Medication is sometimes the answer for anxiety. And maybe, just maybe, we should not wait to use it as a last resort. (Again, this is not medical advice. Speak to your prescriber about options for you.)
A friend of mine tried for years to avoid medication with her children, but when she finally tried it, she found it very helpful. She explained how medication works better than I ever could:
“It was like there were tools on the table in front of them, but they had no hands. Medication gave them hands to pick up the tools.”
Her children were finally able to apply the tools they had been trying to use for years. I have seen this play out over and over with my clients as well.
There are several classes of medications that work for anxiety:
- Usually one of the first options we look to are Anxiolytics.
- The only medication in this class that is not addictive is buspirone. It works by increasing serotonin and limiting dopamine somewhat. This is a frequently used medication for anxiety. It is taken 2-3 times per day and becomes more effective over 6-8 weeks.
- Benzodiazepines are the other option in this category. These are medicines such as Valium, Xanax, Ativan, etc. All of these are addictive within very short periods of time. They work very very well for anxiety and are good for short term problems such as a sudden traumatic event. They also stop the brain from producing GABA which the brain needs to fight anxiety, so when people stop taking it after being on it daily for weeks, they are suddenly extremely anxious. (These should only be stopped under the supervision of a prescriber as stopping these may also cause seizures.) Some benzodiazepines have also been linked to memory loss and falls in older adults. Thus, these are generally avoided unless that are very short term. (Again, the prescriber knows the patient and may choose these sometimes.)
- The most frequently used medications for anxiety disorders, obsessive compulsive disorder, phobias, panic disorder, etc. are antidepressants. There are a few categories of antidepressants. Also one antidepressant that does not treat anxiety is bupropion. Since very often depression exists along with anxiety these can be great options.
- Selective Serotonin Reuptake Inhibitors [SSRIs] such as fluoxetine, sertraline, escitalopram, and others. These work for depression and anxiety diagnoses by increasing the available serotonin in the nerve synapses. They are usually very effective and often the first choice. Typically they only have to be taken once per day and become more effective over 6-8 weeks, but some differences may be noticed in two weeks.
- Serotonin and Norepinephrine Reuptake Inhibitors [SNRIs] such as venlafaxine, duloxetine, desvenlafaxine, and levomilnacipran. These work to increase both serotonin and norepinephrine in the nerve synapses. They work for anxiety and depression conditions. They are thought to possibly work better in depression than SSRIs for persons who have a lot of body inflammation. These also become more effective over 6-8 weeks, but some differences may be noticed in 2 weeks.
- Tricyclic Antidepressants [TCAs] such as nortriptyline, amitriptyline, norpramine, clomipramine, and others were the second antidepressants on the seen and were considered wonder drugs. They usually are not first line options due to side effects such as dry mouth and possible weight gain, but they can be very effective for some people.
- For various reasons, sometimes a good option for anxiety is a mood stabilizer such as lamotrigine, gabapentin, divalproex, and others. These are an especially good option for a person who has bipolar disorder, however, it can also be an option for anyone with anxiety. Mood stabilizers work to stop abnormal activity in the brain and were originally developed and still used as anti-seizure medications. They often work when other more conventional options have not.
- Second Generation Anti-psychotics [SGAs] are also occasionally used for anxiety, but usually as a last resort. These medications work on a specific serotonin receptor that none of the antidepressants work on, thus this could be why they help with anxiety. (We have several types which are all names with letters and numbers, but that is a whole other topic!) These are usually considered a last resort due to side effects. Unfortunately, sometimes the side effects are preferable to the problem being treated.
When should you stop medication for anxiety?
Not until your prescriber says to!
There is research on the timing of stopping medication so that you have the best chance of not needing it again. Therefore, talk to your prescriber so they can advise you on the best time and way to stop them. While some people may need medication for a lifetime, others may be able to learn to manage anxiety while on medication and applying tools learned in therapy and the six antidotes. Medication may also help with the motivation to make lifestyle changes, which could lead to the possibility of no longer needing the medication.
Ultimately it is up to you and your prescriber when or if to stop medication. Some people may simply choose to stay on medication because life is complex and sometimes fighting anxiety is really not worth the struggle. Thankfully, God has given us medication to treat the many conditions which the fall of Adam and Eve has brought upon the human race. There are real genetics and brain structure and function involved in anxiety, much of which we still have not learned. No one should feel like a failure or less than if they choose to use medication as a treatment. God gave it to us.
If you would like to read the first article in this series on how the Biblical strategies to deal with anxiety, check out this article.
(Side effects mentioned are just examples and not to be considered an exhaustive list.)