Anxiety is a feeling that everyone experiences sometimes; it’s a natural part of being human. But when this worry and fear is persistent and begins to interfere with your day to day life, you could be experiencing an anxiety disorder.
Anxiety disorders are the most common mental health disorders in America, affecting 40 million adults in the United States each year according to the Anxiety and Depression Association of America. You’re far from alone if you’re constantly feeling anxious.
What is anxiety?
There are several types of anxiety disorders, including:
generalized anxiety disorder,
panic disorder, as well as
various phobia-related disorders.
Fortunately, they are all highly treatable. Some common and effective treatment options include therapy, anxiety medication, and lifestyle changes.
How is anxiety diagnosed?
The cause of anxiety disorders is often a combination of factors, rather than a single element. Some factors that could trigger this type of mental illness include:
Family history. Some people may have a genetic predisposition towards anxiety. However, it’s important to note that having a family member with an anxiety disorder or other mental illness does not automatically mean you’ll get it.
Stressful events. This can include a job change, death or loss of a loved one, changes in living arrangements, or relationship issues.
Personality traits. Studies suggest that children who are perfectionists or like to control situations, are more likely to develop anxiety disorders as adults.
Physical health problems, such as thyroid disease. Too much thyroid hormone can cause an increased heart rate and palpitations which are symptoms linked to anxiety. Conditions like hypertension, diabetes, and asthma are also associated with anxiety.
Preexisting mental health conditions, like depression. Symptoms of depression are similar to those of anxiety and can often occur hand in hand.
Drug and alcohol use. Caffeine, amphetamines, and cocaine can cause anxiety symptoms. Withdrawal from drugs and alcohol can also cause irritability and anxiety.
Some symptoms of anxiety disorders that may help your doctor diagnose the condition include:
Restlessness, nervousness, and excessive fear or worry
Tightening of the chest and racing heart
Persistent, irrational thoughts
Trouble concentrating
Avoiding things that trigger your anxiety
You can use these symptoms as a guide, but you’ll need to see a doctor for diagnosis.
If you think you may be experiencing an anxiety disorder, speak with your primary care doctor. They’ll be able to check if there are any underlying illnesses that may be contributing to your feelings and refer you to a mental health specialist if necessary.
Medical professionals that specialize in mental health and anxiety disorders are psychiatrists, which are medically trained doctors, and psychologists.
As medically trained doctors, psychiatrists can prescribe medications as part of treatment. Psychologists, on the other hand, focus primarily on treating emotional and mental conditions through psychotherapy and behavioral intervention.
Some questions you may want to ask your doctor about your condition include:
Do I have an anxiety disorder? If so, which type?
Is my anxiety treatable? What are my treatment options?
Will anxiety medication help?
Do I need any tests?
If you’re experiencing intense anxiety, it may help ease your stress to prepare for some of the questions your primary care doctor, psychiatrist, psychologist or mental health professional may ask you in order to confirm a diagnosis and develop a treatment plan. There is no lab test to diagnose anxiety, so answering these questions openly and honestly is essential to getting the best anxiety treatment.
Here are some example questions your physician may ask:
Do you take any prescription drugs?
What are your symptoms?
Are your feelings of anxiety occasional or continuous?
Does anything in particular trigger your anxiety?
When did you first notice signs of anxiety?
Do you regularly take drugs and/or alcohol?
Have you ever experienced a panic attack?
Anxiety treatment options
There are various treatment options for anxiety disorders that can help you get back to enjoying life. The two most common treatments are:
psychotherapy
anxiety medications
Many patients experience great results using a combination of the two. Your doctor may also recommend lifestyle changes, such as reducing alcohol consumption, dietary changes, physical exercise, and meditation.
A popular type of psychotherapy, otherwise known as talk therapy, is cognitive behavioral therapy (CBT). It teaches patients skills to change negative thoughts and behavioral patterns. These techniques can also help treat and prevent panic attacks.
