Using Antidepressants or Benzodiazepines to Treat Anxiety
There are several kinds of anxiety disorders, typically characterized by hypervigilance, consistent worry, and overwhelming, constant fear. Although everyone can suffer some symptoms of anxiety disorders due to specific experiences at some point in life, such as the loss of a job or a dramatic change in relationships, people who do not struggle with anxiety disorders typically see these symptoms clear up in time. People who suffer anxiety disorders, however, can find symptoms triggered or worsened by daily activities or due to no obvious external cause.
What Are the Types of Anxiety Disorders?
- Generalized anxiety disorder (GAD): feeling wound up, on edge, restless, irritable, or fearful almost constantly for several months, as well as feeling fatigue and muscle tension
- Panic disorder: intense fear and anxiety that triggers a panic attack, which includes symptoms like heart palpitations, difficulty breathing, sweating, tremors, feeling smothered or choked, or feeling like catastrophe is near
- Social anxiety disorder: the intense fear of being around other people, especially feeling judged, rejected, or causing offense
- Specific phobias: fear of a specific thing, like spiders or clowns; typically managed through avoidance, despite negative effects on life
Over the years, many medications have been developed to ease symptoms of anxiety disorders, so people can work with a therapist on long-term psychological treatment and navigate their daily lives successfully. Different types of medication work for different people; some people work better with as-needed or short-term treatment for anxiety, while others need consistent, long-term treatment. Anxiety can also be a symptom of a different mental health issue, such as depression, which can lead to a different course of medication and therapy.
Two of the more common medications used to treat anxiety disorders are antidepressants and benzodiazepines. Each has positive and negative effects, and the one that works best is dependent on the individual, their needs, and their type of anxiety.
Antidepressants for Anxiety
There are four classes of antidepressants, and three of them are used to treat anxiety disorders. These are:
- Selective serotonin reuptake inhibitors (SSRIs): These change how the brain absorbs serotonin, so more of the neurotransmitter is available. This helps to improve mood, both for people struggling with depression and those struggling with anxiety. They are currently considered an effective treatment for all anxiety disorders, although side effects can include insomnia and weight gain, which could trigger some anxious feelings at first.
- Serotonin norepinephrine reuptake inhibitors (SNRIs): Like SSRIs, these medications changes rates of absorption of neurotransmitters. This class of drugs works with serotonin as well as norepinephrine, another neurotransmitter related to mood. These are effective at treating depression, and they are also considered a frontline treatment for most anxiety disorders, especially GAD.
- Tricyclic antidepressants: These were some of the first antidepressants developed, and they adjust both the release and absorption of most neurotransmitters, including serotonin, dopamine, and norepinephrine. Because of the drastic changes in brain chemistry, however, these medications typically induce several side effects, and they are not widely prescribed anymore. However, they are an effective second-line treatment for anxiety disorders like panic disorder.
These medications may be effective because they change brain chemistry enough to improve mood, or they may work because many people who experience anxiety struggle with depression.
A recent study published in the Journal of the American Medical Association (JAMA) found that antidepressants did not offer significant improvement over a placebo when treating anxiety; however, study authors noted that effective treatments varied by individual. The study advised that psychiatrists should use the information to make more educated decisions about prescribing these medications to treat anxiety disorders.
Antidepressants, especially SSRIs, typically take several weeks to become fully effective. While they do eventually offer help stabilizing brain chemistry, they do not offer immediate relief of symptoms. For people suffering intense anxiety, panic attacks, and insomnia due to their anxiety disorder, antidepressants may not be the most effective treatment, because they do not offer immediate relief.
Additionally, one of the side effects of taking antidepressants is anxiety. As some people get used to taking antidepressants and potentially develop a tolerance to the medication, they may experience rebound anxiety, or a worsening of anxiety symptoms due to the medication itself. A British Medical Journal study published in 2016 also found that aggression and anxiety symptoms were worsened in children who were prescribed antidepressants to treat anxiety disorders.
For people who need long-term relief from a chronic anxiety disorder, or from co-occurring depression and anxiety, a prescription for antidepressants can be very helpful. It is important for the doctor and patient to discuss needs, wants, and side effects in order to find the right balance of medication and therapy.
Benzodiazepines for Anxiety
Benzodiazepines are a common method of treating anxiety, or temporarily relieving anxiety symptoms, in order for a person’s mood to stabilize so they can focus on daily life and getting therapeutic help. They are especially effective for anxiety symptoms related to social phobia and schizophrenia. Benzodiazepines are grouped into three classes:
- Ultra-short acting
Benzodiazepines are very habit-forming, due to their action on the GABA receptors to calm the person down, to induce a sense of relaxation, and, at high doses, to induce a sense of euphoria. These medications are not recommended for long-term use because the body quickly becomes dependent on and tolerant to these drugs, regardless of whether the person also experiences addiction symptoms like cravings. Most psychologists do not prescribe benzodiazepines for longer than two weeks.
Although many people find benzodiazepines useful for short-term relief of symptoms – long enough to pursue other treatments, especially individual therapy – these medications do not consistently ease symptoms. Rebound and withdrawal symptoms are very similar to the original symptoms of the anxiety disorder. They can include:
- Nervousness, restlessness, or irritability
- Rebound anxiety
- Benzodiazepine withdrawal syndrome (typically after long-term abuse)
Unfortunately, people who are prone to co-occurring substance use and anxiety disorders are more likely to struggle with addiction to benzodiazepines, as they are central nervous system (CNS) depressants. Since benzodiazepines are also sometimes used to treat alcohol withdrawal or delirium tremens symptoms, these medications may become addictive for people who already struggle with alcohol use disorder or who have a family history of this problem.
Benzodiazepines also work quickly, so they are very effective at relieving symptoms; this means that a person with a prescription for a benzodiazepine is more likely to struggle with addiction to this substance since it works well at relieving symptoms. Instead of ending their prescription, the person may develop drug-seeking behavior, receiving multiple prescriptions from multiple doctors, and may take more of the medication than prescribed.
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Get Help for Anxiety Disorders
It is important to get help from medical professionals to treat anxiety disorders. People who struggle with mental health issues, especially anxiety disorders, are more at risk of self-medicating their symptoms. This can lead to a substance use disorder, which can, in the long-term, make anxiety disorders worse. Substance abuse also changes brain chemistry, which can induce other mental health issues.
Rehabilitation programs are, thanks to research into co-occurring disorders, better equipped to help those struggling with both substance abuse and anxiety disorders. Medically supervised detox, individual and group therapy, social support, and small doses of prescription medications can all help a person overcome their addiction and better cope with their anxiety disorder.