Anxiety disorders are serious medical illnesses that affect approximately 40 million American adults. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.
Effective natural cures for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information about traditional and natural cures for anxiety so you can make an informed decision about anxiety treatment.
Each anxiety disorder has its own distinct features, but they are all bound together by the common theme of excessive, irrational fear and dread.
Generalized Anxiety Disorder
"I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer.
"When my problems were at their worst, I'd miss work and feel just terrible about it. Then I worried that I'd lose my job. My life was miserable until I got treatment."
Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It's chronic and fills one's day with exaggerated worry and tension, even though there is little or nothing to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.
People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. Their worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded or out of breath. They also may feel nauseated or have to go to the bathroom frequently.
Individuals with GAD seem unable to relax, and they may startle more easily than other people. They tend to have difficulty concentrating, too. Often, they have trouble falling or staying asleep.
Unlike people with several other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. When impairment associated with GAD is mild, people with the disorder may be able to function in social settings or on the job. If severe, however, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.
GAD affects about 6.8 million adult Americans1 and about twice as many women as men. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.
GAD is commonly treated with medications. GAD rarely occurs alone, however; it is usually accompanied by another anxiety disorder, depression, or substance abuse. These other conditions must be treated along with GAD.
If you are having a panic attack, most likely your heart will pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. You may genuinely believe you're having a heart attack or losing your mind, or on the verge of death.
Panic attacks can occur at any time, even during sleep. An attack generally peaks within 10 minutes, but some symptoms may last much longer.
Panic disorder affects about 6 million adult Americans and is twice as common in women as in men. It most often begins during late adolescence or early adulthood. Risk of developing panic disorder appears to be inherited. Not everyone who experiences panic attacks will develop panic disorder—for example, many people have one attack but never have another. For those who do have panic disorder, though, it's important to seek treatment. Untreated, the disorder can become very disabling.
Many people with panic disorder visit the hospital emergency room repeatedly or see a number of doctors before they obtain a correct diagnosis. Some people with panic disorder may go for years without learning that they have a real, treatable illness.
Panic disorder is often accompanied by other serious conditions such as depression, drug abuse, or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding in an elevator, you may develop a fear of elevators. If you start avoiding them, that could affect your choice of a job or apartment and greatly restrict other parts of your life.
Some people's lives become so restricted that they avoid normal, everyday activities such as grocery shopping or driving. In some cases they become housebound. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person.
Basically, these people avoid any situation in which they would feel helpless if a panic attack were to occur. When people's lives become so restricted, as happens in about one-third of people with panic disorder,2 the condition is called agoraphobia. Early treatment of panic disorder can often prevent agoraphobia.
Panic disorder is one of the most treatable of the anxiety disorders, responding in most cases to medications or carefully targeted psychotherapy.
You may genuinely believe you're having a heart attack, losing your mind, or are on the verge of death. Attacks can occur at any time, even during sleep.
You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You may have frequent thoughts of violence, and fear that you will harm people close to you. You may spend long periods touching things or counting; you may be pre-occupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.
The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.
A lot of healthy people can identify with some of the symptoms of OCD, such as checking the stove several times before leaving the house. But for people with OCD, such activities consume at least an hour a day, are very distressing, and interfere with daily life.
Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.
OCD afflicts about 2.2 million American adults.1 It strikes men and women in approximately equal numbers and usually first appears in childhood, adolescence, or early adulthood.2 One-third of adults with OCD report having experienced their first symptoms as children. The course of the disease is variable—symptoms may come and go, they may ease over time, or they can grow progressively worse. Research evidence suggests that OCD might run in families.3
Depression or other anxiety disorders may accompany OCD,2,4 and some people with OCD also have eating disorders.6 In addition, people with OCD may avoid situations in which they might have to confront their obsessions, or they may try unsuccessfully to use alcohol or drugs to calm themselves.4,5 If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home.
OCD generally responds well to treatment with medications or carefully targeted psychotherapy.
The disturbing thoughts or images are called obsessions, and the rituals performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.
Post-Traumatic Stress Disorder
Whatever the source of the problem, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience other sleep problems, feel detached or numb, or be easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Things that remind them of the trauma may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the traumatic event are often very difficult.
PTSD affects about 7.7 million adult Americans.1 Women are more likely than men to develop PTSD.7 It can occur at any age, including childhood,8 and there is some evidence that susceptibility to PTSD may run in families.9 The disorder is often accompanied by depression, substance abuse, or one or more other anxiety disorders.4 In severe cases, the person may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was deliberately initiated by a person—such as a rape or kidnapping.
Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, may lose touch with reality and believe that the traumatic event is happening all over again.
Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do develop PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn't show up until years after the traumatic event.People with PTSD can be helped by medications and carefully targeted psychotherapy. Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. Anniversaries of the traumatic event are often very difficult.
Social Phobia (Social Anxiety Disorder)
Social phobia can be limited to only one type of situation—such as a fear of speaking in formal or informal situations, or eating, drinking, or writing in front of others—or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Social phobia can be very debilitating—it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends.
Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, nausea, and difficulty talking. If you suffer from social phobia, you may be painfully embarrassed by these symptoms and feel as though all eyes are focused on you. You may be afraid of being with people other than your family.
People with social phobia are aware that their feelings are irrational. Even if they manage to confront what they fear, they usually feel very anxious beforehand and are intensely uncomfortable throughout. Afterward, the unpleasant feelings may linger, as they worry about how they may have been judged or what others may have thought or observed about them.
Social phobia affects about 15 million adult Americans.1 Women and men are equally likely to develop social phobia.10 The disorder usually begins in childhood or early adolescence,2 and there is some evidence that genetic factors are involved.11 Social phobia often co-occurs with other anxiety disorders or depression.2,4 Substance abuse or dependence may develop in individuals who attempt to "self-medicate" their social phobia by drinking or using drugs.4,5 Social phobia can be treated successfully with carefully targeted psychotherapy or medications.
Social phobia can severely disrupt normal life, interfering with school, work, or social relationships. The dread of a feared event can begin weeks in advance and be quite debilitating.
Specific phobias affect an estimated 19.2 million adult Americans1 and are twice as common in women as in men.10 The causes of specific phobias are not well understood, though there is some evidence that these phobias may run in families.11 Specific phobias usually first appear during childhood or adolescence and tend to persist into adulthood.12
If the object of the fear is easy to avoid, people with specific phobias may not feel the need to seek treatment. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation, and if this avoidance is carried to extreme lengths, it can be disabling. Specific phobias are highly treatable with carefully targeted psychotherapy.
Phobias aren't just extreme fears; they are irrational fears. You may be able to ski the world's tallest mountains with ease but feel panic going above the 5th floor of an office building.
Portions of content from NIMH
Causes of Anxiety Disorders
The foods we eat can have an impact on how we feel physically and emotionally. It is important to know that consuming certain foods and substances can trigger anxiety and panic symptoms.
Any stress lasting longer than a few minutes results in increased levels of cortisol being released from the adrenal cortex. The release of cortisol is controlled by the paraventricular nucleus (PVN) of the hypothalamus, where corticotropin-releasing hormone (CRH) is released in response to the stress. CRH then acts on the pituitary gland, causing it to release adrenocorticotrophic hormone (ACTH), which in turn causes the adrenal cortex to release cortisol. Prolonged release of ACTH causes the adrenal cortex to increase in size whereas long-term ACTH deficiency causes it to shrink. The combined system of CRH-ACTH-cortisol release is referred to as the hypothalamic-pituitary-adrenal axis (or HPA axis).
There is evidence that the HPA axis is involved in the neurobiology of anxiety, depression, and mood disorders.Chronically excess cortisol may contribute to many diseases, including cancer, ulcers, heart attacks, diabetes, infections, alcoholism, strokes, skin diseases, psychosis, and possibly Parkinson's and Alzheimer's disease, multiple sclerosis and myasthenia gravis. Cortisol excess may contribute to obesity not only because of the metabolic derangements (including insulin resistance) that it promotes, but also because it induces "stress overeating," especially (but not only) in women.
Excessive cortisol frequently causes increased:
Anxiety can result from imbalances in the levels of chemical messengers in the brain called neurotransmitters. The emotions we feel are based on the release of neurotransmitters in the brain. Prolonged periods of stress can deplete neurotransmitters levels. Our fast paced, fast food society greatly contributes to these imbalances.
Different neurotransmitters have different actions. Some neurotransmitters are inhibitory and tend to calm, while others are excitatory and stimulate the brain. This observation has led to the conclusion that some neurotransmitter imbalances are more likely to underlie certain conditions. Specifically, deficiencies involving the central nervous system's inhibitory neurotransmitters, gamma-amino-butyric acid (GABA) and glycine, appear to be involved in the development of anxiety disorders, while other neurotransmitters like serotonin and norepinephrine have been more closely linked to depression.
A single neurotransmitter imbalance can result in multiple symptoms. By identifying these chemical imbalances with neurotransmitter tests and understanding how neurotransmitters function and interact in anxiety disorders, it is possible to better match therapies to the patient's chemical imbalance.
