The Diagnostic and Statistical Manual (DSM-5) defines anxiety as the anticipation of perceived or real future ‘threat.’ This worry has to be excessive, persistent, and interfere with everyday functioning to constitute any possible anxiety disorder.
This excessive worry can manifest with physical symptoms like restlessness, fatigue, tension, headaches, or difficulty concentrating–things that most of us experience from time to time. However, for some, chronic anxiety impairs how you function each and every day, straining relationships, and affecting work or study.
Types of Anti-Anxiety Medications
Unlike other medicines for psychological conditions that require a psychiatrist or psychiatric nurse, in the US, most doctors can prescribe anxiety medications and antidepressants. While this improves access, family doctors and primary care physicians do not always have the level of training and understanding that psychiatrists and psychiatric nurses do for mental health conditions.
Balancing the side effects with the potential benefits is a tricky business, made even harder when you can’t get access to mental health specialists. Luckily, there is a drive to increase the number of psychiatric nurses with specialist skills through the fastest post master’s PMHNP programs available, taking pressure off family doctors to specialize in mental healthcare and allowing time for more psychiatrists to be trained.
The two main types of anxiety medications are Selective Serotonin Reuptake Inhibitors or SSRIs (occasionally SNRIs) and benzodiazepines:
- SSRIs
This widely prescribed class of drugs is used by 1 in 10 Americans for depression, anxiety, and other mental health issues. For anxiety, SSRIs are thought to work by increasing levels of serotonin, a neurotransmitter that helps regulate mood, by blocking its reabsorption (reuptake) in the brain. This leads to more stable communication between brain cells involved in mood and anxiety control.
While they don’t offer immediate relief, they gradually reduce anxiety symptoms, and you should notice a difference after a few weeks. Common SSRIs like sertraline, escitalopram, and fluoxetine are generally well-tolerated but can cause side effects ranging from nausea to sleep changes, or sexual dysfunction, especially early on.
- Benzodiazepines
You have probably heard of Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), or Valium (diazepam). In 2018, they were prescribed to over 5% of all adults in America, and that number has only grown since. They are also commonly abused, with millions reporting recreational or ‘non-prescribed’ usage every year.
These different types of benzodiazepines work in the same way, by binding to a specific site on the GABA receptors. GABA is generally an inhibitory neurotransmitter that can bind to specific parts of the brain and nervous system to slow down or ‘inhibit’ the cell’s ability to receive other signals. Certain conditions–like anxiety–are linked to disrupted brain circuits, a GABA imbalance, and “disturbed” emotional responses.
So, using benzodiazepines to increase GABA levels and slow down neural activity can be helpful, but it can also make you feel sleepy, sedated, or just ‘out of it,’ something that is less than ideal if you want to drive a car or go to work. On the plus side, they are fast-acting, making them useful for panic attacks and acute anxiety.
In the long run, benzodiazepines have dangers just like any other drug; they can become a habit when the brain gets used to functioning with them, and suddenly stopping them can cause pretty terrible withdrawal symptoms. At the end of the day, only you (with the help of your healthcare providers) can decide if this medication is right for you.
What to Expect When Starting Medication
Like any medication, there are very real pros and cons to consider before starting anti-anxiety drugs. Most people don’t feel better immediately—SSRIs, for example, can take 4 to 6 weeks to show noticeable results. During this adjustment period, it’s common to experience mild side effects such as nausea, dizziness, sleep disturbances, or increased anxiety. These do usually resolve as your body adapts, but not for everyone. Regular follow-ups with your healthcare provider are important to monitor effectiveness and adjust dosage if needed. It’s also essential not to stop medication suddenly, as doing so can trigger withdrawal symptoms or a rebound of anxiety.
Choosing Medication
Medication may be an effective part of anxiety management, but its use is rarely a complete solution in and of itself. Most often, the best outcomes come from a combined approach. Psychotherapy with a focus on cognitive-behavioral therapy (CBT) is very helpful in allowing a person to understand their anxiety, modify counterproductive thinking, and acquire useful coping skills.
Lifestyle changes like exercise, avoiding things like excessive caffeine or alcohol, improved sleep habits, and mindfulness or relaxation techniques can also have a profound impact over time. It’s essential to approach medication with realistic expectations: it’s not a matter of “curing” anxiety but rather making it manageable.
Medication can be life-changing for some people; others don’t respond as positively or prefer not to take it at all. That’s okay. Your experience with anxiety is individual, and so is your treatment journey. At the end of the day, starting medication is your choice, a choice that you should approach with caution, under the guidance of a qualified health provider who will help you weigh the benefits, risks, and alternatives.
