Does anxiety meds help
Anti-Anxiety Medications (Benzodiazepines) | CAMH
Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines.
Benzodiazepines are a group of medications that can help reduce anxiety and make it easier to sleep. They are also used as a muscle relaxant, to induce sedation for surgery and other medical procedures, and in the treatment of seizures and alcohol withdrawal. Benzodiazepines are also called minor tranquillizers, sedatives or hypnotics. They are the most widely prescribed psychoactive drugs in the world.
The calming effects of benzodiazepines can often be achieved without drugs.
Various kinds of exercise, such as walking, running, yoga or tai chi can help, as can reducing the stress in your life and taking time for relaxing activities such as meditation, reading a book or having a warm bath. Talking with a trusted friend, family member or therapist and working out the problems that are troubling you can also help. Whenever possible, these approaches should be tried first, before benzodiazepines. However, when non-drug approaches are not possible or do not help, benzodiazepines can provide relief.
When used appropriately, benzodiazepines are safe and effective drugs. They do, however, have potential for abuse and can be addictive. For this reason, they are usually only recommended for short-term or occasional use.
Do I need this treatment?
A certain amount of anxiety or insomnia is a normal reaction to what is happening in your life. You may worry or feel stressed, and sometimes these feelings can keep you up at night. Most often, these feelings pass and are not a problem. However, these feelings can become a problem when they continue over a longer term, cause severe distress, make you feel physically ill and affect your behaviour. This kind of anxiety may be triggered by a challenging life event. It can also be a symptom of a mental health problem.
The ability to fall asleep and to sleep through the night can be affected by many types of health problems. These include physical conditions that cause pain or trouble breathing, as well as mental health problems. When sleep is disrupted, health can be further affected.
While each situation is unique and different treatment approaches may be called for, benzodiazepines can help to provide relief.
What does Anti-anxiety Medications (Benzodiazepines) do?
Benzodiazepines enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. Their effect also produces drowsiness, making it easier to fall asleep and sleep through the night.
Side effects of Anti-anxiety Medications (Benzodiazepines)
The side-effects of benzodiazepines are generally mild and may not be noticed when these drugs are used at low doses.
Common side-effects include:
- loss of balance.
At higher doses, side-effects can include:
- breathing difficulties
Other possible effects, which are extremely rare, include agitation, hallucinations and nightmares. Reducing the dose can help to reduce side-effects.
Benzodiazepines can make it harder to learn and remember new information and to do certain physical and mental tasks. These abilities return to normal once the effect of the drug wears off.
When used to help you get to sleep, benzodiazepines can have some “hangover” effects, such as morning and daytime drowsiness.
Types of Anti-anxiety Medications (Benzodiazepines)
Many types of benzodiazepines are available in Canada. All benzodiazepines work the same way; however, the intensity and duration of their effects vary.
Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).
Benzodiazepines used for the treatment of insomnia include lorazepam (Ativan), nitrazepam (Mogadon), oxazepam (Serax), temazepam (Restoril), triazolam (Halcion) and flurazepam (Dalmane).
Another drug used for insomnia is zopiclone (Imovane). This drug is similar to benzodiazepines and has similar side-effects. Zopiclone may have less abuse potential than some benzodiazepines; however, people can still become addicted to this drug.
Benzodiazepines are available in the form of tablets or capsules, which are taken by mouth. Some are also available as a sublingual tablet, which is dissolved under the tongue, or as a solution for injection.
* Medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear here in brackets. For example, alprazolam (Xanax) and lorazepam (Ativan).
Frequently Asked Questions
How long should I take benzodiazepines?
For most people, benzodiazepines are helpful only as a temporary measure, to be used only in the following ways:
- on occasion, to help you sleep or when anxiety can’t be managed with non-drug approaches
- daily, for up to a few weeks, to help re-establish sleep patterns or to reduce anxiety while waiting for an antidepressant or other treatment to take effect.
Some people may continue to use benzodiazepines for longer, even months or years. Some do so because they continue to find these drugs helpful and have agreed with their prescribing physician that the benefits of continuing to use them outweigh the risks. There are also those who continue to use benzodiazepines over a longer term because the prescribing doctor has not re-examined their continued use. In this instance, ask another doctor to review your prescription.
Are benzodiazepines addictive?
When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted.
Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence.
Physical dependence: When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug. This is known as physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance and withdrawal.
Tolerance: People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. With benzodiazepines, it is known that:
- Tolerance to the sleep-inducing effects may develop within a few weeks of regular use; however, tolerance does not usually develop with occasional use.
- Tolerance to the anxiety-relieving effects is less likely to develop.
