Which Benzodiazepines Are Used For Anxiety
They can also be used with antidepressants initially while antidepressants take time to work.
“They’re a powerful tool,” says Duckworth, “but you have to be really smart about their use.”
- Light-headedness
- Trouble sleeping
Beta-blockers can be very helpful but in a limited way, says Dr. Salcedo. They are most commonly used for performance anxiety. They are really good for the physical symptoms such as heart racing, sweating, shakiness, but they work less well for the anxious thoughts that might be causing the symptoms.
Additional reporting by Carlene Bauer.
Bottom Line: There Is No Universally Best Antidepressant For Elderly
Those that believe that one antidepressant is better than the field for a specific subset of the population have been mislead. There are many individual factors to consider whenever selecting an antidepressant such as: its effects on memory, interactions with other drugs that the person is taking, as well as how long the person plans to be medicated. Some medications may increase risk of falling due to the fact that they affect balance, coordination, and equilibrium.
Traditional psychiatry would suggest a person start with a logical, safe, proven option like an SSRI. Psychologists would suggest that a person start with psychotherapy and take things from there. The goal is to assess the risk-benefit ratio of each option for the elderly patient and tailor the treatment to fit the individual needs.
Keep in mind that these treatments are devised for those who are doing everything in their power: dietary, exercise, vitamins, sunlight, socialization, etc. to reduce depressive symptoms. Starting with TMS and psychotherapy has promise, and adding an antidepressant if the person doesnt get benefit from those practices can make a difference. Its just a matter of choosing whether you want immediate relief or want to test the waters and hope that something works .
What Does The Treatment Involve
Antidepressants are usually taken daily. The goal in the first few weeks and months is to relieve the symptoms and, where possible, make the go away. Once that has been achieved, the treatment is continued for at least four to nine months. This continuation therapy is necessary to stop the symptoms from coming back. The medication is sometimes taken for longer to prevent relapses. The duration of treatment also depends on how the symptoms continue to develop over time and whether the depression is likely to return. Some people take antidepressants over many years.
It’s important to have regular appointments with your doctor when taking antidepressants. There you can talk about whether the symptoms have improved and whether there are any side effects. The dose will be adjusted if necessary. By no means should you reduce the dose or stop taking the medication on your own. That can make the tablets less effective, or they may cause more side effects.
Towards the end of the treatment, the dose is gradually reduced over the course of several weeks. You may experience temporary sleep problems, nausea or restlessness when coming off antidepressants. These symptoms are especially likely if you suddenly stop taking antidepressants. Sometimes people stop taking their medication as soon as they start feeling better, but that increases the risk of the coming back. Unlike many sleeping pills and sedatives, antidepressants don’t cause physical dependence or addiction.
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Can Antidepressants Give You Suicidal Thoughts
In 2004, the FDA issued a black box label warning for suicidal ideation among 18- to 24-year-olds for common antidepressant drugs. This warning is the FDAs strictest warning for labeling prescription drugs.
The effect of suicidal thoughts is most common with SSRIs, occurring in about 4% of people who take them. However, untreated depression is considered to be much more of a suicide risk than taking antidepressants.
What Are The Different Types Of Antidepressants
Antidepressants fall into one of five medication classes:
SSRIs
TCAs treat depression by raising levels of serotonin and norepinephrine in the brain. While some studies suggest they may be more effective for certain people with severe depression, they have a greater risk of side effects. Because they arent as well-tolerated as previously listed antidepressants, healthcare providers often prescribe them after youve tried other medications first.
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Personal Opinion: When To Use Antidepressants For Anxiety Disorders
It is highly debatable as to whether antidepressants should be considered first-line treatments for anxiety. There are people that are in favor of antidepressants because they believe benzodiazepines are dangerous, while there are other people that believe antidepressants end up creating more problems over the long-term than a benzo. Most professionals will not hesitate to recommend antidepressants as a safe first-line treatment option for anxiety.
I believe that certain medications like Buspar and Clonidine for anxiety are superior to antidepressants in managing pure anxiety if they work. When it comes to treating anxiety, it is always best to start with medications that are specifically created for treating anxiety and not necessarily depression. I have personally used Clonidine for anxiety and found it to be a pretty effective option for generalized anxiety symptoms. Additionally it doesnt seem to impede my focus like a benzodiazepine would nor did it affect my mood like an antidepressant.
Buspar is also relatively safe and is a non-benzodiazepine medication that has been approved specifically for anxiety. If you have just anxiety without depression, you may want to consider taking a medication specifically created for anxiety as opposed to an antidepressant. Why? Because over the long-term, using antidepressants can create a chemical imbalance and may even make you depressed.
Do I Have An Anxiety Disorder
Common signs and symptoms of anxiety include nervousness, restlessness or tenseness, a sense of impending danger or doom, increased heart rate, breathing rapidly, sweating, trembling, feeling weak or tired, trouble concentrating or sleeping, stomach aches and headaches and the urge to avoid things that trigger anxiety.
