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.