- Tolerance to the effects of one type of benzodiazepine leads to tolerance to other benzodiazepines, and to other drugs with similar effects, including alcohol.
Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug. These people may find it difficult to stop using benzodiazepines.
Withdrawal: Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly. Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite. Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and they may continue for two to four weeks or longer.
How do I safely use benzodiazepines?
Take only as directed by your doctor; do not increase your dose.
Once you have slept well for two or three nights in a row, try to get to sleep without taking the medication.
If you have been taking benzodiazepines regularly for a few weeks or more, check with your doctor before reducing or stopping your medication.
How do I cut down or stop taking benzodiazepines?
Most often, benzodiazepines are prescribed to help people get through stressful situations or to provide relief while waiting for other treatment to take effect. When used in this way, on occasion or daily for a few weeks, most people can stop taking them without difficulty or withdrawal effects.
Stopping use can, however, be hard for some people, even when the use is short term. Problems are most likely to occur when:
- the issues that caused you to take these drugs in the first place have not yet been dealt with
- no other medication or talk therapy has been started.
People who wish to stop using benzodiazepines after using them regularly over a longer term will need to cut back their use gradually over an extended period of time. This approach reduces withdrawal effects and helps ensure success in stopping. Because the ideal process for cutting down varies depending on the benzodiazepine you are taking, the dose and the length of time you have been taking it, ask your doctor to help you set up a schedule. If the long-term use has been at high doses, stopping use requires medical supervision.
Will benzodiazepines interact with other medications?
These drugs may interact with other medications. If your doctor or dentist prescribes any medication, inform him or her about the drug you are taking. Check with your pharmacist before using any over-the-counter medication, including herbal products, cold or allergy tablets, or cough syrups.
When taken on their own, the risk of overdose with benzodiazepines is low; however, combining these drugs with other sedatives, such as alcohol, or with medications containing codeine or other opioid drugs, can result in overdose and possible death. Symptoms of overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness.
What if I drink alcohol or coffee while taking benzodiazepines?
Benzodiazepines can be dangerous when combined with alcohol. Benzodiazepines increase the effects of alcohol, making you more sleepy, dizzy or lightheaded. One danger of this is the increased risk of stumbling, falling and related injuries. Another is the increased risk of overdose. Both alcohol and benzodiazepines slow down the central nervous system, which controls breathing. In overdose, breathing can stop.
Drinking too many caffeinated beverages (i.e., more than four cups of coffee or six cups of tea daily) may counteract the anxiety-reducing effects of benzodiazepines.
What if I use street drugs while taking benzodiazepines?
If you are taking benzodiazepines to help reduce the distress of a mental health problem, chances are that you want to feel less anxious and get a good night’s sleep. Street drugs, such as marijuana or cocaine, have effects that can worsen symptoms of anxiety and interfere with sleep—making you feel worse, rather than better.
Taking benzodiazepines to enhance the effect of other sedative drugs, such as opioids, is dangerous and increases the risk of overdose and injury.
Will benzodiazepines affect my ability to drive safely?
Benzodiazepines can affect your ability to drive a vehicle and increase the risk of a crash, especially if taken in combination with alcohol or other sedative drugs. The risk is highest when you first start taking benzodiazepines, before you are used to their effect. Avoid driving or operating other machinery if you feel drowsy or slowed down.
Will benzodiazepines affect my sex drive and function?
There is no clear evidence that benzodiazepines have any effect on sex drive or function.
Is it safe to take benzodiazepines while pregnant or breastfeeding?
The risk of birth defects from taking benzodiazepines while pregnant is not known, though it is thought to be very small. If benzodiazepines are used regularly close to the delivery date, the baby may be born drowsy or may have withdrawal symptoms such as restlessness and feeding problems.
Small quantities of benzodiazepines can be passed through breast milk from the mother to the baby. This may cause drowsiness in the baby.
If you are pregnant or breastfeeding, or thinking about becoming pregnant, talk to your doctor about the risks and benefits of continuing or stopping benzodiazepines. If your doctor recommends that you stop taking benzodiazepines, he or she will help you to slowly reduce your dose over time, to avoid withdrawal symptoms.
Can children and teens use benzodiazepines?
Benzodiazepines are not recommended for use by children and teens, except to bring sedation prior to surgery or for brief medical procedures. Extra caution should be used when considering giving benzodiazepines to children as these drugs may cause children to become irritable rather than calm.
Can older adults use benzodiazepines?
Sensitivity to the effects of benzodiazepines increases with age. When older adults take these drugs, they may become confused and have reduced muscle co-ordination, putting them at greater risk of falls, hip fractures and motor vehicle crashes.