Anxiety disorders often develop from a complex set of risk factors. The risk factors may include exposure to trauma, certain medical problems like thyroid disease or heart disease, stress due to a severe illness and other mental health disorders like depression. The use or misuse of drugs and alcohol can worsen symptoms of anxiety.
Anxiety disorders are best treated with a combination of therapy and medication, Alonzo said. It takes time to find the perfect combination for your symptoms. Your primary care provider is the best place to start that journey.
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I Need Relief And I Need It Now
So where does that leave you if youre suffering? Even when anxiety relief comes with side effects and dangers, that can still sound like a fair trade when panic and fear are ruling your life.
The bottom line is that theres a time and place for anxiety medication. If you have severe anxiety thats interfering with your ability to function, medication may be helpfulespecially as a short-term treatment. However, many people use anti-anxiety medication when therapy, exercise, or other self-help strategies would work just as well or better, minus the drawbacks.
Anxiety medications can ease symptoms, but theyre not right for everyone and theyre not the only answer. Its up to you to evaluate your options and decide whats best for you.
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Which Antidepressant Is The Hardest To Come Off Of
One downside of SSRIs and SNRIs is that they can be difficult to come off of. This is because these medications can cause withdrawal symptoms if your dose is lowered too quickly. Be sure to follow your healthcare providers instructions about how you should lower your dose.
Withdrawal symptoms from these antidepressants may include:
-
Flu-like symptoms
-
Pins-and-needles sensations
-
Electric shock-like sensations
If you experience these symptoms when trying to come off your antidepressant, let your healthcare provider know. But keep in mind that these symptoms are temporary and should resolve within 1 to 2 weeks.
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Management Of Anxiety In The Primary Care Setting
Benzodiazepines and buspirone.
The use of the benzodiazepines in the treatment of anxiety disorders has a long history. For many years, diazepam was the most widely prescribed BZD, but alprazolam is currently the most commonly used drug of this class because of its lower incidence of sedation. Alprazolam often significantly reduces panic attacks within a few days at the recommended daily dosage of 1.5 to 10 mg, although dosages as low as 0.25 mg 3 times daily may be effective in some patients. In more chronic forms of anxiety, such as GAD, typical maintenance dosages of alprazolam are generally lower than those used in panic disorder.
Unlike BZDs, buspirone, a member of the azapirone class of nonbenzodiazepine anxiolytics, does not cause sedation or psychomotor and cognitive impairment and, in general, has a more favorable adverse effect profile. Adverse effects of treatment include headache, light-headedness, nausea, and restlessness. Buspirone also has a low abuse potential, so it may be a suitable alternative to BZDs in addictive patients.
At dosages of 20 mg/day, buspirone is effective in GAD but not in panic disorder or OCD, for which it has shown little effect as a sole agent. However, buspirone has a slow onset of action, and it can take 3 to 4 weeks to provide substantial relief of symptoms.
Newer antidepressants for treatment of anxiety.
Foods That Help Or Hurt Anxiety
There are several types of medications used to treat anxiety disorders.
- Hydroxyzine
- Beta-blockers
Within each of these categories, there are subgroups of drugs that work differently and have their own benefits, risks, and possible side effects.
Theyre supereffective in treating anxiety disorders, says Beth Salcedo, MD, the medical director of the Ross Center for Anxiety & Related Disorders and a past board president of the Anxiety and Depression Association of America. Its not known exactly how SSRIs work on serotonin to alleviate anxiety, says Dr. Salcedo, but what is known is that theyre not addictive like benzodiazepines are .
Its important to follow your doctors instructions when taking any prescription drug. Talk to your doctor if youre concerned about the side effects of a medication, or if the drug youre taking doesn’t seem to be alleviating your symptoms.
Other antidepressants that may be prescribed for anxiety include:
- Wellbutrin, Zyban, Aplenzin, Budeprion, or Buproban
- Tricyclic antidepressants, such as Amitid, Amitril, Elavil, or Endep Aventyl, Pamelor or Tofranil
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Meditation And Mindfulness Practices
These types of therapies help you be more aware of your feelings and better cope with them.
Mindfulness programs help train the mind to become less reactive to negative thoughts or emotions and instead calmly observe them without judgment, which helps people feel more at ease. Yoga is another excellent way to increase mindfulness through physical activity as well.
Why Antidepressants Are Preferred Over Benzodiazepines For Anxiety
There are many reasons why a doctor may prefer to prescribe an antidepressant as opposed to a benzodiazepine for anxiety. Although benzodiazepines are highly effective and arguably the most potent anxiolytic drugs on the market, they should be reserved for only the most extreme cases of anxiety. Unlike benzodiazepines, antidepressants have a low potential for addiction, arent associated with neurodegeneration, and are safer in regards to both usage and withdrawal.
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Using Antidepressants For Anxiety And Depression
It should be mentioned that SSRI antidepressants are a great first-line treatment option for people with anxiety and comorbid depression and individuals with depression and comorbid anxiety. Although most doctors will simply throw SSRIs at you if you mention anxiety and depression, they may tweak treatments based on whether you are experiencing more anxiety than depression or vice versa. Below are various scenarios of how a person may be affected by anxiety.
