Anxiety Drugs (Anxiolytics) Side Effects, List of Names & Interactions

What are anti-anxiety (anxiolytic) drugs?

Anxiolytics (also termed anti-anxiety or anti-panic drugs) are medications that are used to treat a health condition called anxiety. The type of anxiety that requires treatment is called generalized anxiety disorder (GAD). This disorder causes excessive worry and anxiety, significant distress, and affects the ability for a person to function. Moreover, the symptoms of anxiety occur on most days for at least six months. Generalized anxiety disorder is treated with psychotherapy and medications.

How do anti-anxiety drugs and benzodiazepines work (mechanism of action)?

Antidepressants reduce anxiety by increasing the concentration of chemicals (neurotransmitters) that the brain uses to communicate. These neurotransmitters include serotonin, norepinephrine, and dopamine.

Buspirone may reduce anxiety by stimulating serotonin and dopamine receptors on nerves, thereby altering the chemical messages that nerves receive.

Benzodiazepines reduce symptoms of anxiety by increasing the action of a brain chemical called gamma-aminobutyric acid (GABA). GABA is a chemical that nerve cells use to communicate with each other and it reduces brain activity. It is believed that excessive activity in the brain may lead to anxiety or other psychiatric disorders.

Pregabalin is an anticonvulsant. Like benzodiazepines, Pregabalin also increases the action of GABA, and this may be its main mechanism for reducing anxiety.

Hydroxyzine is an antihistamine that causes sedation. It helps treat insomnia caused by anxiety, and other medical conditions.

What are the medical uses for anti-anxiety drugs?

Anxiolytics are used to treat anxiety or symptoms caused by anxiety. Some types of anti-anxiety drugs are used for other health conditions such as:

• Depression
• Insomnia
• Alcohol withdrawal symptoms
• Seizures
• Panic disorder
• Itching
• Nausea
• Vomiting

What are the side effects of anti-anxiety drugs?

Some common side effects of anxiolytic drugs include:

• Drowsiness
• Sedation
• Confusion
• Dependence and withdrawal symptoms
• Stomach upset
• Nausea
• Diarrhea
• Sexual dysfunction
• Headache
• Suicidal thoughts
• Elevated blood pressure
• Dry mouth
• Blurred vision
• Constipation
• Orthostatic hypotension
• Increased heart rate
• Abnormal heartbeat
• Weight gain

What other types of drugs are used to treat anxiety?

• Antidepressants
  • Selective serotonin reuptake inhibitors SSRIs
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)]
• Benzodiazepines (anxiolytic and/or sedative drugs)
• Anticonvulsants (nonbenzodiazepine)
• Antihistamines
• Azaperone (buspirone)

What natural/herbal products and supplements treat anxiety?

Herbal medicines have been studied for the treatment of anxiety. Examples of herbal medications that have been used in clinical studies for treating anxiety include:

• Passionflower
• Kava
• St. Johns’s wort
• Ginkgo biloba
• Ashwagandha (Withania somnifera)
• Valerian (Valeriana officinalis)
• Theanine (found in green tea)
• Chamomile (Matricaria recutita)
• Lemon balm (Melissa officinalis)

Some clinical studies suggest that some herbal medicines may reduce anxiety symptoms. However, many of these clinical studies are small, and there also are clinical studies that show that some herbs are not useful therapy for anxiety. Patients should consult their doctor and pharmacist before self-treating anxiety symptoms with herbal medications. Herbal medications are not a replacement for standard therapy for anxiety.

Some nutritional supplements have shown beneficial effects in small clinical studies. Examples of supplements that may be effective for reducing anxiety symptoms include:

• L-lysine
• L-arginine
• L-tyrosine
• L-phenylalanine
• Omega-3 fatty acids
• Selenium
• Magnesium
• Vitamin C

Based on clinical studies, the effect of magnesium supplementation on anxiety symptoms may not be better than a sugar pill. Patients should consult their doctor and pharmacist before self-treating anxiety symptoms with nutritional supplements.

Researchers have looked into the effect of Yoga on improving anxiety. Some of these small clinical studies suggest that Yoga may improve anxiety symptoms by improving the levels of GABA in the brain. Since Yoga and other types of exercise are beneficial for overall health, it may be a useful addition to standard medical therapy for anxiety.

Which drugs or supplements interact with anti-anxiety drugs?

Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) have many important drug interactions when they are used for the treatment of anxiety or other health conditions.

Patients should not take anxiolytic drugs with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants or other drugs that inhibit MAOIs such as linezolid [Zyvox] and intravenous methylene blue. Examples of MAOIs include:

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• tranylcypromine (Parnate)
• selegiline (Eldepryl)
• procarbazine (Matulane)

Patients that take such combinations may develop confusion, high blood pressure, tremor, hyperactivity, coma, and death. Patients may develop similar reactions if they combine SSRIs or SNRIs with other drugs that increase serotonin in the brain.

Combining SSRIs or SNRIs with warfarin, aspirin, nonsteroidal anti-inflammatory drugs (for ex-ample ibuprofen (Motrin, Advil) or other drugs that affect bleeding may increase the likelihood of patients developing upper gastrointestinal bleeding when these drugs are used for the treatment of anxiety or other health conditions.

Other drug interactions with anxiolytics

• Combining benzodiazepines with alcohol or medications (for example, barbiturates, narcotics, other sedatives) that also suppress brain activity increases the chance of patients becoming sedated.
• Carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol) and rifampin reduce the blood levels of some benzodiazepines and this may reduce the effect of affected benzodiazepines when they are used for the treatment of anxiety or other health conditions.
• Buspirone also interacts with MAOI class of antidepressants. Combining buspirone with warfarin (Coumadin), a blood thinner, may increase the effects of warfarin and increase the risk of bleeding in patients. Grapefruit juice increases the amount of buspirone in the blood of patients, possibly leading to side effects.
• Alcohol and drugs that cause sedation may increase the sedative effects of pregabalin.
• Combining pregabalin with pioglitazone (Actos) and rosiglitazone (Avandia) may increase the occurrence of weight gain, fluid retention, and possibly heart failure.
• Hydroxyzine increases the drying effects of other medications that have anticholinergic effects. Combining hydroxyzine with alcohol or medications that cause drowsiness increases the chance of sedation.

Panic attacks are repeated attacks of fear that can last for several minutes.
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List of examples of brand and generic names available for anti-anxiety drugs

Selective serotonin reuptake inhibitors (SSRIs)

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Vilazodone (Viibryd)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Desvenlafaxine (Pristiq)

Tricyclic antidepressants (TCAs)

• Amitriptyline (Elavil)
• Clomipramine (Anafranil)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Desipramine (Norpramin)
• Nortriptyline (Pamelor – This drug is no longer available in the US.)

Benzodiazepines

• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Alprazolam (Xanax)
• Oxazepam (Serax)

Anticonvulsants

• Pregabalin (Lyrica)

Antihistamine

• Hydroxyzine (Vistaril)

Azaperone

• Buspirone (Buspar)

Are anti-anxiety drugs safe to use for treating my medical condition if I am pregnant or breastfeeding?

• Some studies suggest that the use of SSRIs to treat medical conditions during pregnancy may be linked to increased risk of premature births, stillbirths, birth defects, and miscarriage.
• Benzodiazepines may harm the fetus if taken by pregnant women. Benzodiazepines also can enter breast milk and can cause weakness and weight loss in the newborn.
• Some studies suggest that hydroxyzine may cause birth defects when used during pregnancy. It is not known if hydroxyzine is excreted into breast milk.