If an older person has been taking benzodiazepines regularly for a very long time, the process required to stop taking them may be long and difficult. In some cases, a doctor may decide to leave the older person on the medication, with regular assessment of daytime side-effects.
Copyright © 2009, 2012 Centre for Addiction and Mental Health
Related Programs & Services
- Treatment at CAMH: Access CAMH
- Help for families from CAMH
- For more information on medications, contact your doctor, nurse or pharmacist.
- Anxiety Disorders: An Information Guide (PDF)
- A free tutorial on anxiety disorders is available on the Mental Health 101 page.
Anxiety Medication - HelpGuide.org
Are anti-anxiety drugs right for you? Learn about common side effects, risks, and how to take them responsibly.
The role of medication in anxiety treatment
When you’re overwhelmed by heart-pounding panic, paralyzed by fear, or exhausted from yet another sleepless night spent worrying, you’ll do just about anything to get relief. And there’s no question that when anxiety is disabling, medication may help. But are drugs always the best answer?
Many different types of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs such as benzodiazepines (typically prescribed for short-term use) and newer options like SSRI antidepressants (often recommended as a long-term anxiety solution). These drugs can provide temporary relief, but they also come with side effects and safety concerns—some significant.
They are also not a cure. In fact, there are many questions about their long-term effectiveness. According to the American Academy of Family Physicians, benzodiazepines lose their therapeutic anti-anxiety effect after 4 to 6 months of regular use. And a recent analysis reported in JAMA Psychiatry found that the effectiveness of SSRIs in treating anxiety has been overestimated, and in some cases is no better than placebo.
What's more, it can be very difficult to get off anxiety medications without difficult withdrawals, including rebound anxiety that can be worse than your original problem.
I need relief, and I need it now!
So where does that leave you if you're suffering? Even when anxiety relief comes with side effects and dangers, that can still sound like a fair trade when panic and fear are ruling your life.
The bottom line is that there's a time and place for anxiety medication. If you have severe anxiety that's interfering with your ability to function, medication may be helpful—especially as a short-term treatment. However, many people use anti-anxiety medication when therapy, exercise, or other self-help strategies would work just as well or better, minus the drawbacks.
Anxiety medications can ease symptoms, but they're not right for everyone and they're not the only answer. It's up to you to evaluate your options and decide what's best for you.
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Benzodiazepines for anxiety
Benzodiazepines (also known as tranquilizers) are the most widely prescribed type of medication for anxiety. Drugs such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) work quickly, typically bringing relief within 30 minutes to an hour. That makes them very effective when taken during a panic attack or another overwhelming anxiety episode. However, they are physically addictive and not recommended for long-term treatment.
Benzodiazepines work by slowing down the nervous system, helping you relax both physically and mentally. But it can also lead to unwanted side effects. The higher the dose, the more intense these side effects typically are—although some people feel sleepy, foggy, and uncoordinated even on low doses. This can cause problems with work, school, or everyday activities such as driving. The medication hangover can last into the next day.
Common side effects of benzodiazepines include:
- Poor balance or coordination
- Slurred speech
- Trouble concentrating
- Memory problems
- Stomach upset
- Blurred vision
Benzodiazepine safety concerns
Benzodiazepines are generally not recommended for long-term use since the safety concerns and risk of abuse increase as you build up a tolerance to the medication.
Drug dependence and withdrawal
When taken regularly, benzodiazepines lead to physical dependence and tolerance, with increasingly larger doses needed to get the same anxiety relief as before. This happens quickly—usually within a couple of months, but sometimes in as little as a few weeks.
If you abruptly stop taking your medication, you may experience severe withdrawal symptoms such as:
- Increased anxiety, restlessness, shaking.
- Insomnia, confusion, stomach pain.
- Depression, confusion, panic attacks.
- Pounding heart, sweating, and in severe cases, seizure.
Many people mistake withdrawal symptoms for a return of their original anxiety condition, making them think they need to restart the medication. Gradually tapering off the drug will help minimize the withdrawal reaction.
Drug interactions and overdose
While benzodiazepines are relatively safe when taken only occasionally and in small doses, they can be dangerous and even deadly when combined with other central nervous system depressants. Always talk to your doctor or pharmacist before combining medications.
Don't drink on benzodiazepines. When mixed with alcohol, benzodiazepines can lead to fatal overdose.
Don't mix with painkillers or sleeping pills. Taking benzodiazepines with prescription pain or sleeping pills can also lead to fatal overdose.
Antihistamines amplify their effects. Antihistamines—found in many over-the-counter sleep, cold, and allergy medicines—are sedating on their own. Be cautious when mixing with benzodiazepines to avoid over-sedation.
