxiety Disorders in Children and Adolescents
- Repressed Spaces
- Self-Coaching
- Stress
- Stress Survival Guide
- Textbook of Anxiety Disorders
- The 10 Best Anxiety Busters
- The Age of Anxiety
- The Anxieties of Affluence
- The Dutiful Worrier
- The Emotional Eater's Repair Manual
- The Male Stress Survival Guide
- The Places That Scare You
- The Stress Cure
- The SuperStress Solution
- Treating Affect Phobia
- Under Pressure and Overwhelmed
- Viniyoga Therapy for Anxiety
- When Words Are Not Enough
- Wish I Could Be There
- Yoga for Anxiety
- Yoga Journal's Yoga for Stress
-
Self-Help Groups
-
Links
-
Videos
- How to Manage ADHD and Anxiety
- What You Need to Know about Students with ADHD and Anxiety
- How To Make Room For Gratitude In An Anxious Brain
- How to Stay Calm When You Know You'll Be Stressed
- Anxiety and Teen Girls with Lisa Damour, PhD
- Identifying and Treating Anxiety in Kids and Teens
- Anxiety, Trauma and How Prolonged Exposure Therapy Works For PTSD
- How Weighted Blankets May Lift Anxiety
- Too Scared: Social Anxiety Disorder
- Treating Anxiety Disorders: A Unified Protocol
-
19 more
- Treating Youth Anxiety and Social Phobia
- Overcoming Anxiety in Children and Teens
- Treating Anxiety in Children and Teens with ASD
- Back-to-School Anxiety
- No More Shame: My life with Anxiety and Depression
- Adolescent Depression and Anxiety
- What is Social Anxiety Disorder?
- Living Without Fear
- What is Generalized Anxiety Disorder?
- What is Generalized Anxiety Disorder?
- School Anxiety! Activities To Help Kids and Teens Manage It
- Recognizing and Treating Problematic Fear and Anxiety in Children
- How To Stop Overthinking When You Have Anxiety
- My Anxiety Is Making Me Anxious!
- Evidence-Based Treatment Planning for Generalized Anxiety Disorder Video
- Managing Anxiety in Youth: More Action Than Talk
- Treatment of Social Anxiety Disorder
- Cognitive Behavioral Therapy for Anxiety
- Recent Advances in Anxiety - Children/Adolescents
-
More Information
- Wise Counsel Interview Transcript: An Interview with David Barlow, Ph.D. on the Nature and Treatment of Anxiety and Panic Disorders
- Wise Counsel Interview Transcript: An Interview with Dr. Michelle Craske on Anxiety Disorders Research and Treatment
- Wise Counsel Interview Transcript: An Interview with Richard Heimberg, Ph.D. on Anxiety Research and Treatment
Topics
-
Related Topic Centers
-
Addictions
-
Aging & Elder Care
-
Assessments & Interventions
-
Career & Workplace
-
Emotional Well-Being
-
Life Issues
-
Parenting & Child Care
-
Abuse
-
ADHD: Attention Deficit Hyperactivity Disorder
-
Adoption
-
Autism
-
Child & Adolescent Development: Overview
-
Child & Adolescent Development: Puberty
-
Child Development & Parenting: Early (3-7)
-
Child Development & Parenting: Infants (0-2)
-
Child Development & Parenting: Middle (8-11)
-
Child Development & Parenting:Adolescence (12-24)
-
Child Development Theory: Adolescence (12-24)
-
Child Development Theory: Middle Childhood (8-11)
-
Childhood Mental Disorders and Illnesses
-
Childhood Special Education
-
Divorce
-
Family & Relationship Issues
-
Intellectual Disabilities
-
Learning Disorders
-
Oppositional Defiant Disorder
-
Parenting
-
Self Esteem
-
-
Psychological Disorders
-
Anxiety Disorders
-
Bipolar Disorder
-
Conversion Disorders
-
Depression: Depression & Related Conditions
-
Dissociative Disorders
-
Domestic Violence and Rape
-
Eating Disorders
-
Impulse Control Disorders
-
Intellectual Disabilities
-
Mental Disorders
-
Obsessive-Compulsive Spectrum Disorders
-
Personality Disorders
-
Post-Traumatic Stress Disorder
-
Schizophrenia
-
Sexual Disorders
-
Somatic Symptom and Related Disorders
-
Suicide
-
Tourettes and other Tic Disorders
-