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 Alzheimers disease and dementia.
People with a history of substance abuse. Because theyre 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
What Are The Symptoms Of Anxiety And Panic Attacks
Symptoms of an anxiety attack tend to come on gradually. People who have anxiety attacks often have a low level of anxiety as a baseline.
Symptoms of an anxiety attack include:
- Excessive worry
- Caffeine
- Side effects from medications
- Low oxygen levels from being at high altitudes, having lung diseases such as COPD, or a pulmonary embolism
What Is A Phobia
A phobia is an extreme, unreasonable fear in response to something specific. There are lots of different phobias. Some of the most common phobias include fear of crowds, bridges, snakes, spiders, heights, open places, or social embarrassment.
A phobia is considered a problem only when it keeps you from living a normal life. An example is being afraid to leave home because you are afraid of one of the things listed above.
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Best Medication For Anxiety And Panic Attacks
The medications used to treat anxiety focus on alleviating anxious feelings, and lessening the severity and frequency of panic attacks. They make patients feel calmer even when theres agitation. Feeling anxious from time to time is part of life. Anxiety is a component of the human bodys natural defense system and is closely linked to the flight and fright response.
However, its best to keep in mind that theres a difference between being afraid of stepping out of the house and feeling anxious before facing new people or a crowd. Essentially, anyone who battles an anxiety disorder can be put on anxiety medication. However, just because someone experiences anxiety doesnt mean he/she should take anxiety medication because psychotherapy and exercise may be equally effective. That said, here are some common medications for anxiety and panic attacks:
Foods That Help Or Hurt Anxiety
There are several types of medications used to treat anxiety disorders.
- Hydroxyzine
- Beta-blockers
Within each of these categories, there are subgroups of drugs that work differently and have their own benefits, risks, and possible side effects.
Theyre supereffective in treating anxiety disorders, says Beth Salcedo, MD, the medical director of the Ross Center for Anxiety & Related Disorders and a past board president of the Anxiety and Depression Association of America. Its not known exactly how SSRIs work on serotonin to alleviate anxiety, says Dr. Salcedo, but what is known is that theyre not addictive like benzodiazepines are .
Its important to follow your doctors instructions when taking any prescription drug. Talk to your doctor if youre concerned about the side effects of a medication, or if the drug youre taking doesn’t seem to be alleviating your symptoms.
Other antidepressants that may be prescribed for anxiety include:
- Wellbutrin, Zyban, Aplenzin, Budeprion, or Buproban
- Tricyclic antidepressants, such as Amitid, Amitril, Elavil, or Endep Aventyl, Pamelor or Tofranil
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Development Of Panic Disorder
How do panic symptoms develop? A phobia of internal sensations is thought to drive the patients avoidance behavior. In addition to neurochemical and genetic models for the disorder, some researchers have proposed a cognitive model, in which patients learn to misinterpret thoughts and emotions as physical symptoms. For example, a woman who is afraid of being left alone when her husband leaves for work may experience that fear physiologically , which in turn makes her feel more anxious , deepening the spiral and leading to more symptoms. Another theory is that patients escalate otherwise benign body sensations into panic attacks . For example, a man whose heart rate accelerates when he becomes angry may escalate that sensation and the resulting anxiety into the chest pain of a heart attack. Both examples demonstrate the patients phobia of internal sensations.
What Are The Complications Of Panic Attacks
Panic attacks are highly treatable. Unfortunately, many people put off seeking help because theyre embarrassed. Untreated panic attacks or panic disorder can interfere with your ability to enjoy life. You may develop:
- Anticipatory anxiety: The possibility of having a panic attack triggers extreme anxiety.
- Phobias: A phobia is an extreme, unreasonable fear of something specific. For instance, acrophobia is a fear of heights, while claustrophobia is a fear of enclosed spaces.
- Agoraphobia: Approximately two-thirds of people with panic disorder develop agoraphobia. This anxiety disorder makes you afraid to be in places or situations where a panic attack might happen. The fear can become so extreme that you become too afraid to leave your house.
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Drugs To Treat Anxiety Disorder
Xanax has boxed warnings. These are the most serious warnings from the Food and Drug Administration . Boxed warnings alert doctors and patients about drug effects that may be dangerous.
Using benzodiazepines, even as prescribed, can lead to physical dependence and withdrawal if you stop taking the drug suddenly. Withdrawal can be life threatening.
Using benzodiazepines can also lead to misuse and addiction. Misuse of benzodiazepines increases your risk of overdose and death.
Only take these drugs as your doctor prescribes. Talk with your healthcare professional if you have any concerns about safely taking a benzodiazepine.
The Role Of Medication In Anxiety Treatment
When youre overwhelmed by heart-pounding panic, paralyzed by fear, or exhausted from yet another sleepless night spent worrying, youll do just about anything to get relief. And theres 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 and newer options like SSRI antidepressants . These drugs can provide temporary relief, but they also come with side effects and safety concernssome 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.
Whats 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.
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Lets Get Specific: Which Ssri/snri Medications Are Best For Which Anxiety Conditions
What does it mean to be FDA approved? Before they can be marketed, prescription medicines must go through an extensive approval process to prove that they work and that their benefits outweigh their risks. It takes an average of 12 years for a new drug to hit the pharmacy shelves, and hundreds of millions of dollars are spent on research, development, and clinical trials. Note that the FDA does not actually perform testing it only reviews the testing process.