Be cautious when combining with antidepressants. SSRIs such as Prozac and Zoloft can heighten benzodiazepine toxicity. You may need to adjust your dose accordingly.
Special benzodiazepine risk factors
Anyone who takes benzodiazepines can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:
People over 65. Older adults are more sensitive to the sedating effects of benzodiazepines. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Benzodiazepine use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents. Long-term benzodiazepine use also increases the risk of Alzheimer's disease and dementia.
People with a history of substance abuse. Because they're physically addicting and on their own and dangerous when combined with alcohol and other drugs, anyone with a current or former substance abuse problem should use benzodiazepines only with extreme caution.
Pregnant and breastfeeding women. Benzodiazepine use during pregnancy can lead to dependence in the developing baby, with withdrawal following birth. Benzodiazepines are also excreted in breast milk. Therefore, pregnant women need to have a thorough discussion about the risks and benefits of these medications with their prescribing doctor. If medication is necessary, the goal is the smallest effective dose.
The connection between benzodiazepines and accidents
Benzodiazepines cause drowsiness and poor coordination, which increases your risk for accidents at home, at work, and on the road. When on benzodiazepines, be very careful when driving, operating machinery, or doing anything else that requires physical coordination.
SSRI antidepressants for anxiety
Many medications originally approved for the treatment of depression are also prescribed for anxiety. In comparison to benzodiazepines, the risk for dependency and abuse is smaller. However, antidepressants take up to 4 to 6 weeks to begin relieving anxiety symptoms, so they can't be taken “as needed.” Their use is limited to chronic anxiety problems that require ongoing treatment.
The antidepressants most widely prescribed for anxiety are SSRIs such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. SSRIs have been used to treat generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder.
Common side effects of SSRIs include:
- Weight gain
- Sexual dysfunction
- Dry mouth
- Increased sweating
Although physical dependence is not as quick to develop with antidepressants, withdrawal can still be an issue. If discontinued too quickly, antidepressant withdrawal can trigger symptoms such as extreme depression and fatigue, irritability, anxiety, flu-like symptoms, and insomnia.
Antidepressant medication and suicide risk
Antidepressants can make depression worse rather than better for some people, leading to an increased risk of suicide, hostility, and even homicidal behavior. While this is particularly true of children and young adults, anyone taking antidepressants should be closely watched. Monitoring is especially important if this is the person's first time on depression medication or if the dose has recently been changed.
Signs that medication is making things worse include anxiety, panic attacks, insomnia, hostility, restlessness, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate. If you spot the warning signs in yourself or a loved one, contact a doctor or therapist immediately.
If you are concerned that a friend or family member is contemplating suicide, see Suicide Prevention. The suicide risk is greatest during the first two months of antidepressant treatment.
Other types of medication for anxiety
Drugs such as buspirone, beta blockers, and bupropion may also be used in the treatment of anxiety.
Buspirone, also known by the brand name BuSpar, is a newer anti-anxiety drug that acts as a mild tranquilizer. Buspirone relieves anxiety by increasing serotonin in the brain—as the SSRIs do—and decreasing dopamine. Compared to benzodiazepines, buspirone is slow acting—taking about two weeks to start working. However, it's not as sedating, it doesn't impair memory and coordination, and the withdrawal effects are minimal.
Since the risk of dependence is low and it has no serious drug interactions, buspirone is a better option for older individuals and people with a history of substance abuse. However, its effectiveness is limited. It works for generalized anxiety disorder (GAD), but doesn't seem to help other types of anxiety disorders.
Common side effects of buspirone include:
- Weight gain
- Upset stomach
- Dry mouth
Beta blockers—including drugs such as propranolol (Inderal) and atenolol (Tenormin)—are a type of medication used to treat high blood pressure and heart problems. However, they are also prescribed off-label for anxiety. Beta blockers work by blocking the effects of norepinephrine, a stress hormone involved in the fight-or-flight response. This helps control the physical symptoms of anxiety such as rapid heart rate, a trembling voice, sweating, dizziness, and shaky hands.
Because beta blockers don't affect the emotional symptoms of anxiety such as worry, they're most helpful for phobias, particularly social phobia and performance anxiety. If you're anticipating a specific anxiety-producing situation (such as giving a speech), taking a beta blocker in advance can help reduce your “nerves.”
Common side effects of beta blockers include:
Bupropion (known by the brand names Wellbutrin, Forfivo, and Zyban) is an antidepressant. However, there is some evidence that it may also be a useful treatment option for anxiety and panic disorders.
