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Anxiety Drugs: List of Anxiety Drugs Types Side Effects Indications & More

December 22, 2021

Anxiety is an emotional state that pays off itself if used correctly. Anxiety or stress is the driving force that prepares you for that important presentation at your college or makes you arrive at the office on time. However, too much stress that progresses to persistent feelings of worry, fear, and unease are detrimental to your health. It is this threshold that is termed anxiety disorder that disturbs your everyday work. There is a list of different anxiety drugs groups available that help anxiety disorders.

As per one meta-analysis, about 33.7% of people experience an anxiety disorder at some point in life.

Anxiety disorder is of many types. The types depend on the severity of the presenting complaints and the underlying cause. Cognitive-behavioral therapy is suggested for such patients. However, the efficacy of CBT is increased by the intake of certain medications.

There is a definite range of anxiety medicines, each catering to the specific underlying cause. This article will share a detailed insight into each of them. 

Anxiety Drugs List of Anxiety Drugs Types  Side Effects Indications

What are the types of anxiety drugs - medication?

The Anxiety and Depression Association of America (ADAA) suggests four major drugs for anxiety disorders. These are as follows;

1. Selective serotonin reuptake inhibitors   (A group of Anxiety Drugs)

Selective serotonin reuptake inhibitors (SSRIs) are a common prescription for depression. However, they are also effective at treating anxiety and obsessive-compulsive disorder (OCD). Some doctors prescribe SSRIs as a first-line therapy drug for anxiety.

Serotonin is a chemical that is responsible for mood regulation besides many other bodily functions. The chemical is released into the neuronal synapses (space between two neurons) during a relay of a message. The neurons are equipped with the ability to reabsorb the released serotonin.

This class of drug inhibits the reuptake of serotonin from the synapses. As a result, the levels of the serotonin increase in the brain so more chemical is available in the neuronal synapse to delay messages. This has an overall effect of alleviating anxiety and regulating mood disorders.

The drugs included in this class act upon only serotonin reuptake. They do not influence the levels of other chemicals in the brain. In addition, SSRIs do not have a role in synthesizing serotonin; these drugs simply make use of the serotonin available in the body.

Selective serotonin reuptake inhibitors do not work for everyone. They usually take about two to six weeks before catering to notable results.

SSRIs are not habit-forming. They are prescribed for about twelve months to treat anxiety, followed by a gradual dose reduction.

Indications of SSRIs

Besides depression, SSRIs are used to treat conditions like;

  • Anxiety (as an off label therapy)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Bulimia
  • Post-traumatic stress disorder (PTSD)
  • Premenstrual dysphoric disorder (PMDD)
  • Hot flashes caused by menopause

Drugs included in SSRIs

Some examples of SSRIs for anxiety include:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac, Sarafem)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil, Paxil XR, Pexeva)
  • Sertraline (Zoloft)

Side effects of SSRIs

Side effects vary from person to person as well as among the different SSRIs. Possible side effects include:

  • nausea
  • dry mouth
  • headache
  • trouble sleeping
  • upset stomach
  • tiredness
  • dizziness
  • diarrhea
  • weight gain
  • increased sweating
  • rash
  • nervousness
  • sexual dysfunction including low sex drive, erectile dysfunction, or ejaculation problems

SSRIs are generally considered safe. This drug class should be used with caution in children and pregnant women, related to an increased risk of suicide and fetal defects, respectively.

2. Serotonin-norepinephrine reuptake inhibitors (A group of Anxiety Drugs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are the second group of antidepressants prescribed for anxiety disorders. They are sometimes called dual reuptake inhibitors or dual-acting antidepressants because of their effects on serotonin and norepinephrine levels.  

The drugs included in this class work in the same way as SSRIs but also block the reabsorption of norepinephrine. They are also effective in managing chronic pain conditions, especially nerve pain.

This helps improve the levels of neurotransmitters in the brain by influencing brain chemistry. When the messages are relayed effectively between neurons, the situation helps improve mood, relieve anxiety, and alleviate depression.

SNRIs drugs may be prescribed when a patient has failed to respond satisfactorily to SSRIs.

Indications for SNRIs

  • Depression
  • Anxiety disorders
  • Failure to respond to SSRIs

Drugs included in SNRIs

Some examples of this class of drug include;

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor XR)
  • Desvenlafaxine (Pristiq, Khedezla)
  • Levomilnacipran (Fetzima)
  • Milnacipran (Savella)

Sibutramine (Meridia) was a previously used SNRI that was pulled off the shelves in 2010 owing to its association with side effects as cardiovascular side effects and stroke.