The function of a neurotransmitter is to properly relay messages across the synaptic cleft from one neuron to the next. The excitatory neurotransmitters increase the likelihood that a neuron's signals are sent and the inhibitory neurotransmitters decrease the likelihood that a neuron's signals are sent. This balance ensures that unimportant signals are terminated or ignored and that important signals are relayed and acted upon.
If the levels of the excitatory neurotransmitters are in excess, this balance is disturbed and the ability to discern between what is important and what is not can be impaired. This can result in excessive excitation and lead to seizures, insomnia, anxiety, and hyper-excitability.
Hyperthroidism causes panic attacks, pounding heartbeat, tremors, and sweats.
Mitral Valve Prolapse
One out of every three panic attack victims have Mitral Valve Prolapse. It is a minor heart condition which can cause anxiety palpitations, chest pain, fatigue, and difficulty breathing.
Anxiety Supplements and other natural anxiety cures
Ashwaganda (Withania Somnifera)
Bach Flower Remedies
Bach Flower Remedies are prescribed according to the individual and the cause and nature of the anxiety and identifying the exact feeling underlying the problem. Agrimony and aspen are useful for mild to moderate anxiety. For severe cases, use cherry plum or red chestnut. Anxiety for no apparent reason may be treated with aspen. The victims suffer from a persistent feeling that something bad is about to happen them. Anxiety over the welfare of loved ones (such as worrying excessively about the well-being of others) may be red chestnut; anxiety about inability to cope would be elm or larch.
Dandelion leaves have been shown to release stress and promote relaxation. They help you let go of irrational fears and promote trust in yourself. They have been known to ease muscle tension and help backaches. It is nutritious and boosts your digestive system as well.
Eleuthero or Siberian Ginseng (Eleutherococcus Senticosus)
Gamma-aminobutyric acid (GABA) - GABA (Gamma Aminobutyric Acid) is an amino acid and neurotransmitter that helps reduce anxiety, allows rational decision making, promotes restful sleep and enhances workout recovery. It has also been shown to have similar effects as the benzodiazepine drugs. You will also feel more relaxed and notice that you are sleeping better. The recommended dose for GABA is 500 mg - 3 times daily
Inositol has been shown in studies to have a positive effect in the calming of the symptoms of panic attacks and obsessive-compulsive disorder. Taking up to 4 grams daily has shown to be beneficial. Research suggests a range of applications with inositol for promoting brain wellness and healthy
L-Tryptophan is the precursor to Serotonin, a neurotransmitter in the brain, which is deficient in depression. L-Tryptophan is a natural relaxant and helps alleviate insomnia by inducing normal sleep. L-Tryptophan reduces anxiety & depression; helps in the treatment of migraine headaches; helps the immune system; helps reduce the risk of artery & heart spasms.
Passion flower is one of nature's best tranquilizers. As well as being used to help the mind in extreme emotional upsetting times, it also relieves anxiety, muscle tension, insomnia and headaches. Passionflower is used as an alternative medicine in the treatment of insomnia, nervous tension, irritability, neuralgia, irritable bowel syndrome, and premenstrual tension.
Japanese researchers have discovered that theanine is a caffeine antagonist, meaning that it offsets the "hyper" effect of caffeine (Kakuda et al. 2000). That is why many people will have a "soothing" cup of tea and not a soothing cup of coffee. Theanine does not cause drowsiness like kava kava, nor does it interfere with the ability to think clearly like prescription tranquilizers.
There is evidence that tea exerts far more than just a psychological effect. According to one study, drinking one or more cups of tea can almost halve the risk of heart attack (Sesso et al. 1999). Green tea contains a much higher concentration of theanine than other teas. Theanine has been proven to lower blood pressure (Abe et al. 1995; Yokogoshi et al. 1995; Yokogoshi et al. 1998a). It works through its GABA enhancing effects. Along with its calming effect on the brain, GABA also lowers blood pressure. Genetically hypertensive rats taking 2000 mg of theanine per kg of body weight each day showed significant reductions in blood pressure. Green tea extract contains a phytochemical known as GMA that also lowers blood pressure. Combining them may have significant effects. Theanine is now available in the United States as a dietary supplement. Suggested dosage: The suggested dose of theanine to induce a state of relaxation is 100 mg. For those seeking a continuous mood elevating effect, 1 theanine capsule can be taken 4 times throughout the day.
Valerian is one of the most studied herbs, particularly in Germany where it has been used for years to quiet and calm the central nervous system. Valerian is believed to enhance the release of the neurotransmitter GABA. This may explain its ability to help promote sleep and relaxation.