Depending on the dosage, in some people bupropion can actually worsen anxiety (as can other antidepressants). However, in others, it can help with generalized anxiety and anxiety symptoms that co-occur with depression. Some trials show that it may be as effective as SSRIs in treating depression with anxiety.
Some common side effects of bupropion include:
- Dry mouth
- Loss of appetite
Hydroxyzine is an antihistamine often used to relieve allergic reactions. However, it can also be used to treat anxiety symptoms such as tension and nervousness. It works by altering the body's levels of histamine and serotonin, leading to changes in mood. It's typically prescribed as a short-term solution, meaning you only use the medication when anxiety symptoms appear.
One 2020 study found that when it comes to treating generalized anxiety disorder, hydroxyzine might be similar in efficacy as benzodiazepines and buspirone.
Common side effects of hydroxyzine include:
- Dry mouth
- Dizziness and confusion
Medication isn't your only option for anxiety relief
Anxiety medication won't solve your problems if you're anxious because of mounting bills, a tendency to jump to “worst-case scenarios”, or an unhealthy relationship. That's where self-help, therapy, and other lifestyle changes come in. These non-drug treatments can produce lasting changes and long-term relief.
Exercise – Exercise is a powerful anxiety treatment. Studies show that regular workouts can ease symptoms just as effectively as medication.
Worry busting strategies – You can train your brain to stop worrying and look at life from a more calm and balanced perspective.
Therapy – Cognitive behavioral therapy can teach you how to control your anxiety levels, stop worrisome thoughts, and conquer your fears.
Yoga and tai chi – Yoga and tai chi are mind-body interventions that engage you emotionally, psychologically, and spiritually. Data has shown their efficacy for many different medical conditions, including anxiety.
Mindfulness and meditation – Mindfulness is a state of mind where you learn to observe your thoughts, feelings, and behaviors in a present, compassionate, and non-judgmental way. It often brings a sense of calm and relaxation.
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Deciding if anxiety medication is right for you
If you're trying to decide whether or not to treat your anxiety with medication, it's important to weigh the pros and cons in conjunction with your doctor. It's also important to learn about the common side effects of the anxiety medication you are considering. Side effects of anxiety medication range from mild nuisances such as dry mouth to more severe problems such as acute nausea or pronounced weight gain. For any anxiety medication, you will have to balance the side effects against the benefits.
Questions to ask yourself and a mental health professional
- Is medication the best option for my anxiety problem?
- Am I willing to put up with unpleasant side effects in return for anxiety relief?
- What non-drug treatments for anxiety might help?
- Do I have the time and am I willing to pursue non-drug treatments such as cognitive-behavioral therapy?
- What self-help strategies might help me get my anxiety under control?
- If I decide to take anxiety medication, should I pursue other therapy as well?
- Is anxiety really my problem? Or is something else going on, such as an underlying health condition or pain, for example?
Questions to ask your doctor
- How will the medication help my anxiety?
- What are the drug's common side effects?
- Are there any food and drinks I will need to avoid?
- How will this drug interact with my other prescriptions?
- How long will I have to take the anxiety medication?
- Will withdrawing from the medication be difficult?
- Will my anxiety return when I stop taking the medication?
Authors: Melinda Smith, M. A., Lawrence Robinson, and Jeanne Segal, Ph.D. Reviewed by Anna Glezer, M.D.
Anna Glezer, M.D. is a Harvard-trained clinician with joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center. She is the founder of Mind Body Pregnancy.
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Roest, A. M., de Jonge, P., Williams, C. D., de Vries, Y. A., Schoevers, R. A., & Turner, E. H. (2015). Reporting Bias in Clinical Trials Investigating the Efficacy of Second-Generation Antidepressants in the Treatment of Anxiety Disorders: A Report of 2 Meta-analyses. JAMA Psychiatry, 72(5), 500. https://doi.org/10.1001/jamapsychiatry.2015.15
Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97, 111–121. https://doi.org/10.1016/j.addbeh.2018.08.027
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“Reporting Bias in Clinical Trials Investigating the Efficacy of Second-Generation Antidepressants in the Treatment of Anxiety Disorders: A Report of 2 Meta-Analyses | Anxiety Disorders | JAMA Psychiatry | JAMA Network,” November 12, 2020. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2205839
Baldwin, D. S., Waldman, S., & Allgulander, C. (2011). Evidence-based pharmacological treatment of generalized anxiety disorder. International Journal of Neuropsychopharmacology, 14(5), 697–710. https://doi.org/10.1017/S1461145710001434
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Bupropion (Wellbutrin) | NAMI: National Alliance on Mental Illness. (n.d.). Retrieved August 28, 2022, from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Bupropion-(Wellbutrin)
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Rudolph, M., & Liegl, S. (2020). In adults with generalized anxiety disorder, is hydroxyzine superior to placebo in reducing anxiety symptoms? Evidence-Based Practice, 23(8), 42–43. https://doi.org/10.1097/EBP.0000000000000713
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Medication Options – What you should know when talking with your health care provider. (Anxiety and Depression Association of America)
Benzodiazepines: Side Effects, Abuse Risk and Alternatives – Article written for health care professionals on the benefits and risks of benzodiazepines. (American Family Physician)
Anxiety – Worksheet to help you cope. (Centre for Clinical Interventions)
Last updated: November 1, 2022
7 remedies for anxiety that don't work
Many people now experience anxiety, and it can be difficult to deal with it on your own. About what ways can really help, we wrote in the article "5 tips on how to cope with anxiety in difficult times."