Milnacipran is used as an off-label option for depression. The drug is prescribed for treating fibromyalgia.

SNRIs may take several weeks to exert noticeable effects in a patient.

Side effects of SNRIs

Some side effects that are possible with SNRIs are;

  • nausea
  • appetite changes
  • muscle weakness
  • tremor
  • nervousness
  • palpitations
  • high blood pressure
  • increase in heart rate
  • headache
  • disturbance in urination
  • dizziness
  • insomnia
  • sleepiness
  • dry mouth
  • excessive sweating
  • constipation
  • fluid retention and edema (especially in older adults)
  • erection dysfunction or failure to have an orgasm (in men)

This class of drugs can pass the placenta in a pregnant woman and cause damage to the fetus. Babies born to mothers taking SNRIs may exhibit;

  • tremors
  • difficulty in breathing
  • feeding difficulties

These drugs also pass into breast milk. So expectant mothers and breastfeeding women should consult with their doctor for taking other options.

SNRIs are metabolized in the liver. In people with liver dysfunction, the drug metabolites may not be effectively removed from the blood. This may raise the blood concentration of these drugs to dangerous levels potentiating the side effects.

Similarly, SNRIs are contraindicated in hypertensive patients since the drug may result in a dangerous elevation in blood pressure.

3. Tricyclic antidepressants (A group of Anxiety Drugs)

As the name indicates, this class of drugs works against depression. However, they are used for managing anxiety in patients who do not respond well to SSRIs or other anti-anxiety medications.

These drugs are non-addictive and are not habit-forming. These are available as generics, so it reduces the cost of treatment. They are supported by scientific research to help manage panic attacks and elevate depressed mood states.

Tricyclic antidepressants also work in the same way as SSRIs and SNRIs. They inhibit the reuptake of serotonin and norepinephrine in the synapses.

Tricyclic antidepressants take about four to twelve weeks to take effect. They have their share of side effects, which may last initial weeks, two to three weeks of treatment. The side effects resolve with time. Perhaps the most noticeable side effect is weight gain, which affects 25% of the patients.

Tricyclic antidepressants are contraindicated in people suffering from wide-angle glaucoma. Heart patients and men with prostate trouble should also avoid taking TCAs and opt for other alternative medicines. Old age, epilepsy, concomitant use with MAO inhibitors are some other contraindications for using tricyclic antidepressants.

These drugs should be used cautiously in pregnant and nursing women. People with suicidal tendencies should never be suggested TCAs.

Withdrawal effects are possible. That is why these medicines should be tapered off gradually. Overdose is also possible and is associated with severe morbidity and death.

Indications for tricyclic antidepressants

Besides the primary option for depression, the tricyclic antidepressants are effective for;

  • Post-traumatic stress syndrome
  • Panic disorder
  • Generalized anxiety disorder
  • Off-label option for chronic pain syndromes (migraines, low back pain, neuropathic conditions, fibromyalgia, etc.)
  • Off labels use for chronic bedwetting

TCAs used for treating anxiety

The drugs included in the subject class of drugs are;

  • amitriptyline
  • clomipramine
  • doxepin
  • desipramine
  • maprotiline
  • imipramine
  • nortriptyline

Side effects of tricyclic antidepressant

Some of the side effects of TCAs include;

  • blurred vision
  • dry mouth
  • dry eyes
  • dizziness
  • fatigue
  • headaches
  • disorientation
  • seizures
  • drowsiness
  • constipation
  • urinary retention
  • hypotension
  • tachycardia
  • tremor
  • weight gain
  • low blood pressure
  • sexual dysfunction
  • Discontinuation syndrome; dizziness, insomnia, headaches, nausea, vomiting, flu-like aches and pain, restlessness, rebound depression, anxiety, panic, and so on.
  • Drug interactions with cimetidine and epinephrine

4. Benzodiazepines (A group of Anxiety Drugs)

Benzodiazepines address a variety of medical issues, yet this class of drug carries a black box warning. This is because long-term use of these medicines causes dependence and tolerance development besides other side effects.

The medicines included in this class are very effective and valuable for short-term use. They are not usually prescribed for more than a month. Sometimes benzodiazepines are used as a combination therapy with SSRIs to help manage symptoms till the latter start exerting their therapeutic effects.

As regards anxiety, benzodiazepines function as a sedative. These help to alleviate physical symptoms associated with anxiety. The medicines result in relaxation by relieving the tension in the muscles and other associated symptoms of anxiety.

Benzodiazepine influence brings about changes in the activity of neurons that trigger reactions tagged with stress and anxiety. These drugs work by act as an adjunct to the neurotransmitter known as gamma-aminobutyric acid (GABA).

