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Are Anxiety Pills Bad for You?

What Are Anxiety Disorders?

When used as directed, anxiety pills like benzodiazepines provide vital relief. They are addictive, however, and can cause a variety of side effects.
When used as directed, anxiety pills like benzodiazepines provide vital relief. They are addictive, however, and can cause a variety of side effects.

Anxiety disorders are a common type of psychiatric disorder characterized by anxiety or fear that does not diminish over time. 

Types of anxiety disorders include:

Many drugs treat anxiety, including antidepressants, MAOI inhibitors and others. Common anxiety medications include benzodiazepines like Xanax (alprazolam), Valium (diazepam) and Ativan (lorazepam). These are indicated for emergencies and short-term use. Even when used as directed, they can cause drowsiness, lightheadedness, confusion and balance problems among others. Benzodiazepines are also habit-forming.

What Are Symptoms of Anxiety Disorders?

Symptoms of anxiety disorders vary depending on the type of anxiety disorder present. 

Symptoms of generalized anxiety disorder include:

  • Excessive anxiety and worry that are difficult to control

Anxiety and worry are associated with at least 3 of the following 6 symptoms occurring for at least 6 months on more days than not:

  • Restlessness or feeling on edge
  • Being easily fatigued
  • Irritability
  • Difficulty concentrating 
  • Sleep problems
  • Muscle tension

Symptoms of social anxiety disorder (social phobia) include:

  • Fear of social situations and possible judgment by others, that can hinder functioning at work or school 
  • Fear of humiliation or embarrassment

Symptoms of panic disorder include:

  • Chest pain
  • Shortness of breath
  • Feeling as if a heart attack is occurring (patients may come to a hospital’s emergency department because they fear a heart attack is happening)
  • Sudden onset of fear, usually peaking within 10 minutes 
  • Recurrent panic attacks, with 1 or more attacks followed by at least 1 month of fear of another panic attack or significant behavior changes related to the attacks 
  • A panic attack is a sudden period of intense fear or discomfort accompanied by 4 or more of the following 13 symptoms:
  • Palpitations or fast heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath or feeling of being smothered
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal upset
  • Dizziness, unsteadiness, lightheadedness, or fainting
  • Feeling hot or cold
  • Numbness or tingling sensations
  • Disconnect from surroundings or self (derealization or depersonalization)
  • Fear of losing control or going crazy 
  • Fear of death
  • Sense of impending doom
  • Urge to flee or escape
  • Headache
  • Cold hands
  • Diarrhea
  • Insomnia
  • Fatigue
  • Intrusive thoughts
  • Repetitive thoughts (ruminations)

May result in changes in personality, such as a person becoming more passive, dependent, or withdrawn

Symptoms of agoraphobia include:

  • Intense anxiety when exposed to specific situations such as heights, small spaces, animals, or storms
  • Fear of being trapped with no escape 

Symptoms of specific (simple) phobias include:

  • Irrational and out-of-proportion fear attached to specific situations (such as flying, heights, animals, insects, blood, needles)
  • Fear can be disabling and can lead to other anxiety disorders, depression, suicidal ideation, and substance-abuse disorders

What Causes Anxiety Disorders?

Anxiety disorders may have a number of possible causes, including:

  • Genetic factors
  • Environmental factors such as early childhood trauma
  • Known or undiagnosed medical condition 
  • Substance-induced

How Are Anxiety Disorders Diagnosed?

Anxiety disorders are usually diagnosed with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association provides diagnostic criteria for an anxiety disorder. 

Lab studies to diagnose or exclude medical conditions that may cause anxiety disorders include:

  • Complete blood cell (CBC) count
  • Chemistry profile
  • Thyroid function tests
  • Urinalysis
  • Urine drug screen

Tests to rule out central nervous system (CNS) disorders that can cause anxiety include:

Tests to rule out heart conditions that can cause anxiety include:

  • Electrocardiography (ECG) 
  • Treadmill ECG

Tests to rule out infectious causes of anxiety include:

  • Rapid plasma reagent test
  • Lumbar puncture (CNS infections)
  • HIV testing

Other tests to rule out other physical causes of anxiety include:

What Is the Treatment for Anxiety Disorders?

Treatment for anxiety disorders usually consists of a combination of medication and/or psychotherapy. 

Anxiety medications are neither good nor bad – it depends on the patient and how well the drugs work to manage symptoms, and what the side effects are. Medications used to treat anxiety disorders include: 

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa) may be used to treat anxiety disorders.

Side effects may include:

  • Nausea
  • Tremor (shaking) 
  • Nervousness 
  • Problems sleeping 
  • Sexual problems
  • Sweating
  • Agitation
  • Feeling tired

Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor and Effexor XR) and duloxetine (Cymbalta) are laso in use for anxiety disorders. Side effects may include:

Atypical antidepressants such as nefazodone (Serzone), mirtazapine (Remeron), and trazodone (Desyrel) are indicated for anxiety as well. Side effects may include:

  • Dry mouth 
  • Dizziness 
  • Blurred vision 
  • Feeling drowsy or sleepy
  • Constipation
  • Weight gain

Tricyclic antidepressants such as imipramine (Tofranil) and clomipramine (Anafranil) are sometimes prescribed. Side effects include

  • Dry mouth
  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Drowsiness
  • Dizziness
  • Weight gain
  • Excessive sweating (especially at night)
  • Heart rhythm problems, such as palpitations or fast heartbeat 

MAOI Inhibitors

Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan) can be beneficial for people with clinical levels of anxiety. Side effects of these drugs are:

  • Restlessness 
  • Problems sleeping 
  • Dizziness 
  • Drowsiness

Benzodiazepines

Benzodiazepines are maybe the most well-known class of anti-anxiety drugs, especially in emergency situations. Lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax) are some examples. Side effects may include

  • Drowsiness
  • Lightheadedness
  • Confusion
  • Balance problems
  • Dizziness
  • Slurred speech
  • Muscle weakness
  • Memory problems
  • Constipation
  • Nausea 
  • Dry mouth
  • Blurred vision
  • Addiction and withdrawal symptoms

Buspirone

Buspirone (BuSpar) in an anti-anxiety drug in a class of its own. Side effects may include

Anticonvulsants

Anticonvulsants such as pregabalin (Lyrica), divalproex (Depakote), and gabapentin (Neurontin) may help in cases of extreme anxiety. Side effects include: 

  • Feeling tired
  • Stomach upset or discomfort
  • Dizziness
  • Blurred vision

Blood Pressure Drugs

Antihypertensive drugs such as clonidine (Catapres), propranolol (Inderal, Betachron E-R, InnoPran XL), nadolol (Corgard), and atenolol (Tenormin) – side effects may include:

Therapy and other treatments

Types of therapy used to treat anxiety disorders include:

  • Behavioral therapy and cognitive behavioral therapy (CBT) 
  • Computerized CBT (FearFighter) 
  • Psychodynamic therapy (or insight-oriented therapy) is rarely used on its own for phobias but may be used for phobic disorders that overlap personality disorders
  • Interpersonal psychotherapy 
  • Relaxation therapy
  • Supportive psychotherapy
  • Mindfulness therapy

Other treatments used for anxiety disorders include: 

  • Cranial electrotherapy stimulator (CES) for treatment of anxiety, depression, and insomnia

Hospitalization may be indicated to treat anxiety disorders in severe cases such as: 

  • Severe functional impairment (cannot meet own daily needs)
  • Suicide or homicide risk
  • Deficits in social skills 

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