Your top 10 questions about treatment for anxiety
Anxiety is the most common mental health condition in the U.S. For nearly 30% of adults, it will rise to the level of a clinical disorder at some point, according to the American Psychiatric Association.
A diagnosis can be frightening. Relief can feel out of reach. But the truth is, anxiety disorders are considered some of the most treatable of all mental health disorders. Strategies include medication, therapy and lifestyle changes. Used alone or in combination, they can help you manage your symptoms and return to a productive, satisfying life. To help you navigate your options, we tapped the experts. Keep reading to learn more.
1. What are the most common medications used for anxiety and how do they work?
You’ve likely heard of the medications Prozac® and Zoloft®, which are often used to treat depression. These same drugs are also used to treat anxiety. They’re part of a class of medications known as selective serotonin reuptake inhibitors (SSRIs). “They work by increasing levels of serotonin, a neurotransmitter [or brain chemical] that helps regulate mood and sleep, both of which are [negatively] affected by anxiety,” says Joy Alonzo, PharmD. He’s a clinical assistant professor of pharmacy practice at the Texas A&M Rangel College of Pharmacy in College Station.
SSRIs commonly used for anxiety include (click each drug name to access coupons instantly):
2. How quickly do SSRIs take effect?
For anxiety specifically, SSRIs can take 8 to 10 weeks to fully kick in. But you may notice minor improvements in just 2 to 4 weeks. At that point, you might find that your sleep is improving, and your anxiety may become less intense.
3. What are some medications that can help in the moment when my anxiety feels overwhelming?
A class of medications called benzodiazepines is very effective at calming anxiety. They’re among the most prescribed medications in the U.S. They work quickly — within an hour, sometimes faster. This makes them helpful for people experiencing severe anxiety attacks, sometimes called panic attacks.
Benzodiazepines are sedating, so they can help you fall asleep. They relax your muscles, and by slowing the brain and nervous system, they help quiet racing thoughts and worries.
Benzodiazepines commonly used for anxiety include:
Interestingly, a medication called buspirone (BuSpar®) can treat anxiety both in the moment and over the course of weeks or months. “It’s in a class by itself,” Alonzo says. “It can work right away.” You can take it for immediate relief, she says, or take it daily while starting on an SSRI. “Then as the SSRI starts to work, you may wean off the buspirone and just take it as needed.”
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4. How will I know my medication is working?
SSRIs don’t kick in suddenly. Rather, “it happens subtly,” Alonzo says. “Patients often notice more capacity to deal with stress, and they notice they’re sleeping better as their anxiety improves.” The medication can be very effective, but it takes time, she says.
Your doctor should schedule a checkup with you within the first month or so of treatment. That’s an opportunity to discuss how things are going. If you don’t experience significant improvement after 8 to 10 weeks, you may need a higher dose or a different medication, which your doctor can prescribe.
Benzodiazepines are different. With them, you’ll know right away that they’re working. They provide a sense of euphoria or general well-being, Alonzo explains. But the immediate relief from anxiety also gives them the potential to be addictive. People who begin taking the medication more than is necessary may find that they need increasingly higher doses to get the same effect.
5. Are there side effects?
All medications carry side effects, and you should ask your doctor about your specific prescription. In general, SSRI side effects are mild but may include nausea and stomach upset (more so in the beginning). They could also cause headaches, dry mouth, sleep difficulties, sexual problems (inability to orgasm or poor sex drive) and more.
Buspirone tends to cause few side effects that can include headache, nausea, dizziness, drowsiness or changes in dreaming, according to the National Alliance on Mental Illness.
Benzodiazepines can cause drowsiness, slurred speech, muscle weakness and confusion. And because of the addiction potential, “your physician will think long and hard [before prescribing them],” Alonzo says. Never mix benzodiazepines with alcohol, opioids (prescription pain relievers or illegal substances such as heroin and fentanyl) or other medications. This can lead to a coma or even death.
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6. Are most anxiety medications affordable?
Yes. SSRIs and buspirone cost less than $10 a month in generic form and are typically covered by most insurance plans. The generic form of many benzodiazepines costs less than $1 a pill.
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7. Is medication always required?
Not always. Talk therapy, sometimes called psychotherapy, can be very effective. It offers patients an emotional outlet and gives them a chance to learn coping strategies.
8. Does it matter what therapist I choose?
Yes, the right therapist can make a huge difference in your recovery. Whether you meet with a psychologist, social worker, licensed therapist or other type of mental health provider, “your relationship is the best predictor of success,” says LaToya Gaines, PsyD, a clinical psychologist based in New York City. So do what you can to find a great fit.
Arrange a first meeting and then consider:
- Do you feel comfortable with this person?
- Does the atmosphere feel safe and welcoming?
- Is there a good vibe between the two of you?
9. What else can I do to help improve my symptoms?
Exercise has been shown to help improve anxiety in some people. Experts think it works by sparking the release of natural pain-relieving chemicals called endorphins, which ease stress and improve sleep. Working out may also teach the brain how to better cope with stress.
Deep breathing is another smart strategy. People tend to take shallow breaths when they’re anxious, inhaling into their chest instead of their abdomen. Doing so can intensify anxiety, says Leah Lagos, PsyD, an NYC-based psychotherapist and author of Heart, Breath, Mind: Train Your Heart to Conquer Stress and Achieve Success.
Try breathing in for 4 counts, then out for 6. “Think low and slow, inhaling through the nose and exhaling through pursed lips, as if you were blowing on hot soup,” Lagos says.
10. How long will I need to be in treatment for anxiety?
Many people can manage their anxiety to the point where they start enjoying life again and feel well enough to stop treatment after a few months. But it’s important to not suddenly quit your medication just because you’re feeling good. This can lead to unpleasant withdrawal symptoms.
If you’re feeling better, meet with your doctor and discuss an “exit plan,” as Alonzo calls it. “If you’re stable and have had good results, you can discuss tapering off your medication, usually after 6 to 18 months.” Ideally, she adds, you will have been in therapy as well, which teaches you how to cope better with the issues that triggered the anxiety.
But be patient. Full recovery is possible, but some people will need to remain in treatment longer, maybe years, says Alonzo. Others will return as necessary. Remember: Recovery isn’t a race. The most important thing is to manage the symptoms so you can get on with enjoying your life.
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Anxiety stats: American Psychiatric Association
Impact of exercise: Anxiety and Depression Association of America
Overview of benzodiazepines: Johns Hopkins Psychiatry Guide