However, some popular medications and supplements that are marketed as anti-anxiety medications have no evidence of effectiveness.
Some of them are relatively harmless, but others have side effects and contraindications, so under certain conditions they can do more harm than good. If you are planning to purchase a medication for anxiety, we recommend that you consult with your doctor. And this list will help you make an informed decision.
Essential Skills in Times of Stress - WHO Picture Guide
What You Will Learn
Go to the doctor
Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.
What is it. Phytotherapeutic tablets or solution based on herbal extracts of Valerian officinalis, lemon balm, St.
Novo-Passit - GRLS
According to the manufacturer, the drug helps with a state of constant mental stress and mild forms of insomnia.
Proof of effectiveness. Novo-Passit is not mentioned in international databases of medicines, nor is it in clinical recommendations for the treatment of any diseases.
14 authoritative medical sources
Some drugs are made from chemicals derived from plants. For example, cardiac glycosides are made from digitalis purpurea. But for the manufacture of the drug, not the whole plant and not the extract from it are used, but separate, carefully purified chemicals, the concentration of which is very strictly controlled.
Products containing extracts or whole parts of one or more plants are classified as herbal medicine and are considered dietary supplements in most countries. Therefore, they are neither in international drug databases nor in clinical guidelines for the treatment of diseases.
What is Phytotherapy - MedlinePlus Medical Guide
There is no need to look for evidence of the effectiveness of dietary supplements, since by law it is just food.
All that is required of them is to be safe, that is, not to harm the health of the people who take them. Since it is not necessary to prove the effectiveness of herbal remedies, they are very poorly studied. When it comes to complex herbal remedies, research is further complicated by the fact that they do not work the way they would work separately.
They say expensive dietary supplements are more effective than cheap ones. Truth?
For example, although the European Medicines Agency, or EMA, considers valerian essential oil and rhizome preparations to have a calming effect, we do not know how this plant extract will work in combination with other plant extracts.
Valerian essential oils - EMA
Valerian rhizomes - EMA
Finding out how effective a multi-herb formulation works is also difficult because different researchers study different sets of herbal extracts at different concentrations. As a result, most scientists admit that we do not yet have reliable information on how effective herbal preparations based on herbs are for anxiety.
For example, psychotherapists in Switzerland who were trying to understand whether a combination of extracts of valerian, lemon balm, passionflower and butterbur helps with anxiety disorders. They gave part of the patients these supplements and compared the effect with patients who did not receive supplements, and came to the conclusion that the supplements can reduce the dosage of the main drugs - benzodiazepines.
Effect of a combination of valerian, lemon balm, passionflower and butterbur extracts on benzodiazepine prescribing in hospitalized patients with psychiatric disorders - Journal of Phytotherapy
These types of studies are called case-control studies. Even if they show that patients got better, this cannot be considered conclusive evidence of the effectiveness of the drug, since doctors knew who was receiving which drug and could unwittingly embellish the result. Patients who received supplements could also believe in their power and feel better - this is called the placebo effect.
To understand how well supplements really work, you need to study them the way you study drugs, that is, subject them to a randomized clinical trial. With this procedure, patients are randomly divided into two groups, one of which receives the drug, and the other receives exactly the same type of dummy pills, and neither doctors nor patients know which group they fell into until the end of the experiment. But there are still no such works devoted to supplements with herbal extracts for anxiety. Until they appear, nothing definite can be said about whether they work.
Another component of Novo-Passit, guaifenesin, is known mainly as a cough suppressant and expectorant. There is still no convincing evidence that guaifenesin helps with coughing - but it has quite a few side effects.
Guaifenesin - a cough remedy - drugs.com
I have not been able to find studies of guaifenesin as an anti-anxiety agent.
