Anxiety Medication

What You Need to Know About Anti-Anxiety Drugs

Medication can relieve some of the symptoms of anxiety, but it doesn’t cure the
underlying problem and it’s usually not a long-term solution. Anxiety medications
also come with side effects and safety concerns, such as the risk of addiction.

In order to decide whether medication is right for you, it’s important to weigh the
drug benefits against the drawbacks. Once you’ve researched your options,
including other therapies and lifestyle changes that may help, you can make an
informed decision.

Understanding anxiety medication

Many different types of medications are used in the treatment of anxiety disorders,
including traditional anti-anxiety drugs such as benzodiazepines, and newer options
like antidepressants and beta-blockers. These medications can be very effective,
but they shouldn’t be thought of as a cure. Anxiety medication can provide
temporary relief, but it doesn’t treat the underlying cause of the anxiety disorder.
Once you stop taking the drug, the anxiety symptoms often return in full force.

It’s important to be aware of the risks of anxiety medication, too. Anxiety

medication can cause a wide range of unpleasant and sometimes dangerous side
effects. Many medications for anxiety are also habit forming and physically
addictive, making it difficult to stop taking them once you’ve started. The bottom
line is that anxiety medications can be helpful, but they’re not right for everyone
and they’re not the only answer.

Anti-anxiety drugs (tranquilizers, benzodiazepines)

Anti-anxiety drugs, also known as tranquilizers, are medications that relieve anxiety
by slowing down the central nervous system. Their relaxing and calming effects
have made them very popular: anti-anxiety drugs are the most widely prescribed
type of medication for anxiety. They are also prescribed as sleeping pills and muscle
relaxants.

Benzodiazepines are the most common class of anti-anxiety drugs. They include:

• Xanax (alprazolam) • Valium (diazepam)

• Klonopin (clonazepam) • Ativan (lorazepam)

Benzodiazepines are fast acting—typically bringing relief within thirty minutes to an

hour. Because they work quickly, benzodiazepines are very effective when taken
during a panic attack or another overwhelming anxiety episode. But despite their
potent anti-anxiety effects, they have their drawbacks.

Side effects of anti-anxiety drugs

Anti-anxiety drugs like benzodiazepines work by reducing brain activity. While this
temporarily relieves anxiety, it can also lead to unwanted side effects.

The higher the dose, the more pronounced these side effects typically are. But
some people feel sleepy, foggy, and uncoordinated even on low doses of
benzodiazepines, which can cause problems with work, school, or everyday
activities such as driving. Some even feel a medication hangover the next day.

Because benzodiazepines are metabolized slowly, the medication can build up in

the body when used over longer periods of time. The result is oversedation. People
who are oversedated may look like they’re drunk.

Common side-effects of benzodiazepines or tranquilizers

• Drowsiness, lack of energy • Dizziness, lightheadedness

• Clumsiness, slow reflexes • Impaired thinking and judgement
• Slurred speech • Memory loss, forgetfulness
• Confusion and disorientation • Nausea, stomach upset

• Depression • Blurred or double vision

Benzodiazepines are also associated with depression. Long-term benzodiazepine

users are often depressed, and higher doses are believed to increase the risk of
both depressive symptoms and suicidal thoughts and feelings. Furthermore,
benzodiazepines can cause emotional blunting or numbness. The medication
relieves the anxiety, but it also blocks feelings of pleasure or pain.

Paradoxical effects of anti-anxiety drugs

Despite their sedating properties, some people who take anti-anxiety medication
experience paradoxical excitement. The most common paradoxical reactions are
increased anxiety, irritability, and agitation. However, more severe effects can also
occur, including:

• Mania
• Hostility and rage
• Aggressive or impulsive behavior
• Hallucinations

While rare, these adverse effects are dangerous. Paradoxical reactions to these
anxiety medications are most common in children, the elderly, and people with
developmental disabilities.

Anti-anxiety medication safety concerns

The connection between anxiety medication and accidents

Anti-anxiety medication causes drowsiness and poor coordination, which contributes
to accidents at home, at work, and on the road. Studies show that taking anti-
anxiety medication increases your risk of having a serious traffic accident.

Beyond the common side effects, medication for anxiety comes with additional
risks. While the tranquilizing anti-anxiety drugs are relatively safe when taken only
occasionally and in small doses, they can lead to trouble when combined with other
substances or taken over long periods of time. Furthermore, certain people have
adverse reactions to them–so they’re not safe for everyone, even when used
responsibly.

Drug interactions and overdose

Used alone, anti-anxiety medications such as Xanax or Valium rarely cause fatal
overdose, even when taken in large doses. But when combined with other central
nervous system depressants, the toxic effects of these anxiety medications
increase. Taking anti-anxiety medication with alcohol, prescription
painkillers, or sleeping pills can be deadly. Dangerous drug interactions can
also occur when anti-anxiety drugs are taken with antihistamines, which are found
in many over-the-counter cold and allergy medicines. Antidepressants such as
Prozac and Zoloft can also heighten their toxicity.

