7 Popular Medication Classes For Anxiety, Explained By an RN
Selective Serotonin Reuptake Inhibitors SSRIs
citalopram, celexa, escitalopram, lexapro, fluoxetine, prozac, sarafem, symbyax, fluvoxamine, luvox, luvox CR, paroxetine, paxil, paxil CR, pexeva, sertraline, zoloft, vilazodone, viibryd Drug class
This is a very common drug class; prescribed to treat anxiety, depression, bipolar disorders, migraines, panic attacks, eating disorders, PTSD, OCD, and even chronic pain.
Over 10% of the US takes an SSRI
What Do SSRIs Do?
What does
every medication within this class have in common? They all increase the level of Serotonin in your brain. Serotonin is a neurotransmitter. When you take a Serotonin Reuptake Inhibitor, you’re blocking the neurons from
reabsorbing Serotonin, meaning there is
more Serotonin available.
Since this medication increases serotonin levels, you’ll have more of it to regulate your mood and symptoms of anxiety. Your brain also has to adapt to more Serotonin. It’s thought that by your brain having to restructure from an increase in serotonin, it becomes more able to “remodel” and better able to adapt to stressors like anxiety.
So what does Serotonin do? Well, A LOT. Serotonin influences our mood and emotional state, our digestion, appetite, and our sleep cycle. It is found in your brain, in your intestines and even in your blood. One could argue that it impacts everything.
Did You Know?
Serotonin is even in animals, plants and fungus. We can measure the levels in our blood, but we can’t measure the levels within our brain. Meaning we’re all in the dark as to how much we have in our brain.
Azapirones
Buspar Buspirone Drug Class
Buspirone is in the drug class of Azapirones. There is no addiction risk, overall there are less side effects than many other anxiolytic medicines. It can take up to a month for the medication to work fully. Typically prescribed for
generalized anxiety.
What Does It Do?
This drug class impacts serotonin and dopamine receptors. The full mechanism of the drug aren’t known actually. But, because it seems to take 2-4 weeks to make a difference, that would mean it likely has to do with the receptors for serotonin and dopamine.
It is thought that by the receptors adjusting, it can make them more adaptive and therefore
better able to handle stress. Another possibility is that by blocking serotonin receptors, an increase of serotonin is available, which improves symptoms for some types of anxiety disorders.
Did You Know?
The drug Buspar was originally developed for schizophrenia, but wasn’t useful. It did however seem to help people with anxiety. Dizziness seems to be one of the most common complaints as far as side effects.
Antihistamines
brompheniramine, dimetane, benadryl, diphenhydramine, carbinoxamine, clistin, clemastine, tavist, doxylamine, unisom, hydroxyzine, atarax, vistaril, promethazine, phenergan, triprolidine, triafed Drug Class
Commonly used for allergies but also used for anxiety. Antihistamines are divided into different ‘generations’ & target different histamine receptors in our body.
- H1 Receptors: Found Throughout the Body
- H2 Receptors: Mostly Stomach Acid Secretion
- H3 Receptors: Central Nervous System
- H4 Receptors: Still Being Researched
What Do Antihistamines Do?
We’re actually still learning a lot about histamines but what we do know is that
anti-histamines are usually anticholinergic;
blocking receptors for choline.
Vistaril, hydroxyzine and Atarax are commonly prescribed for anxiety.
While your risks with this drug class are much less severe than when taking benzodiazepines, these are first generation antihistamines. Therefore, they do have a sedating effect (precisely why they can relieve tension) but this also means they can impair our ability to remember, think and learn. Especially the first generation antihistamines that easily penetrate our brain.
An example of
second generation antihistamines are Claritin & Zyrtec. Unlike first generation antihistamines, these do not cross the blood-brain barrier as easily. Therefore, they relieve many effects of allergies, but do not have as many sedating properties or memory impairments associated with them. When it comes to anxiety though, Claritin & Zyrtec won’t do you much good.
Did you know?
The only drug within this class that can be given intravenously is Benadryl. Since Benadryl is a first generation, it impacts our body in many ways
in addition to the reason why it’s administered. Since first generation antihistamines are much
less specific in their effects, they have more side effects.
Though, being the only IV antihistamine available, it is still widely used in hospital settings (for anxiety included).
Benzodiazepines
alprazolam, xanax, chlordiazepoxide, librium, clonazepam, klonopin, clorazepate, tranxene, diazepam, valium, lorazepam, ativan, oxazepam, serax, temazepam, restoril, triazolam, halcion Drug Class
These are commonly used as anxiety medicines (though can be used for seizures, insomnia, and muscle spasms). They work by quickly slowing down important parts of our brain.