The FDAs decision to approve a medication is supported by reliable scientific data. A long, detailed document accompanies every FDA-approved prescription drug, referred to as the package insert or label. The approved label provides key information about the medication that includes the specific conditions that the drug is approved to treat as well as dosage and safety info.
Healthcare providers may choose to prescribe a medication for an off-label or unapproved use when they judge that it is medically appropriate for their patients. Off-label prescribing is very common for the treatment of various types of anxiety disorders but typically not before trying first-line options.
Doctors Are Quick To Prescribe Drugs
It’s extremely common to find out you have panic attacks from a medical doctor, rather than a psychologist. That’s because the physical symptoms of panic attacks are very similar to serious health disorders. It is common for people to seek help from their primary care physician rather than thinking that they are suffering from a mental health issue.
Often doctors will recommend a medication for treating panic attacks. While you should always follow your doctor’s advice, you should also know that medication alone will not eliminate panic attacks. Often people find that once they stop taking the medication, their symptoms return.
Problems with Panic Attack Medications
Medications will always have their place. If your panic attacks are severe, other treatment options aren’t working and you need immediate help, they can provide that relief. There are however side effects and other issues to consider:
Medications for panic attacks don’t address the root cause of them. While you may find some relief from your panic attacks, you may also suffer from fatigue and other significant side effects.
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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.
How Are Panic Attacks Diagnosed
Serious health problems, such as heart disease, thyroid disease and respiratory problems, cause symptoms similar to panic attacks. Your healthcare provider may run tests to rule out a physical problem. If theres no physical cause, your provider may make a diagnosis based on your symptoms and risk factors.
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Monoamine Oxidase Inhibitors For Panic Disorder
Certain monoamine oxidase inhibitors have been shown to be more effective than placebo for treatment of panic disorder however, they are not specifically FDA-approved for this use. Due to food restrictions, risk for severe high blood pressure , and severe drug interactions, MAOIs are rarely used to treat panic disorder. MAOIs should not be used with serotonin-modulating antidepressants such a SSRIs or SNRIs due to the risk for serotonin syndrome.
Any patient who is treated with a MAOI should have a drug interaction screen performed by their doctor or pharmacist any time a medication, over-the-counter product, herbal, vitamin or dietary supplement is added to their treatment. Learn more about MAOIs, dietary restrictions and drug interactions here.
Table 5: MAOIs Used for Panic Disorder
| Generic Name |
|---|
- Although several herbal treatments have been marketed for treatment of anxiety disorders, more research is required. Products such as kava kava, valerian and St. John’s Wort are often sold over-the-counter for stress and anxiety relief and to help with sleep. Studies have not proven these products as helpful and side effects such as liver damage can occur.
- Herbal and dietary supplements are not reviewed by the FDA for effectiveness, and may cause serious side effects or drug interactions. Always check with your doctor or pharmacist before using any natural remedy or over-the-counter product for panic attacks or anxiety.
When To Get Help
See a GP if you’ve been experiencing symptoms of panic disorder.
They’ll ask you to describe your symptoms, how often you get them, and how long you have had them.
They may also carry out a physical examination to rule out other conditions that could be causing your symptoms.
It can sometimes be difficult to talk about your feelings, emotions and personal life, but try not to feel anxious or embarrassed.
You may be diagnosed with panic disorder if you have regular and unexpected panic attacks followed by at least a month of continuous worry or concern about having further attacks.
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Comorbidities With Panic Disorder
Until recently, the panic disorder was not distinguished from agoraphobia . As it stands in the current Diagnostic and Statistical Manual of Mental Disorders – 5 agoraphobia is one of the most common disorders to co-occur with panic disorder. Current estimates contend that just under 2% of teens and adults have agoraphobia . Often, people associate panic attacks or their panic disorder with certain places, people, or events and the fear of another attack occurring can lead to comorbid fears of the location or idea that there is no escape, which leads to extreme avoidance. Panic disorder can also occur simultaneously with other anxiety disorders, such as Generalized Anxiety Disorder and/or Social Anxiety Disorder , for example.
Depression also commonly co-occurs with panic disorder, with reports estimating comorbidity between 10-65% over one’s life. This comorbidity is more likely to develop at the same time that panic disorder is recognized and diagnosed, although roughly 30% of people have major depression before meeting criteria for panic disorder as well .
Medications For Panic Attacks
Suffering from panic attacks can be like having non-fatal heart attacks. Panic attacks can be debilitating, often causing stress that interferes with daily functioning. Often one of the first treatment options that you’ll consider is medication. In this article, we’ll discuss some of the most common medication recommendations for treating panic attacks.
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What Are Ssris And Snris
Selective serotonin reuptake inhibitors like Zoloft and Prozac, and serotonin and norepinephrine reuptake inhibitors like Effexor and Pristiq are antidepressant medications, but they can help with anxiety symptoms as well. For this reason, many providers will prescribe an SSRI or SNRI if you have a combination of depression and anxiety.
SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief, Alonzo said. They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.
Some patients may respond better to one of these medications than others. If after taking the medication for two weeks and symptoms have not improved, talk to your provider to have your medication regimen adjusted. Treatment trials with more than one medication are not uncommon.