Other anti-anxiety drug risk factors

Anyone who takes benzodiazepines can experience unpleasant or dangerous side

effects. But certain individuals are at a higher risk:

• People over 65. Older adults are more sensitive to the sedating effects of
anti-anxiety medication. Even small doses can cause confusion, amnesia, loss
of balance, and cognitive impairment that looks like dementia. Anti-anxiety
drug use in the elderly is associated with an increased risk of falls, broken
hips and legs, and car accidents.
• Pregnant women. Expectant mothers should avoid anti-anxiety drugs.
Since these anxiety medications cross the placenta, their use during
pregnancy can lead to dependence in the baby. Following birth, the baby will
then go through withdrawal, with symptoms such as muscle weakness,
irritability, sleep and breathing problems, and trembling. These anxiety drugs
are excreted in breast milk, so they should be avoided while breastfeeding,
too.
• People with a history of substance abuse. Anyone with a current or
former problem with alcohol or drugs should avoid anti-anxiety drugs or use
them only with extreme caution. The greatest benefit of benzodiazepines is
that they work quickly, but this also makes them addictive. This can quickly
lead to their abuse, often in dangerous combination with alcohol or other
illicit drugs.
 Anti-anxiety drugs

Generic Daily Implementation

(trade) name Dosage
Range
Drug class: Benzodiazepines
alprazolam 0.5-8 mg Instruct client to avoid use of alcohol and sleep-
(Xanax) inducing or over-the-counter drugs and not to drive
GAD, panic a car if dizziness or drowsiness occurs; instruct
disorder client about the potential for drug dependence and
withdrawal syndrome if drug is discontinued
abruptly
clonazepam 0.5-20 mg Monitor liver function and blood count in clients
(Klonopin) receiving long-term therapy; monitor for mild
GAD, panic paradoxical excitement during the first two weeks
disorder, of therapy, respiratory distress, palpitations, and
performance constipation; instruct client to avoid use of alcohol
anxiety and sleep-inducing over-the-counter drugs.
lorazepam 1.0-10 mg Inform client of increased central nervous system
(Ativan) GAD, depression when taken with alcohol; monitor for
performance transient mild drowsiness or sedation and mild
anxiety paradoxical excitement during first two weeks of
therapy; instruct client to report constipation, dry
mouth, or nausea; discuss potential for drug
dependence and withdrawal syndrome with client.
Drug class: SSRIs, SNRIs, and Atypical Agents
buspirone 15-60 mg Provide sugarless lozenges or ice chips if dry
(BuSpar) GAD mouth or altered taste occurs; arrange for
analgesic if headache or musculoskeletal aches are
reported; monitor for dizziness, nervousness, GI
disturbances, dreams, nightmares, or excitability.
citalopram 10-60 mg Limit amount of drug given in prescription to
(Celexa) OCD potentially suicidal clients; give in the morning with
food if desired; monitor for GI disturbances,
diaphoresis, dizziness, insomnia or somnolence,
and palpitations; instruct male client that
medication may cause ejaculatory disorders.
escitalopram 10-20 mg Contraindicated with use of MAOIs or until after two
(Lexapro) GAD weeks of discontinuation; avoid use in third
trimester of pregnancy; do not give with citalopram
(Celexa) or alcohol; monitor with use of lithium,
oral anticoagulants, NSAIDS, aspirin; monitor for
nausea, sleep disturbance, decreased appetite,
abnormal bleeding, and diaphoresis
fluoxetine 20-50 mg Give drug in the morning; give in divided doses if
(Prozac) GAD, taking 20 mg/day; not to be given concurrently
OCD, panic with or until after two weeks of discontinuation of
disorder an MAOI; avoid use of alcohol; monitor client’s
response closely in the presence of hepatic or renal
 impairment or diabetes as well as for headache,
nervousness, abnormal sleep pattern, GI
disturbances, and weight loss
fluvoxamine 50-300 mg Give at bedtime; if dose is 100 mg, divide dose and
(Luvox) OCD give larger dose at h.s.; limit quantity of dispensed
drug to clients at risk for suicide; monitor for
dizziness, drowsiness, insomnia, GI disturbances,
mania, rash, seizures, and weight loss
paroxetine 10-60 mg Give in the morning; not to be given concurrently
(Paxil) GAD, with or under after two weeks of discontinuation of
OCD, PTSD, an MAOI; contraindicated with use of pimozide
panic disorder, (Orap) or throdridazine (Mellaril); avoid use of
social anxiety alcohol; monitor digoxin, phenytocin,
disorder phenobarbital, theophylline or warfarin levels; do
not give St. John’s wort concomitantly as it may
cause serotonin syndrome; monitor for
hypernatremia, abnormal bleeding, tremor, and
decreased appetite
sertraline 25-200 mg Give once daily in AM or PM, do not give
(Zoloft) GAD, concurrently with or until after two weeks of
OCD, PTSD, discontinuation of an MAOI; contraindicated with
panic disorder, use of pimozide (Orap); monitor for mania or
social anxiety hypomania, suicidal ideation, hyponatremia, weight
disorder loss, tremor, serotonin syndrome, or GI upset
venlafaxine 75-375 mg Monitor BP and reduce dose or discontinue if
(Effexor) GAD, hypertension occurs, monitor for dreams, tremor,
social anxiety dizziness, somnolence, GI disturbance, and dry
disorder mouth
Drug class: Beta Blockers
atenolol 50-200 mg Give with meals if GI disturbances occur; obtain
(Tenormin) baseline vital signs and monitor for any changes
Performance while taking drug; monitor for dizziness, loss of
anxiety, panic appetite, nightmares, depression, and sexual
disorder impotence
propanolol 40-120 mg Give with meals to facilitate absorption; monitor BP
(Inderal) and pulse while taking drug; monitor for dizziness,
performance drowsiness, blurred vision, GI disturbances,
anxiety panic nightmares, sexual impotence, and difficulty
disorder breathing