Anxiety with comorbid depression: In this diagnosis, a person is primarily dealing with anxiety. The anxiety may be causing them to feel depressed and/or may be significantly more problematic than the depression. In this case, treating the anxiety may help the depression. In other cases, both the anxiety and depression need to be targeted.
Depression with comorbid anxiety: In this diagnosis, a person primarily is dealing with major depression. The depression could be causing them to feel anxiety and/or may be significantly more problematic than the anxiety. In this case, treating the depression may help the anxiety. In other cases, a doctor may need to target the depression and the anxiety for a person to feel relief.
Pure anxiety: For individuals with pure anxiety, it may be better to pursue anxiolytics prior to using antidepressants. If you get no relief from any drugs that your psychiatrist prescribes, you may get put on a benzodiazepine.
Special Benzodiazepine 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 benzodiazepines. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Benzodiazepine use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents. Long-term benzodiazepine use also increases the risk of Alzheimers disease and dementia.
People with a history of substance abuse. Because theyre physically addicting and on their own and dangerous when combined with alcohol and other drugs, anyone with a current or former substance abuse problem should use benzodiazepines only with extreme caution.
Pregnant and breastfeeding women. Benzodiazepine use during pregnancy can lead to dependence in the developing baby, with withdrawal following birth. Benzodiazepines are also excreted in breast milk. Therefore, pregnant women need to have a thorough discussion about the risks and benefits of these medications with their prescribing doctor. If medication is necessary, the goal is the smallest effective dose.
The connection between benzodiazepines and accidents
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How Long Will I Need To Take Antidepressants For
This will depend on a number of factors and is best discussed with your doctor. It is common to be on antidepressants for at least 6 to 12 months for a first episode of moderate to severe depression needing medication.
- If you have troublesome side effects or little improvement in your symptoms after 6 weeks, talk to your doctor about changing the dose, trying a different antidepressant , or adding a second antidepressant or another medication . A medication combination may work better for you than a single antidepressant.
- If this is not your first experience of depression, your doctor may prescribe longer treatment. You may be able to stop these medicines after a while. They are not addictive.
- If you plan to stop taking antidepressants, talk with your doctor first about how to do it safely. It’s best to slowly decrease your dose. Suddenly stopping can cause side effects. It may also cause your depression to come back or get worse.
What Are The Best Antidepressants
Over the years, studies have compared various antidepressants. After reviewing the available research, the American Psychiatric Association concluded that no one antidepressant was more effective at treating depression than others. Instead, antidepressants are typically recommended based on factors like their side effects, the cost, and whether youve responded favorably to a particular medication in the past.
Healthcare providers typically start most people on either a selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor . These medications are generally better tolerated than other antidepressants and can also treat other conditions that people sometimes experience along with depression, like anxiety.
But in the end, the best antidepressant is the one that provides you the most benefit with the fewest side effects. Everyones journey to finding the right depression treatment is unique.
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Side Effects Of Antidepressant Medications
All medications can have side-effects. Some people experience no side-effects. Others may find the side-effects distressing. In most cases, side-effects lessen as treatment continues.
Treatment is usually started at a low dose, to minimize side-effects, and then slowly increased until the ideal dose is found. The ideal dose is one that provides the greatest benefit with minimum side-effects.
If you are experiencing side effects, check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If side-effects are not mild and tolerable, it is best to continue taking your medication as prescribed but let your doctor know as soon as possible. Your doctor may:
- encourage you to wait a little longer for the side-effects to fade
- adjust your dose
- suggest you take the medication at a different time of day
- prescribe other medications to help control side-effects
- change your medication
- stop medication treatment and suggest a different type of treatment approach.
Side-effects vary depending on the type of medication. More information on side-effects is included for each type of types of antidepressant.
You can help to control possible side-effects on your own by:
Do antidepressants increase the risk of suicide?
Before starting treatment, prepare for the possibility of feeling worse before you feel better. Know what supports are available to you and who you can call.
Depression: How Effective Are Antidepressants
Like psychotherapy, antidepressants are a key part of treating . They aim to relieve symptoms and prevent depression from coming back.
Opinions vary on how effective antidepressants are in relieving the symptoms of . Some people doubt that they work well, while others consider them to be essential. But, like with many other treatments, these medications may help in some situations and not in others. They are effective in moderate, severe and chronic depression, but probably not in mild cases. They can also have side effects. It is important to discuss the pros and cons of antidepressants with your doctor.
The main aim of treatment with antidepressants is to relieve the symptoms of severe , such as feeling very down and exhausted, and prevent them from coming back. They are meant to make you feel emotionally stable again and help you to follow a normal daily routine. They are also taken to relieve symptoms such as restlessness, anxiety and sleep problems, and to prevent suicidal thoughts.
This information is about using medication to treat the most common form of , known as unipolar depression. The treatment options for manic depression aren’t discussed here.
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