This drug class specifically targets the GABA-A receptor, enhancing its effect, which
slows down our central nervous system; this makes us feel relaxed, because the drug has retarted a major gear in our system (sometimes this is EXACTLY what we need).
Anesthesiologists often give Versed (a benzodiazepine) so patients will not remember surgery?
The Drawbacks of Benzos
When Benzodiazepines were first discovered they offered an immediate solution to the overwhelming crippling anxiety that many people face, but the harsh reality is we’re now in a benzo addiction crisis. We’re learning over time as a society, and those changes don’t happen overnight.
This drug class changes our mental state & while the drug is
advantageously quick acting, the effects linger. Short-term memory is not as affected, but long-term memory is specifically impaired. The memory loss may occur because events are not transferred from short-term memory to long-term memory.
The effects are similar to the long-term effects of alcoholism (alcohol is also a CNS depressant). Both of these substances, used long term actually damage our brain.
This is why a rehab center isn’t going to allow the use of this drug class while recovering. This is why therapists often (but not always) stray away from patients taking benzodiazepines while trying to work on trauma, recovery, etc. If the brain is not functioning at full capacity & you’re not able to retain information, progress becomes much more difficult.
The most effective aspects of benzodiazepines are precisely why individuals have a tendency to become dependent on them.
Obviously, there is a time and a place for benzodiazepines. They’re a life saver for the (hopefully) occasional panic attack. But how sadistic is that Benzodiazepines have addictive properties, which means that with consistent
repeated use we will need
increasingly higher doses.
Another point of concern is that this drug will inhibit your brain from initiating activity of GABA A (since the medication has so kindly been doing it). What this means is that after the drug is long gone from your system, your brain experiences a lag in restoring the normal GABA balance.
This is often what is referred to as
“rebound anxiety” because your anxiety is likely to get worse,
before it gets better after taking a benzodiazepine, especially if taken frequently and long term.
The mental health world is increasingly trying to move towards low dosing and only prescribing for a limited amount of time. I’ve even worked with prescribers who won’t prescribe them, period.
Now, Benzodiazepines are very dangerous to quit cold turkey, so please don’t go flush yours down the toilet after reading this!
Beta Blockers
acebutolol, atenolol, tenormin, bisoprolol, zebeta, metoprolol, lopressor, toprol XL, nadolol, corgard, nebivolol, bystolic, propranolol, inderal, innopran XL Drug Class
A beta blocker is most often used for heart conditions since this drug class lowers blood pressure and heart rate. But, they do this by blocking epinephrine which we commonly refer to as adrenaline. By blocking adrenaline, you prevent the progression of the physical symptoms of anxiety, like increased heart rate and blood pressure.
These can be prescribed “as needed” and is also prescribed long term to be taken regularly. Sometimes doctors will prescribe them for public speaking, or other stressful events someone has to face.
What do Beta Blockers Do?
Well, they Block Beta-adrenergic receptors, preventing norepinephrine and epinephrine from activating those receptors. This relaxes heart muscles, slows the heart beat, and lowers blood pressure.
That might seem completely unrelated to anxiety to some people, but when anxiety starts it will create
physical symptoms that tend to make us feel even more panicked. This is why it can be pretty helpful to stop the physical symptoms from escalating an already
not-so-good state of mind.
Did you know?
Beta blockers can be used for tremors, migraines, abnormal heart rhythms, and chest pain too.
Summary
Beta blockers can be a useful anxiety medication. As a nurse some of the things I pay attention to when a patient is prescribed them are obviously heart rate and blood pressure.
Energy level is always something that can be impacted too.
It’s not uncommon for someone to become tired, groggy, lightheaded, or get headaches from beta blockers. Even for people who take it for high blood pressure and heart rate, it can have a tendency to drop them too low.
Everyone is different, our diets change, our weight changes, our stress levels change, how hydrated we are fluctuates, our salt intake varies; and
all of these impact our blood pressure. So, it’s always a good idea to be keeping an eye on your heart performance with a beta blocker and your doctor who is prescribing should be too.
Tricyclic Antidepressant TCAs
anafranil, clomipramine, asendin, amoxapine, elavil, amitriptyline, norpramin, desipramine, pamelor, nortriptyline, sinequan, doxepin, surmontil, trimipramine, tofranil, imipramine, vivactil, protiptyline Drug Class
The word “tricyclic” refers to the three molecular ring shapes associated with this drug class. These existed
before SSRIs, but they seem to cause more side effects. This has led to SSRIs being more commonly prescribed nowadays.
TCAs are still often prescribed for things like anxiety, depression, migraines, panic disorder, eating disorders, mood disorders, insomnia, hormone disorders, bedwetting, and even nerve pain.