The type of medication prescribed depends on the type of anxiety disorder you have. These medications can include antidepressants, anti-anxiety medications like Buspar (buspirone), and beta-blockers. Beta blockers can provide rapid relief of the physical symptoms of panic attacks, such as rapid heartbeat and sweaty palms.
Anxiety medications
There are numerous types of medications that can treat anxiety disorders. Your doctor will recommend which type is best for you based on your medical history, any current medications you’re taking, and the specific type of anxiety disorder you’re experiencing.
These are some of the most common classes of drugs your doctor may prescribe.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant medications, and are often used to treat anxiety symptoms. They work by increasing levels of serotonin (a neurotransmitter) in the brain, which helps regulate your mood, sleep, and energy levels.
Bear in mind, SSRIs may take four to six weeks to reach full effect, and side effects can include drowsiness, nausea, insomnia, erectile dysfunction, and dizziness.
Like SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing neurotransmitter levels in the brain. They do this by blocking the reabsorption of two neurotransmitters, serotonin and norepinephrine. The resulting increased levels of serotonin and norepinephrine help regulate patients’ moods, which is how they treat symptoms of both depression and anxiety.
Commonly prescribed SNRI’s are Effexor (venlafaxine) and Pristiq (desvenlafaxine). Few people report side effects when using these medications. Possible side effects can include dizziness, headache, dry mouth, insomnia, constipation, and erectile dysfunction.
Tricyclic antidepressants
Tricyclic antidepressants are another class of antidepressants that physicians sometimes prescribe to treat the symptoms of anxiety disorders. Much like SSRIs and SNRIs, they work by rebalancing the levels of neurotransmitters in the brain. Popular brand names include Tofranil (imipramine), and Vivactil (protriptyline).
Some disadvantages of taking tricyclic antidepressants is their delayed onset—they can take four to 12 weeks to take effect. Like some other antidepressants, side effects can include dizziness, dry mouth, constipation, insomnia, and rapid weight gain.
Tricyclic antidepressants also have some antihistamine activity similar to other prescribed antihistamines (such as hydroxyzine). This activity can be useful for its sedative effects.
Benzodiazepines
Benzodiazepines are a group of medications commonly prescribed for their anti-anxiety and tranquilizing effects. They induce a state of relaxation by influencing the gamma-aminobutyric acid (GABA) receptors of the brain, resulting in the slowing of the central nervous system.
Because of their fast acting and sedative effects, benzodiazepines are prescribed for insomnia and muscle spasm, as well as panic attacks and anxiety.
Like all medications, you should only take them as prescribed by your doctor. This is especially important with benzodiazepines, as the dosage can vary significantly between individuals. They can be taken once per day, multiple times per day or on an as-needed basis, and are often initially prescribed in small doses that are increased gradually as needed.
Because they work to slow down a patient's central nervous system, the most common side effect of this class of drug is drowsiness and impaired coordination. They work best as short term solutions to anxiety as they can be addictive. If you decide to stop taking benzodiazepines, speak with your doctor first as there is a risk of withdrawal symptoms.
It’s important never to mix benzodiazepines with alcohol, as it can cause a lethal drug interaction.
If one of the more popular anti-anxiety medications above does not work to ease your symptoms, your doctor may recommend an off-label medication to treat your anxiety. Off-label means prescribing the medication for your anxiety, even though the drug is officially approved for another condition.
These are some of the more common off-label medications your doctor may prescribe:
Beta-Blockers
Most often used to treat high blood pressure, beta-blockers like Inderal (propranolol), can be used to treat the physical symptoms of acute anxiety, such as rapid heart rate and tightness of the chest.
However they will not improve the emotional factors of anxiety, such as worry or fear.
Because they only treat physical symptoms of anxiety and panic attacks, beta-blockers are often prescribed for event-triggered anxiety like stage fright or social anxiety disorders.
