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How Antidepressants are Used to Treat Anxiety 

By Eileen Bailey

There are a number of different medications that are currently used to treat anxiety disorders. Antidepressants, although originally intended to treat depression, have been found to be effective in relieving symptoms of anxiety. Medication does not “cure” anxiety. While some people may not feel relief from anxiety symptoms and some may not be able to tolerate side effects, the majority of people do find relief from the debilitating impact of anxiety in their lives.

There are a number of antidepressant medications on the market today used to treat different types of anxiety:

Obsessive Compulsive Disorder (OCD)
•    Clomipramine (Anafranil)
•    Fluoxetine (Prozac)
•    Fluvoamine (Luvox)
•    Paroxetine (Paxil)
•    Sertaline (Zoloft)

Social Anxiety Disorder (SAD)
•    Paroxetine (Paxil)

Generalized Anxiety Disorder (GAD)
•    Paroxetine (Paxil)
•    Venlafaxine (Effexor)
•    Fluoxetine (Prozac)
•    Imipramine (Tofranil)
•    Escitalopram (Lexapro)
•    Duloxetine (Cymbalta)

Panic Disorder
•    Paroxetine (Paxil)
•    Sertaline (Zoloft)

Post Traumatic Stress Disorder (PTSD)
•    Sertaline (Zoloft)

Types of Antidepressants


Tricyclic

Tricyclic antidepressants include such medications as imipramine, amitriptyline, nortriptyline and desipramine. These medications were commonly used from the 1960s through the 1980s. Today, they are more of a second or third line choice because they have more side effects than newer antidepressants.


Monoamine Oxidase Inbibitors - MAOIs


MAOIs are effective in treating panic disorder and include medications such as phenelzine (Nardil), tranylcypromine (Parenate) and isocaroxazid (Marplan). MAOIs can interact with certain foods, beverages and other medications (including over the counter medicines) and therefore people taking MAOIs must be careful to avoid certain foods. This has made this medication a second or third choice for many patients and doctors. They are, however, sometimes effective when people do not respond to other types of antidepressants.

Selective Serotonin Reuptake Inhibitors – SSRIs


SSRIs are a newer class of antidepressants on the market and include medications such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa). These medications have fewer side effects than the Tricyclic antidepressants and the MAOIs, but are still effective. These medications work by affecting one neurotransmitter.


Atypical Antidepressants - Serotonin and Norepinephrine Reuptake Inhibitors - SNRIs


In addition, medications that became available in the late 1990s affect the neurotransmitters serotonin and norepinephrine without the side effects of the tricyclic antidepressants. These medications include venlafaxine (Effexor) and nefazadone (Serzone).

 

How Antidepressants Work


All of the antidepressant medications work to influence the activity of neurotransmitters in the brain. Our brains continually manufacture neurotransmitters, such as, serotonin, dopamine and norepinephrine. These neurotransmitters are then released and reabsorbed. Antidepressant medications work to block the reabsorbtion, therefore increasing the amount of these neurotransmitters in our brain. Some, such as the tricyclics affect two different neurotransmitters. Others, such as most of the SSRIs affect only one neurotransmitter.


These medications normally take several weeks of constant use to be effective. Some may take up to six weeks for a patient to feel the full effects of the medication. Therefore, these medications cannot be used to treat specific anxiety attacks. Some people will use therapy to develop skills to help them during the initial period of time or use anxiety medications to provide relief during an anxiety attack.


Most people find one of the antidepressant medications to be effective in treating anxiety and in helping with depression, a common co-existing condition. Patients must take into account their ability to withstand side-effects and may need to try different medications before finding the correct medication and dosage to help them. Antidepressants are often started at a low level and increased until the proper dosage is found.

 

Stopping Antidepressants


Some people experience withdrawal symptoms when stopping antidepressant medication. Therefore, it is always recommended to slowly stop rather than to just stop taking them. Some of the symptoms of antidepressant withdrawal can include dizziness, nausea, lethargy, and headache.


In addition to these physical symptoms of withdrawal, some people experience increased anxiety and depression. This can be confusing as it may seem as if the original condition being treated has returned, and may appear worse. This may cause the person to immediately begin medication again, possibly at a higher dosage than before.


It is important, therefore, to discontinue antidepressant medication under a doctor’s supervision and to taper the dose gradually. For some people, this process can take from several weeks to several months. However, it is the safest way to discontinue this type of medicine.

 

Antidepressants and Suicide


The Federal Food and Drug Administration requires all depression medications to carry a warning regarding the increased risk of suicide, hostility and aggression the medicine may cause in children and adolescents. There is a current recommendation to extend this warning to include people between the ages of 18 and 24. Any person taking these medications needs to be monitored by a physician. Special care should be taken to watch for signs of depression or suicidal thoughts when dosage is changed or a new medication begins.

Some of the signs to be aware of are:


•    Increased thoughts of suicide

•    Increased depression

•    Increased anxiety

•    Insomnia

•    Restlessness

•    Aggressiveness or irritability

•    Impulsiveness


If any of these symptoms appear suddenly or are severe, your physician should be contacted immediately.

 

Sources:


Antidepressant Medications, 2008, National Institute of Mental Health

General Anxiety Disorder Treatment, 2007, Mayo Clinic

Antidepressants: Medicine for Depression, 2005, FamilyDoctor.org, American Academy of Family Physicians

Antidepressants: Medications for Depression, 2007, Melinda Smith M.A., Jaelline Jaffe, hD. And Jeanne Segal, PhD, Helpguide.org

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