Drug treatment - Generalised Anxiety Disorder
Anxiolytic medication refers to any medication prescribed to reduce symptoms of anxiety.
Medication should be used selectively for Generalised Anxiety Disorder. It can be used to bring symptoms under control while the effects of psychological treatments are awaited. Medication is also helpful in patients with severe anxiety related disability who do not improve with psychological treatments. There are a number of groups of drugs available.
Benzodiazepines
These are indicated for the short-term relief of severe anxiety but are not usually prescribed for more than 3 weeks at a time because of the risk of dependence and abuse. If they have been prescribed for long-term use, they have to be withdrawn slowly because of the risk of withdrawal symptoms. However, a proportion of people are prescribed benzodiazepines in the long term, often due to concern over the potential for withdrawal symptoms.
Benzodiazepines in current use include:
- Diazepam [Valium]
- Chlordiazepoxide [Librium]
- Chlorazepate [Tranxene]
- Lorazepam [Ativan]
- Oxazepam
Commoner side effects include drowsiness, light-headedness, confusion, unsteadiness, amnesia and muscle weakness.
Buspirone
Buspirone is as effective as the benzodiazepines in the short-term management of Generalised Anxiety Disorder. It is unlikely to cause dependence and abuse. It is licensed for short-term use only but psychiatrists occasionally use it for several months.
Commoner side effects include nausea, dizziness, headache, nervousness, light-headedness and excitement.
Beta-blockers
These do not affect psychological symptoms such as worry, fear and tension but do reduce physical symptoms such as palpitations and tremor.
The commoner prescribed beta-blockers include:
- Propranolol [Inderal, Half-Inderal]
- Oxprenolol [Trasicor, Slow -Trasicor]
- Side effects include slowing of the pulse rate, low blood pressure, breathlessness, dizziness, nausea, fatigue, sleep disturbance and impotence.
Antidepressants
Most antidepressants have anxiety reducing as well as antidepressant effects. They act more slowly than benzodiazepines and Buspirone but their effect is equivalent or greater and they are much less likely to cause dependence than benzodiazepines. There is a tendency to use an antidepressant with more sedative effects, such as Amitriptylline or Trazadone, but Imipramine seems to be just as effective. Of the newer antidepressants, Venlafaxine appears to be effective.
Antidepressants in current use include:
Serotonin Reuptake Inhibitors [SSRI antidepressants]:
- Citalopram [Cipramil]
- Escitalopram [Cipralex]
- Fluoxetine [Prozac]
- Fluvoxamine [Faverin]
- Paroxetine [Seroxat]
- Sertraline [Lustral]
Side effects include; nausea, diarrhoea, headache, insomnia, agitation and sexual dysfunction. Some of these medicines may cause adverse effects if suddenly stopped.
Tricyclic antidepressants:
- Amitriptylline [Lentizol]
- Amoxapine [Asendis]
- Clomipramine [Anafranil]
- Dosulepin/Dothiepin [Prothiaden]
- Doxepin [Sinequan]
- Imipramine [Tofranil]
- Lofepramine [Gamanil]
- Nortriptylline [Allegron, motipress, motival]
- Trimipramine [Surmontil]
Side effects include; irregularity of heart rhythm, low blood pressure, drowsiness, convulsions, hence dangerous in overdose and can cause death.
Also can cause blurred vision, dry mouth, constipation and urinary retention.
All of these can reduce compliance with treatment.
Drowsiness and blurred vision may be dangerous for those who drive, operate machinery or work at heights.
Related antidepressants:
- Venlafaxine [Efexor, Efexor XL]
- Reboxetine[Edronax]
- Mirtazapine [Zispin]
- Moclobemide [Manerix]
- Mianserin
- Maprotiline [Ludiomil]
- Trazodone [Molipaxin]
- Flupenthixol/flupentixol [Fluanxol]