Dietary Factors that Contribute to Anxiety
Nutritional deficiencies are a common cause of stress and anxiety.. When under stress, the need for nutrients is much greater. Carbohydrates, when excessive in the diet, stress the adrenals. Diets low in protein may also create deficiencies and inadequate or poor quality water affects oxygenation of the tissues.
Be aware to check for food allergies as they can be one of the main causes of many mental and emotional problems. Although an individual could be allergic to any food, such as fruits, vegetables, and meats, there are eight foods that account for 90% of all food-allergic reactions. These are: milk, egg, peanut, tree nut (walnut, cashew, etc.), fish, shellfish, soy, and wheat. Find out more about the Food Allergy Tests we have available!
Hormones in Meat
Many brands of meat have been fed hormones to promote fast weight gain and growth. One hormone diethylstilbestrol (DES) has been implicated in the development of breast cancer and fibroid tumors. Buy organically raised beef, poultry and fish such as cod, salmon, snapper, sole, trout when possible.
There are over 5000 chemical additives in commercial food processing. Our bodies are not equipped to handle these, and little is known about long term biological effects. Additives such as MSG, and artificial sweeteners such as NutraSweet can function as excitotoxins in the brain. Try and eat whole unprocessed foods as much as possible. Try to purchase organic fruits and vegetables when possible.
Caffeine – Eliminating coffee should be the first step. Many anxious people are sensitive to caffeine. Try to wean yourself off coffee, tea, and anything else containing caffeine, or switch to noncaffeinated varieties of these beverages. Chocolate and herb guarana also contain caffeine. They overstimulate your adrenal glands, causing and adrenaline or cortisol release. This can provoke anxiety, nervousness and insomnia. Coffee does not give you energy; coffee gives you the illusion of energy. Coffee actually drains the body of energy and makes you more tired, because of vitamin, mineral, and adrenal depletion.
Avoid all foods containing refined sugars. These foods can affect your blood sugar leading to anxiety and mood swings.Hypoglycemia causes irritablity, fatigue, rapid heart beat, lightheadedness, and panic attacks.
Foods that reduce Anxiety
Riboflavin (vitamin B2)
Thiamin (vitamin B1)
Other Natural Remedies for Anxiety
Have a stress-free home environment
Keep the noise level down as noise contributes to stress. Use as much natural lighting in your home as possible as unnatural florescent lighting can be especially aggravating.
Cognitive-Behavioral and Behavioral Therapy
The behavioral component of CBT seeks to change people's reactions to anxiety-provoking situations. A key element of this component is exposure, in which people confront the things they fear. An example would be a treatment approach called exposure and response prevention for people with OCD. If the person has a fear of dirt and germs, the therapist may encourage them to dirty their hands, then go a certain period of time without washing. The therapist helps the patient to cope with the resultant anxiety. Eventually, after this exercise has been repeated a number of times, anxiety will diminish. In another sort of exposure exercise, a person with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee. In some cases the individual with social phobia will be asked to deliberately make what appear to be slight social blunders and observe other people's reactions; if they are not as harsh as expected, the person's social anxiety may begin to fade. For a person with PTSD, exposure might consist of recalling the traumatic event in detail, as if in slow motion, and in effect re-experiencing it in a safe situation. If this is done carefully, with support from the therapist, it may be possible to defuse the anxiety associated with the memories. Another behavioral technique is to teach the patient deep breathing as an aid to relaxation and anxiety management.
Behavioral therapy alone, without a strong cognitive component, has long been used effectively to treat specific phobias. Here also, therapy involves exposure. The person is gradually exposed to the object or situation that is feared. At first, the exposure may be only through pictures or audiotapes. Later, if possible, the person actually confronts the feared object or situation. Often the therapist will accompany him or her to provide support and guidance.
If you undergo CBT or behavioral therapy, exposure will be carried out only when you are ready; it will be done gradually and only with your permission. You will work with the therapist to determine how much you can handle and at what pace you can proceed.
A major aim of CBT and behavioral therapy is to reduce anxiety by eliminating beliefs or behaviors that help to maintain the anxiety disorder. For example, avoidance of a feared object or situation prevents a person from learning that it is harmless. Similarly, performance of compulsive rituals in OCD gives some relief from anxiety and prevents the person from testing rational thoughts about danger, contamination, etc.
To be effective, CBT or behavioral therapy must be directed at the person's specific anxieties. An approach that is effective for a person with a specific phobia about dogs is not going to help a person with OCD who has intrusive thoughts of harming loved ones. Even for a single disorder, such as OCD, it is necessary to tailor the therapy to the person's particular concerns. CBT and behavioral therapy have no adverse side effects other than the temporary discomfort of increased anxiety, but the therapist must be well trained in the techniques of the treatment in order for it to work as desired. During treatment, the therapist probably will assign "homework"—specific problems that the patient will need to work on between sessions.
