Human beings have been dealing with anxiety for a long time. For our caveman ancestors, anxiety was a survival technique — after all, they had to sleep with one eye open to spot the tiger lurking just beyond the campfire. Today, anxiety is just as common as it was back then. But it’s way less useful. It won’t help you pay the bills, raise the kids or cope with a global pandemic.
A little bit of anxiety can keep you alert. Yet if you’re grouchy or nervous most every day, you may have classic signs of severe anxiety. Fortunately, modern-day solutions can help tame the worry.
If you do have anxiety, you’re in good company. Anxiety is the most often diagnosed mental health problem in the U.S. It affects 40 million Americans every year. But only about a third seek help, says the Anxiety & Depression Association of America.
“I want people who have anxiety to know that this is a treatable condition,” says Gary Kennedy, MD. He’s a geriatric psychiatrist at Montefiore Medical Center in New York City. “It may take a while, but your doctor will work with you to help you feel better.” Talk therapy is one important strategy. Relaxation techniques, meditation and yoga can help, too.
Some people also benefit from medication, especially if anxiety is impacting their ability to function in everyday life. Virtual care through Optum Store can even help here: It allows you to speak to a therapist and a medication prescriber right from your home.
But which option is right for you? Here’s what to consider as you begin thinking about treatment.
Managing anxiety with medication
The first thing to know about anti-anxiety medication: It isn’t a cure-all. Rather, it can lessen your symptoms so that you can get back to your daily life and better focus on the source of your anxiety with your doctor or therapist.
Your health care provider will talk with you about your symptoms and help you decide which medications may be right for you, and when. “When I meet with a patient, I always ask, ‘What do you hope for? What is the first thing you hope gets better?’” explains Dr. Kennedy. “We talk about what causes their anxiety and what makes it better or worse.”
There are 2 main types of medications for anxiety: benzodiazepines and selective serotonin reuptake inhibitors (SSRIs). The first is typically used for severe anxiety episodes or flare-ups. And they’re considered a short-term option. SSRIs, on the other hand, are considered a longer-term treatment. They are antidepressants that can change the way your brain uses certain chemicals that control mood and stress over time, according to the National Institute of Mental Health (NIMH).
Take Dr. Kennedy’s example: “If someone can’t sleep because they’re jittery, that may be our first target. I’ll usually begin treating it with a benzodiazepine like lorazepam [Ativan®], which calms them down almost at once. That’s the short-term strategy, and my goal is to taper off soon and start on longer-term meds like SSRIs.”
It may take some trial and error before you and your doctor find the right pick and dose for you. Arm yourself with details about each type of anti-anxiety medication so that you can feel confident weighing in on what may be best for you.
How do benzodiazepines work?
Benzodiazepines such as lorazepam (Ativan), alprazolam (Xanax®) and diazepam (Valium®) are sedatives that slow your brain’s activity. (Here are the 5 essential things you should know before starting lorazepam.)
They act quickly to calm you down and ease symptoms such as trembling or rapid heartbeat. They can even help get you through a tough situation. As many as 94% of Americans with anxiety are treated with benzodiazepines, according to a study cited in Dialogues in Clinical Neuroscience.
“They won’t make you completely free of anxiety,” explains Dr. Kennedy. “But they will help you reach a lower level so you can resume your activities, connect with your friends and sleep better — and all those things can help improve your anxiety.”
One important caveat: People can build up a tolerance to benzodiazepines. And this means they may need a higher and higher dose to get the same effect, says the NIMH. “It’s also easy to become dependent on these medications,” says Dr. Kennedy. “[Benzodiazepines] can be good for the short term, but I like to get patients off them within about 2 weeks.”
What are the side effects of benzodiazepines?
The most common side effects are drowsiness and dizziness, plus tiredness, nausea and confusion. “Older adults, may have an increased risk of falls, and patients may not be as mentally sharp when they take [benzodiazepines],” says Dr. Kennedy.
Tips for taking benzodiazepines
It’s a good idea to take benzodiazepines at bedtime and to avoid caffeine and alcohol, Dr. Kennedy advises. And it may be best that you and your provider create a long-term management strategy that doesn’t involve benzodiazepines.
Selective serotonin reuptake inhibitors (SSRIs)
How do SSRIs work?
SSRIs lower your levels of anxiety by increasing your levels of serotonin. This is a hormone that helps to stabilize your mood and feelings of well-being. SSRIs, such as sertraline (Zoloft®), fluoxetine (Prozac®) and escitalopram (Lexapro®), are also used to treat depression.
In fact, about 60% of people who have anxiety also have signs of depression, says the National Alliance on Mental Illness. “With most people, there’s a little overlap between the 2 conditions, so SSRIs can work for both,” says Dr. Kennedy.
What are the side effects of SSRIs?
SSRIs are usually well tolerated, though you may have nausea, headaches, dry mouth, diarrhea or constipation. “Sertraline has the best safety and side-effect profile, so that’s often my first choice,” Dr. Kennedy says.
Tips for taking SSRIs
Stomach trouble is a common complaint. “But don’t let it stop you from taking your meds,” advises Dr. Kennedy. “Try to tough it out — in a day or 2, you’ll start to feel better.”
And if you have any concerns, speak up. “I like to tell people, ‘Don’t be a good patient,’” says Dr. Kennedy. “Question the doctor about your worries. Be assertive.”
Want more information on managing anxiety? We answered your top questions here.
Expensive medications can put a strain on the budget — and even be their own source of anxiety. Download the Optum Perks app today to see if you can save up to 80% off the medications you (and your loved ones) need the most.
Anxiety disorders overview: National Institute of Mental Health
Medications for mental health: National Institute of Mental Health
SSRIs and benzodiazepines for anxiety: Anxiety & Depression Association of America
Review of anxiety treatment options: Dialogues in Clinical Neuroscience (2017). “Treatment of Anxiety Disorders”