What do Tricyclic Antidepressants Do?
What do
all TCAs have in common? Similar to an SSRI, tricyclic antidepressants impact neurotransmitters. But, in addition to serotonin, they also block the reabsorption of norepinephrine. They ALSO block acetylcholine receptors.
These key differences from SSRIs create a cascade of effects in the body that make them a bit more likely to cause side effects; like dry mouth, blurred vision, and urinary retention.
Did You Know?
In 1945, the Sulphur bridge of the phenothiazine ring of promethazine was altered to synthesize G22355 (a weak antihistamine and mild anticholinergic with sedative properties). The new ‘invention’ was tested as an antipsychotic. It was ineffective for schizophrenia, but did have antidepressant properties. Thus, the first clinically useful tricyclic antidepressant (TCA) was discovered.
Summary
These drugs interfere with our bodies baseline of norepinephrine and acetylcholine. As with any drug; sometimes they create an optimal effect on a person, as for others, not so much. If a person is too excitable and anxious, a TCA can improve their quality of life, while for another it can leave a bad impression.
*Note each drug
within the class impacts the
degree of these effects a little differently.
Antipsychotics
sometimes referred to as major tranquilizers or neuroleptics risperidone, risperdal, quetiapine, seroquel, olanzapine, zyprexa, ziprasidone, zeldox, paliperidone, invega, aripiprazole, abilify, clozapine, clozaril, fluphenazine Drug Class
Commonly used as the first line treatment for schizophrenia & sometimes used for mood disorders, depression, personality disorders, Tourette’s syndrome, Huntington’s disease, and anxiety.
What Do They Do?
Most drugs in this class work to block Dopamine, though some do impact other chemicals in the brain.
Schizophrenia is the
major psychotic disorder we use antipsychotics for. Some of the main symptoms are delusions, lack of motivation, unusual behaviors, and hallucinations. Dopamine has been thought to regulate our brains understanding of our surroundings and what it all means to us. So, it’s to be expected that drugs within this class target Dopamine.
This class is broken up into two categories;
First Generation (old, typical): Block Dopamine-2 Receptors, which means they also block acetylcholine, histamine and norepinephrine. which can impact our cognition and the complex way in which we store memories.
*More movement disorders come with the first generation antipsychotics.
Second Generation: (new, atypical): Block Serotonin and Dopamine Receptors
. Less risk of extra movements, increased risk of diabetes, high cholesterol, and weight gain.
Hopefully this helps clarify some information on these common 7 classes of medications. If not feel free to submit a question in the comments, or by using my contact form below and I’ll do my best to answer.
Original Post
https://twoforsue.com/medications-for-anxiety/ Hey everyone, I wanted to have a discussion about Entresto. I read the trial (PRARADIGM-HF) and had some questions and possible discussion points.
Why Enalapril? Authors stated that it's because of published information in: OVERTURE CONSENSUS SOLVD-Treatment SOLVD-Prevention
While I haven't been practicing long at all (<1year), I personally have most commonly seen Lisinopril prescribed for HFrEF/HFpEF patients. Were the results from the Enalapril trials overwhelmingly better than results published for Lisinopril even though those weren't directly compared?
I couldn't find any head-to-head trials with Enalapril vs. Lisinopril, just non-inferiority type trials.
"Furberg CD, Pitt B. Are all angiotensin-converting enzyme inhibitors interchangeable?. J Am Coll Cardiol. 2001;37(5):1456-60." - Poses the conclusion that they aren't all interchangeable, but then again where is the evidence to choose enalapril?
Captopril, enalapril, ramipril and trandolapril have been proven independently in their own respective large scale trails. This is certainly true among beta-blockers. Certain proven beta-blockers (Coreg, Bystolic, Toprol-XL) ARE in fact proven for HF, while that is not true class-wide.
What are your all's thoughts? I think the results from the Entresto trial are amazing, I just wanted to discuss some points of how it was tested.
I don't like to admit this because it makes me feel, I dunno, bad-I have to take blood pressure meds. It's hereditary and despite my 28 miles per week of running and healthy weight, it's still high. All my other heart/fitness tests show I'm pretty dang healthy and in shape.
ANYWAY, had to get that out there. With that said, anyone have issues with meds and your weight? I was put on generic Toprol XL and my weight loss has stalled ever since. They moved me to Bystolic and all the internet says they have gained weight. I thought I was eating more because I was running more, but maybe it's the meds? Do I walk around hungry half the day? Run 50 miles a week?
what's your experience? I only want to lose another 10-15 pounds and right now I'm at a healthy weight so it's not the end of the world if I don't lose anything else but still, BE GONE 10LBS.