Contraindications and side effects. In the instructions, the manufacturer writes that Novo-Passit is contraindicated in children under 12 years of age and people with intolerance to the components of the drug - especially guaifenesin. As a rule, it is well tolerated, but some people complain of allergies, dizziness, weakness, drowsiness and gastrointestinal disorders - from vomiting and heartburn to diarrhea.
|The cost of the drug depends on the number of tablets in the package and the volume of the vial||A pack of 10 tablets and a 100 ml bottle of solution cost about the same - 460-470 R|
What is it. Phytotherapeutic tablets and capsules based on the extract of rhizomes of valerian, lemon balm and mint.
Persen — GRLS
According to the manufacturer, the drug has a sedative effect.
Proof of effectiveness. Persen is not mentioned in the international drug databases, it is not in the clinical recommendations for the treatment of any diseases either. This is a phytotherapeutic drug similar to Novo-Passit, but with a slightly different composition. He has exactly the same problems with evidence of effectiveness.
Contraindications and side effects. According to the manufacturer, the drug should not be taken by people with hypersensitivity to its components, people with low blood pressure, diseases of the biliary tract, children under 12 years of age, pregnant and lactating women. The drug can cause allergic reactions - from rashes to edema, and with prolonged use, provoke constipation.The cost of the drug depends on the number of tablets in the package. The price of a pack of 20 tablets is 351 R
What is it. Corvalol is sold in two versions:
- phytotherapeutic agent based on extracts of lemon balm leaves, peppermint and motherwort grass in tablets and water-based drops;
- phytotherapeutic agent based on extracts of lemon balm leaves, peppermint, motherwort herb, which contains phenobarbital. These are drops based on 95% alcohol.
Corvalol tablets - GRLS
Corvalol drops with phenobarbital - GRLS
According to the manufacturers, Corvalol in both versions "has a calming effect."
Proof of effectiveness. As a remedy for anxiety, both versions of Corvalol, both with and without phenobarbital, are not mentioned in any international drug database. In clinical recommendations for the treatment of any diseases, they are also absent.
There is no convincing evidence that any of the components of Corvalol without phenobarbital can work as a sedative. According to some studies, lemon balm tea or tincture relieves insomnia, and the smell of peppermint can reduce stress a little. But there is no evidence that in tablets or drops these components will act in the same way as in the form of tea or essential oil.
Perhaps lemon balm tea or tincture helps with insomnia - RxList
Perhaps the smell of mint can relieve stress - RxList
Why phenobarbital is dangerous - drugs.com
Corvalol with phenobarbital may indeed have a sedative effect - for account, in fact, phenobarbital. This is a very old tranquilizer, in most countries its is prescribed only as an anticonvulsant and its use is strictly controlled, since phenobarbital is addictive and has many side effects.
Contraindications and side effects. Manufacturers of Corvalol without phenobarbital warn that it has quite a few contraindications: from allergies to its components to peptic ulcer, liver or kidney diseases, pregnancy and breastfeeding. Children under 18 years of age should not take the drug.
Manufacturers of Corvalol with phenobarbital add alcoholism and traumatic brain injury to the list of contraindications. Experts from other countries warn that phenobarbital is also contraindicated in severe asthma and chronic obstructive pulmonary disease, i.e. COPD, porphyria, and for people with a history of drug dependence in the past. The list of side effects of phenobarbital drops includes dizziness, weakness, nausea, decreased alertness, and rash.
14 important questions for Anton Rodionov, a cardiologisttablets
Motherwort preparations and supplements
What is it. Phytotherapeutic agents based on motherwort extract. According to the manufacturers, such drugs have a pronounced sedative effect - that is, they work as a strong sedative.
Preparation based on motherwort extract - GRLS
Motherwort-based supplements registered in Russia
Motherwort as a source of bioactive compounds - European Medicines Agency report medical reference book RxList
In Russia, there are both medicines and biologically active supplements based on motherwort - both in the form of liquid extracts and in capsules.
Proof of effectiveness. Motherwort-based preparations are not listed as an anxiety remedy in any international drug database. In clinical recommendations for the treatment of any diseases, it is also absent.
Theoretically, motherwort may have a potential neurological effect. Some substances in this plant can bind to receptors for gamma-aminobutyric acid, or GABA. This neurotransmitter is responsible for the inhibition of the nervous system, so the researchers suggested that the biologically active substances in motherwort would work in a similar way.
But when the substances in the motherwort extract that could work as sedatives were tested separately, their biological effect was very weak. Most likely, patients with anxiety would simply not feel its effects.
