Mental Health Reimagined

When I work within a primary care setting, I get asked a lot of questions about medication, especially for anxiety. The most important thing to remember about medication is that it has risks and benefits. You need to weigh both before making your decision, and this means being educated on side effects, risks, other drug interactions, long term use, and dependance.

There is no medical “cure” for anxiety. You can take medication that temporarily reduces your anxiety but they will never cure it. If medication is your only route for anxiety treatment, you will need to take this medication for the rest of your life. The only current cure for anxiety, is psychotherapy.

In addition to medications for anxiety, don’t overlook the power of proper diet, exercise, and supplements. Certain supplements, such as P5P (vitamin B6), magnesium, kava kava, passionflower, melatonin, theanine, and others, have been shown to have some impact on anxiety symptoms. If you have concerns about taking prescription medications, try naturally relieving your anxiety first. Sometimes anxiety is the symptom of an underlying deficiency.

Discuss all options with your physician and have them help you decide what is best for you. Remember that they are prescribing this medication to you under the assumption that the medications risks are outweighed by its benefits.

Selective Serotonin Re-uptake Inhibitors (SSRI’s) – Commonly referred to as anti-depressant medications. These are a great front line medication for treating anxiety. SSRI medications are thought to increase serotonin in your brain. Serotonin is a “slow down” neurotransmitter, it tells your brain to relax, among other functions. These are drugs such as prozac and zoloft.

• PROS – Non-habit forming, no risk of dependance or addiction, relatively safe, tons of clinical data supporting its effects, inexpensive, covered by most insurance companies, moderate reduction of anxiety symptoms.
• CONS – Takes up to 4-6 weeks to take full effect, no immediate relief, unpleasant side effects such as weight gain, loss of sexual desire, etc. Does increase chance of suicide in certain people.

Serotonin-norepinephrine re-uptake inhibitors (SNRI’s) – These are a less commonly used form of anti-depressant medication. SNRI’s are thought to increase serotonin and norepinephrine in your brain. Serotonin, as already described, is used to relax your brain. Norepinephrine on the other hand is used to get your brain excited, alert, and aroused. These are drugs such as pristiq and effexor.

• PROS – Non-habit forming, relatively safe, tons of clinical data supporting its effects, covered by most insurance companies, moderate reduction of anxiety symptoms, can improve attention and concentration.
• CONS – Takes up to 4-6 weeks to take full effect, no immediate relief, unpleasant side effects such as weight gain, loss of sexual desire, etc. Does increase chance of suicide in certain people. Need to be careful when stopping this medication as it can cause unwanted side effects if stopped too quickly – creates somewhat of a chemical dependance. Is more expensive than SSRI medications and can be more difficult to get covered by your insurance.

Buspirone – This is an easy to miss anxiety medication. Buspirone is thought to work by increasing a single type of serotonin in the brain. This drugs brand name is Buspar.

• PROS – Immediate relief for some people, works much faster than SSRI or SNRI’s, non-habit forming, relatively safe, tons of clinical data supporting its effects, covered by most insurance companies, moderate reduction of anxiety symptoms.
• CONS – Unpleasant side effects such as drowsiness. Is often prescribed to be taken multiple times per day.

Benzodiazepines – These drugs work on the GABA receptors in your brain and allow more GABA to be present in chemical reactions. GABA, similar to serotonin, can work as a slow down or relaxation chemical. These are drugs such as xanax, klonopin, valium, and ativan.

• PROS – Immediate relief, often more than moderate reduction of anxiety symptoms.
• CONS – High risk for dependance, high risk for addiction, deadly and dangerous during withdrawal, short acting.