What are the main medicines for anxiety?
If you are prescribed a medicine, then there may be many reasons why that one has been chosen. These might include:
- side effects (which ones are important to you)
- local policies or agreements (such as what your GP surgery uses or agreements in your area)
- national policies (e.g. NICE, SIGN - see last question)
- familiarity (it may be better for prescribers to use medicines they are familiar with)
- relative costs for similar medicines (if two medicines are very similar, why waste money on the more expensive one?)
- personal preference (either yours or your prescriber)
- how bad your symptoms are
- any medicine you might have done well with in the past (as it's more likely to work again)
The main medicine treatment options are listed below. They are divided in "Main medicines" and "Others".
For convenience, the "Main medicines” are those medicines that are officially "approved" to treat the condition or symptoms (www.bnf.org/bnf/) and which are listed in the British National Formulary (BNF). To be listed in the BNF there needs to be good evidence that the medicine works and that the manufacturers have applied for a license (a long and costly exercise). "Others" are those medicines where there is some evidence that they help, but either not enough for a license or that no license has been applied for. These should usually only be used where other standard treatments have failed.
Main medicines:(BNF listed)
- Benzodiazepines from the well-known Valium and Librium group (such as alprazolam, chlordiazepoxide (formerly Librium®), diazepam (formerly Valium®), lorazepam and oxazepam)
- Beta-blockers (such as propranolol and oxprenolol), to help reduce the increased heart rate and shaking that can occur in anxiety
- Buspirone (Buspar®), a unique drug affecting serotonin
- SSRIs (such as escitalopram [Cipralex®] 10-20mg a day, paroxetine 20mg a day) - the other SSRIs are probably just as effective but their manufacturers haven't applied for a license
- Pregabalin (Lyrica®) - usually around 300mg a day, and also used as an antiepileptic and for pain
- Serotonin and noradrenaline boosting medicines such as venlafaxine (usually 75mg a day, but sometimes may be better at higher doses) and duloxetine (around 60mg a day)
Having problems getting to sleep can be a symptom of anxiety. Some medicines can make you a bit drowsy and so help you go to sleep. They don't, however, actually help improve the quality of your sleep.
- Antipsychotics (such as pericyazine, quetiapine, risperidone, olanzapine) which can be helpful to aid sleep by making you sleepy or less anxious. Quetiapine, at a dose of 150mg a day, is the only one of these that we know helps other symptoms of anxiety as well (LaLonde 2011).
- Mirtazapine (Zispin®) which can make you feel very sleepy
- Tricyclics (such as amitriptyline, imipramine, lofepramine)
To help you make a choice between these, click here for a handy chart comparing the different medicines for anxiety. It has the names, doses, how they work, the main side effects, how long to take it for and how to stop.
Sometimes the symptoms of anxiety can become very severe. This can result in the person becoming very distressed and/or too difficult to cope with and might need to be admitted to hospital. This might then become what is called an "acute psychiatric emergency" or crisis. The treatments for this may need to include some other medicines just to calm the person down and prevent harm to that person, or others. If this happens, follow the link to some information that might help explain what might be going on.