The neurotransmitter is responsible for relaying calming messages in the brain. When the GABA levels increase in the brain, it helps to counteract the overstimulation of an anxious brain.

Benzodiazepines are related to withdrawal effects. One should always follow the doctor's instructions while stopping these drugs. Overdose with benzodiazepines is also a common occurrence. Vigilant following of dosage schedule is advised.

Benzodiazepines are often misused. Concomitant use with alcohol, opioids, and cannabis can be fatal.

Indications for the use of benzodiazepines

Benzodiazepines are commonly recommended for;

  • generalized anxiety disorder
  • social anxiety disorder
  • insomnia
  • seizure activity as in epilepsy
  • panic disorder

Off-label use of these drugs include management of;

  • sleep disorders
  • bipolar disorder
  • tic disorders
  • alcohol withdrawal

Benzodiazepines for anxiety

Common drugs included in this class are;

  • alprazolam or Xanax
  • chlordiazepoxide
  • diazepam is commonly known as Valium
  • lorazepam

Side effects of benzodiazepines

Some of the side effects of this class of drug include;

  • Confusion
  • Dizziness and drowsiness
  • Compromised coordination
  • Rebound depression
  • Increased anxiety
  • Impaired memory
  • Irrational and irresponsible behavioral changes (increased risk-taking)
  • Delirium (mainly in adults)
  • Dependence with long-term use
  • Drug interactions

Are there other medications and anxiety drugs?

Though the afore-mentioned classes of drugs effectively address anxiety and its related disorders. But they have their side effects, drug interaction, and contraindications.

If your doctor thinks that SSRIs or other drugs may not work for you or their adverse effects outweigh the benefits, some other medications can be opted for. These include;

Beta-blockers

A Beta-blocker drug is prescribed for heart ailments, high heart rate, and blood pressure.  However, an off-label prescription may also be recommended for anxiety, if not for all but some patients. Cases of social anxiety disorder significantly benefit from beta-blocker administration.

Beta-blockers work by reducing the effects of the chemical norepinephrine in the body. This helps relieve some physical symptoms of anxiety. The most common names of beta-blocker drugs include atenolol and propranolol.

Beta-blockers may cause some side effects, like;

  • cold extremities (hands and feet)
  • depression
  • tiredness and fatigue
  • dizziness
  • drowsiness
  • dry mouth
  • low blood pressure
  • shortness of breath
  • sleep disturbances
  • weight gain
  • nausea

Beta-blockers are contraindicated in asthmatic patients. The drug should be prescribed with caution in people with diabetes.

Buspirone

This drug is used to treat anxiety owing to its low risk of dependence and fewer side effects. The medicine is suggested to influence the brain chemicals and improve mood and calm the nerves.

Buspirone is effective for short and long-term treatment of anxiety. It may not address all anxiety types. Also, the drug is slow to exert its effects. Yet, in some cases, the drug proves to be a better option than its other counterparts. 

Some of the side effects of this class include nausea, dizziness, disturbed sleep, and headache. Others are

  • blurry vision
  • diarrhea
  • drowsiness
  • dry mouth
  • fatigue
  • muscle pains
  • poor focus and concentration
  • restlessness
  • sweating
  • weakness

Monoamine oxidase inhibitors Used as Anxiety Drug

Monoamine oxidase inhibitors (MAOIs) are a class of drugs that effectively treat panic disorder and social phobia. They work similarly to other anxiety drugs by increasing the number of neurotransmitters in the brain that regulate mood.

The MAOIs are an off-label option for addressing anxiety.

Some of the common names included in this class of drug are;

  • isocarboxazid
  • phenelzine
  • selegiline
  • tranylcypromine

MAOIs contribute to their share of side effects. They interact with several drugs, as birth control pills, pain relievers, such as acetaminophen and ibuprofen, cold and allergy medications, and herbal supplements. These medicines are also not to be taken with certain food elements like red wine and cheese.

Some of the side effects related with use of MAOIs include;

  • constipation or diarrhea
  • difficulty while urinating
  • dizziness and drowsiness
  • dry mouth
  • headaches
  • low blood pressure
  • nausea
  • sexual dysfunction
  • sleep trouble
  • sweating
  • weight gain

Takeaway

Anxiety is becoming a prevalent condition owing to fast-paced lifestyles. Medications certainly help, particularly when combined with combination therapy like cognitive behavioral therapy. Your doctor can guide you best about anxiety medicine after evaluating your physical and mental health status. It is essential to follow the doctor's advice religiously to get the best of each anxiety medicine.

Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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