Medications

Medications

Until recently, the anti-anxiety drugs known as benzodiazepines were the primary medications for anxiety. Increasingly, antidepressants, particularly the selective serotonin-reuptake inhibitors (SSRIs), are being used as the initial treatment. They are proving to be effective, nonaddictive, and to have relatively minor side effects.

Many standard antidepressants take 2 - 4 weeks, and sometimes up to 12 weeks, before they are fully effective. People who take them may also experience a temporary period of increased anxiety. Consequently, about a third of patients stop taking antidepressants for anxiety disorders before completing the initial phase of therapy. A combination of a benzodiazepine and an antidepressant is sometimes used to avoid the initial anxiety symptoms and to hasten control of panic symptoms. The benzodiazepine can then be withdrawn, and the antidepressant, with its negligible chance for long-term abuse, is continued.

No one should become disheartened if one drug treatment fails. Another may prove to be very effective, even it is a drug of a similar type. Drug combinations should be tried if a single drug and cognitive-behavior therapy has failed. Because many anxiety disorders are chronic, drug therapy sometimes is needed for prolonged periods, even years.

Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs). Selective serotonin-reuptake inhibitors (SSRIs) are the first-line treatment of major depression and proving to be helpful for many anxiety disorders. They work by increasing levels of serotonin in the brain. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). Escitalopram is similar to citalopram and may have fewer side effects than other SSRIs. All of these drugs are proving to be very valuable for adults and even for many children with most anxiety disorders. The following are some indications for their use in specific anxiety disorders:

• Obsessive-Compulsive Disorder. SSRIs are the first-line treatment for obsessive-compulsive disorder (OCD). They reduce symptoms by 25 - 35% in about half of all patients. (SSRIs may be less effective with tics, hoarding, and compulsive behaviors than with other OCD symptoms.)
• Panic disorder. SSRIs may also be very useful in treating patients with panic disorder. Some -- but not all -- studies suggest that higher doses than those used for depression may be required in order to achieve benefits. More research is needed on the optimal dosages.
• Phobias. SSRIs may also help people with phobias, including agoraphobia and social phobias. Relapse is common in social phobia patients, and treatment for longer than a year may be needed in some patients. Combining medications with cognitive-behavioral therapy can help prevent relapse.
• Post-Traumatic Stress Disorder. SSRIs may help some people with post-traumatic stress disorder (PTSD). Their benefits may be limited. Victims of child abuse, for example, tend to respond poorly to SSRIs. A study on sertraline suggested that although it was particularly effective in women it may not offer many benefits for combat veterans. At this time sertraline (Zoloft) and paroxetine (Paxil) are specifically FDA-approved for PTSD, although studies suggest that other SSRIs may be helpful.
• Generalized Anxiety Disorder. SSRIs have been less studied for generalized anxiety, but studies on paroxetine (Paxil), sertraline (Zoloft), and escitalopram (Lexapro) suggest that SSRIs may be very effective for many people with GAD.
• Anxiety Disorders in Children. SSRIs may be effective for children who have both OCD and major depression. Fluoxetine (Prozac) is the only SSRI approved for use in children. In addition to depression, it is approved for treating children with OCD. The FDA has strongly advised against prescribing certain SSRIs, such as paroxetine, to children and young adults due to increased risk for suicidal behavior.