The effectiveness of motherwort remedies in healthy people with severe anxiety has not been tested. According to some studies, the combination of motherwort, valerian, hops, and lemon balm improves sleep in people with alcoholism who are trying to quit drinking. However, there is no conclusive evidence for this yet.
Contraindications and side effects. Motherwort preparation companies warn that some people may have allergies or digestive disorders - indigestion, that is, pain or discomfort in the stomach, and diarrhea.
Motherwort preparations and supplements are contraindicated in people taking neurological preparations based on calcium hydroxybutyrate, magnesium hydroxybutyrate, potassium hydroxybutyrate, or sodium hydroxybutyrate. Motherwort can enhance the effect of such drugs - up to severe poisoning and coma.
Motherwort is incompatible with hydroxybutyrates - Medscape Medical Guide
Some pharmaceutical companies offer motherwort extract based on 70% alcohol. According to the instructions, you need to use the drug in 30-50 drops diluted in water - the maximum content of ethyl alcohol in such a dose is 0.55 g, and in the maximum daily dose - 2.2 g.
International organizations believe that women can take no more than one standard serving of alcoholic beverages per day, and for men - no more than two servings. This is 14 g of pure ethanol.
The amount of ethyl alcohol that can be obtained with the maximum dose of the drug is much less than the standard serving of alcohol. Nevertheless, people who take drugs that are incompatible with alcoholic beverages, such as antidepressants, should, just in case, abandon the alcohol tincture of motherwort.The cost of the drug depends on the pricing policy of the manufacturer. The cheapest package of 10 tablets can be bought for 18 R
What is it. Sublingual tablets based on levomenthol - a substance that is obtained from peppermint essential oil.
Validol - GRLS
Manufacturers claim that this drug "has a sedative effect" - that is, it works as a sedative.
Proof of effectiveness. Levomenthol-based drugs are not listed as anti-anxiety drugs in any international drug database.
In some countries, levomenthol is approved only as an external agent for veterinary use. It is mainly used as a cough suppressant, anti-inflammatory and antipruritic drug in humans and animals.
Levomenthol — drugs.com
How levomenthol is used in medicine — PubChem chemical guide
No one has studied the effectiveness of peppermint essential oils and levomenthol preparations for anxiety in people.
Contraindications and side effects. There are few contraindications for drugs with levomenthol: mostly it is an allergy or intolerance to the components of the drug, the medicine is not suitable for children under 18 years of age. But there are side effects: nausea, watery eyes and dizziness. According to the manufacturers, the drug is incompatible with alcohol.The cost of the drug depends on the number of tablets in the package and on the pricing policy of the manufacturer. The cheapest package of 20 tablets costs 54 R
What is it. A drug based on a substance that received the international name fabomotizol. In our country, "Afobazol" of immediate and delayed action is sold. In the delayed-release preparation, the concentration of the active substance is three times higher, and it is absorbed during the day.
Afobazol - GRLS
According to the manufacturers, tablets with fabomotizol reduce anxiety and stimulate the nervous system.
Proof of effectiveness. Fabomotizole is not listed as an anti-anxiety drug in any international drug database.
The effectiveness of "Afobazole" as a remedy for anxiety was studied only in Russia - the drug is not used anywhere else in the world. I could not find independent studies on the effectiveness of the active substance for anxiety.
Contraindications and side effects. Among the contraindications, the manufacturer lists only individual intolerance to the components of the drug, age under 18, pregnancy and the period of feeding a child. And among the side effects are allergies and headaches.
|An immediate drug. Price: 720 R||Delayed drug. As a rule, slow-acting drugs are more expensive. Price: 894 R|
What is it. Lozenges based on lactose sugar. The composition of the drug intended for adults includes antibodies to the brain-specific S-protein at a concentration of 10 -15 ng / g, and the children's version - 10 -16 ng / g.
Tenoten for adults - GRLS
According to the manufacturer, it has a calming and anti-anxiety effect.
Proof of effectiveness. The concentration of the active substance makes it possible to recognize Tenoten as a homeopathic remedy, since at a concentration of 10 -15 -10 -16 ng / g, not a single antibody may appear in the tablet. But even if there were more antibodies, manufacturer-independent data that antibodies to the brain-specific S-protein reduce anxiety, no.
On the pseudo-science of homeopathy - Memorandum No. 2 of the RAS commission on combating pseudo-science
Contraindications and side effects. Although Tenoten does not actually contain an active ingredient, the manufacturer believes that its use may be harmful to people suffering from lactose intolerance and glucose-galactose malabsorption - in this rare hereditary disease, a person cannot absorb glucose and galactose normally.
How I gave up sugar
|Tenoten for adults costs 360 R||Children's version of the drug - 296 R|
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