CBT or behavioral therapy generally lasts about 12 weeks. It may be conducted in a group, provided the people in the group have sufficiently similar problems. Group therapy is particularly effective for people with social phobia. There is some evidence that, after treatment is terminated, the beneficial effects of CBT last longer than those of medications for people with panic disorder; the same may be true for OCD, PTSD, and social phobia.
Medication may be combined with psychotherapy, and for many people this is the best approach to treatment. As stated earlier, it is important to give any treatment a fair trial. And if one approach doesn't work, the odds are that another one will, so don't give up.
If you have recovered from an anxiety disorder, and at a later date it recurs, don't consider yourself a "treatment failure." Recurrences can be treated effectively, just like an initial episode. In fact, the skills you learned in dealing with the initial episode can be helpful in coping with a setback.
As stated earlier, psychologists, social workers, and counselors sometimes work closely with a psychiatrist or other physician, who will prescribe medications when they are required. For some people, group therapy is a helpful part of treatment.
It's important that you feel comfortable with the therapy that the mental health professional suggests. If this is not the case, seek help elsewhere. However, if you've been taking medication, it's important not to discontinue it abruptly, as stated before. Certain drugs have to be tapered off under the supervision of your physician.
Remember, though, that when you find a health care professional that you're satisfied with, the two of you are working together as a team. Together you will be able to develop a plan to treat your anxiety disorder that may involve medications, cognitive-behavioral or other talk therapy, or both, as appropriate.
You may be concerned about paying for treatment for an anxiety disorder. If you belong to a Health Maintenance Organization (HMO) or have some other kind of health insurance, the costs of your treatment may be fully or partially covered. There are also public mental health centers that charge people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.
Part of the information in this section has been provided by NIMH.
The major classes of medications used for various anxiety disorders are described below.
Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. These medications act in the brain on a chemical messenger called serotonin. SSRIs tend to have fewer side effects than older antidepressants. People do sometimes report feeling slightly nauseated or jittery when they first start taking SSRIs, but that usually disappears with time. Some people also experience sexual dysfunction when taking some of these medications. An adjustment in dosage or a switch to another SSRI will usually correct bothersome problems. It is important to discuss side effects with your doctor so that he or she will know when there is a need for a change in medication.
Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram are among the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are often used to treat people who have panic disorder in combination with OCD, social phobia, or depression. Venlafaxine, a drug closely related to the SSRIs, is useful for treating GAD. Other newer antidepressants are under study in anxiety disorders, although one, bupropion, does not appear effective for these conditions. These medications are started at a low dose and gradually increased until they reach a therapeutic level.
Similarly, antidepressant medications called tricyclics are started at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied for treating anxiety disorders. For anxiety disorders other than OCD, they are as effective as the SSRIs, but many physicians and patients prefer the newer drugs because the tricyclics sometimes cause dizziness, drowsiness, dry mouth, and weight gain. When these problems persist or are bothersome, a change in dosage or a switch in medications may be needed.
Tricyclics are useful in treating people with co-occurring anxiety disorders and depression. Clomipramine, the only antidepressant in its class prescribed for OCD, and imipramine, prescribed for panic disorder and GAD, are examples of tricyclics.
Monoamine oxidase inhibitors, or MAOIs, are the oldest class of antidepressant medications. The most commonly prescribed MAOI is phenelzine, which is helpful for people with panic disorder and social phobia. Tranylcypromine and isoprocarboxazid are also used to treat anxiety disorders. People who take MAOIs are put on a restrictive diet because these medications can interact with some foods and beverages, including cheese and red wine, which contain a chemical called tyramine. MAOIs also interact with some other medications, including SSRIs. Interactions between MAOIs and other substances can cause dangerous elevations in blood pressure or other potentially life-threatening reactions.
Some people experience withdrawal symptoms when they stop taking benzodiazepines, although reducing the dosage gradually can diminish those symptoms. In certain instances, the symptoms of anxiety can rebound after these medications are stopped. Potential problems with benzodiazepines have led some physicians to shy away from using them, or to use them in inadequate doses, even when they are of potential benefit to the patient.
Benzodiazepines include clonazepam, which is used for social phobia and GAD; alprazolam, which is helpful for panic disorder and GAD; and lorazepam, which is also useful for panic disorder.
Buspirone, a member of a class of drugs called azipirones, is a newer anti-anxiety medication that is used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike the benzodiazepines, buspirone must be taken consistently for at least two weeks to achieve an anti-anxiety effect.
Last Modified 3/30/08
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