Buspirone (Buspar)
Buspar is an anti-anxiety medication prescribed in tablets of 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg, most commonly used for generalized anxiety disorder (GAD).
It helps alleviate anxiety by regulating serotonin and dopamine receptors in the brain.
Buspirone is not commonly prescribed as a first-line treatment. Instead, it’s more commonly used in conjunction with selective serotonin reuptake inhibitors, or when other medications have not been effective or trigger too many side effects.
Monoamine oxidase inhibitors (MAOIs)
The first antidepressant available, monoamine oxidase inhibitors (MAOIs), are no longer considered a first-line treatment for depression and anxiety. However if other options have not been effective, they are a second-line option.
Like most antidepressants, MAOIs work by balancing brain neurotransmitters, thereby improving mood levels. One reason other antidepressants are more popular is because, when combined with certain foods and medications, MAOIs can cause dangerously high blood pressure. That said, they can still be very effective for some people.
What is the best medication for anxiety?
In order to figure out which medication is going to best treat your anxiety and alleviate symptoms, you must speak with your doctor.
The best anxiety medication and treatment depends on a number of factors, including what is causing the anxiety disorder. Your doctor will recommend a prescription based on your medical history, taking into account any other medications or conditions you may have. They’ll also be able to monitor your progress and alter treatment according to your response.
Here is a comparison of the most commonly prescribed anxiety medications:
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight.
Other possible side effects exist. This is not a complete list.
Common side effects of anxiety medication
As with most medications, the drugs most commonly prescribed for anxiety disorders have a risk of some side effects. These can include:
Drowsiness
Fatigue
Headaches
Loss of appetite
Weight gain
Impaired coordination
Dry mouth
This, of course, is not a full list of side effects of all medications your doctor may prescribe. For more specific information, talk with your doctor who can advise you on any potential adverse reactions or drug interactions.
Living with anxiety
If you’d like to complement your treatment with natural options, your doctor may suggest some other strategies. Some natural remedies patients may find effective include:
Before starting any natural treatment or trying home remedies for anxiety, be sure to speak with your doctor and get their professional medical advice.
Frequently asked questions about anxiety
Which SSRI is best for anxiety?
Given the many contributors to anxiety disorders, and your own personal medical history and lifestyle, only a doctor can determine which SSRI is best for you. Your physician can make a recommendation based on your particular type of anxiety, symptoms, and any other health concerns you may have, as well as monitor your progress and response to treatment.
Some popular SSRI medications are Zoloft, Prozac, and Lexapro.
How do antidepressants help anxiety?
Antidepressants work by preventing the brain from absorbing serotonin and norepinephrine, both of which are neurotransmitters. This allows their levels to increase and stabilize. When the levels of serotonin and norepinephrine are balanced, it stabilizes a person's mood, decreases anxiety, and impacts overall well-being.
What over-the-counter medicine can you take for anxiety?
There are no recommended over-the-counter (non-prescription) drug treatments available for anxiety disorders. Your doctor, however, may recommend some specific vitamins or supplements to complement your treatment.
What does it feel like to be on anti-anxiety
medications?
Some anti-anxiety medications work within 30 minutes, others take days to build up in your system and become effective. Once working, patients often feel a physical sense of relief and decrease in worry and stress—they’re back to their ‘normal’ selves. That said, how it feels is different for each individual.
It’s not uncommon to feel some side effects, such as headaches, nausea, and fatigue in the first few weeks of taking anti-anxiety medications. However many patients find they eventually subside. If you think you’re experiencing any side effects, tell your doctor immediately.
Does anxiety medication cause weight loss?
There are some reports that anxiety medication causes weight loss, while other reports claim weight gain. At this stage, more research is required to understand exactly how anxiety drugs affect a patient’s weight.
Gerardo Sison, Pharm.D., graduated from the University of Florida. He has worked in both community and hospital settings, providing drug information and medication therapy management services. As a medical writer, he hopes to educate and empower patients to better manage their health and navigate their treatment plans.
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