Anxiety Medication and Side Effects

Home » Public Resources » Anxiety » Anxiety Medication and Side Effects

The Whole Psychiatry approach recognizes that because all medications have side effects, and many people are on multiple medications (which often cause dangerous and even life threatening interactions) good medical practice dictates that we strive to avoid medication use, make it temporary or use the lowest effective dose. Achieving this goal is possible because the need for medication is lower when all bodily systems are harmonized, malfunctioning systems are corrected, and functioning optimally.

Side effects of medication are very common, and vary with the type of medication. See the chart below for details.

In traditional psychiatric practices, various medications are commonly used to stabilize aspects of the anxiety circuitry in the brain, and for the most part traditional psychiatrists now prescribe medications to combat all of the anxiety disorders. Specific medications work for specific aspects of anxiety disorders.

Anxiety Medication for Panic and Anxiety Attacks

SSRI’s (serotonin reuptake inhibitors) are the most common first line medication for nearly all anxiety disorders. These include fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), fluvoxamine (Luvox)
SNRI’s (serotonin-norepinephrine reuptake inhibitors) are also commonly used first line for anxiety disorders and there is some reason to believe they may be more effective than the SSRI’s listed above, for panic and anxiety attacks. These include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
Tricyclic antidepressants (imipramine), and MAO Inhibitors such as phenylzine (Nardil) are the most effective drugs of the tricyclic and MAO inhibitor classes, which are second or third-line choice for panic and anxiety attacks. Clomipramine (Anafranil) is useful for obsessive compulsive disorder, as is fluvoxamine (Luvox)
Benzodiazepines: are commonly used for the anticipation of a panic attack (anticipatory anxiety) or to relieve general anxiety. Buspirone (Buspar) is a medication which is useful in this regard, but unlike the benzodiazepines, is not addictive.
Mood stabilizers: Valproic Acid (depakote) has anti anxiety, anti-OCD, and anti-panic activity. Some of the medications in the anti-psychotic class (such as quetiapine (Seroquel) have effects on anxiety and OCD-but not much effect on panic attacks.
Supplements: If a person has a genetic test that shows they are positive on both chromosomes for the COMT genetic mutation, they may have a reduction in anxiety with the use of folic acid or SAM-e.

The Antidepressant Medications (listed alphabetically)

Brand Name (Generic Name)	Daily Dosage	Side Effects*	Special Uses/ Risks
Anafranil (Clomipramine)	25-75mg 3x/day with food	A, B, c	D, O, Bld; possibly P, M,C
Cymbalta (duloxetine)	20-100mg	B, t, n, h	D, Anx, C, P
Deseryl (trazodone)	25- 600 mg/day	a, b, c	D, Anx, SP, M, C
Effexor (venlafaxine)	25mg-125mg 3x/day with food	N, T, h, i, a, b	D, Anx, P May be useful in AD/HD Active in serotonin and norepinephrine systems.
Elavil (amitriptyline)	25-300 mg/day	A, B, C	D, U, M, C, Bld
Ludiomil (maprotiline)	25-225 mg/day	a, b, c	D, must raise dose slowly
Luvox (fluvoxamine)	25-150mg 2x/day	a, b, h ,n	O, probably P, C, D
Nardil (phenelzine)	15-105 mg/day	a, b, c	D, AD/HD, P, SP, Anx, C (MAO Inhibitor)
Norpramin (desipramine)	25-350 mg/day	A, b, c	D, AD/HD, Bld
Pamelor (nortriptyline)	25-150 mg/day	A, b, c	D, Bld (therapeutic window-level must be in specified range)
Parnate (tranylcypromine)	10-90 mg/day	a, c	D--energizing; dietary restrictions (MAO Inhibitor)
Paxil (paroxetine)	5-20 mg/day	a, b, n	D; probably O, SP, SOM, C, M
Pristiq	50 mg	A, b, C, N	Active metabolite of Effexor-see above
Prozac (fluoxetine)	5-80 mg/day	b, n	D; O, PMS
Serzone	100-300 mg twice daily	N, a, b, c	Soon to be approved. Fewer sexual side effects. D, possibly Anx.
Seroquel (quetiapine)	25-800mg	B, c	For Bipolar Depression
Sinequan (doxepin)	25-300mg/day	A, B, C	D, Anx, Bld, U, C, SOM
Surmontil (trimipramine)	75-150 mg/day	A, B, C	D, Anx.
Tofranil (imipramine)	25-300 mg/day	A, B, C	D, AD/HD, P, Anx, Bld; possibly useful in O, SP, SOM
Vivactil (protriptyline)	5-15mg 3x per day	A, c	D--Energizing; tolerated in patients with sleep apnea
Wellbutrin	75-450 mg/day in divided doses	a	D, AD/HD; no weight gain; increased risk of seizures in certain populations.
Zoloft	25-200 mg/day	b	D; possibly useful in O, Anx, S, C

* Note nearly all can cause weight gain and sexual dysfunction.

Key

Upper case - significant effect; Lower case - minor effect

A, a - Dry Mouth, Constipation, Blurry Vision.
B, b - Sedation
C, c - Dizziness on Standing
N, n - Nausea
H, h - Headache
I, i - Insomnia
T, t - Hypertension

D - Depression
AD/HD - Attention Deficit Disorder
Anx - Anxiety
Bld - Monitoring of the level of medication in the patient's blood is necessary.
C - Chronic Pain
M - Migraine
O - Obsessive Compulsive Disorder
P - Panic Disorder
SP - Social Phobia
U - Ulcers
SOM - Somatization Disorder

Commonly Used Benzodiazepines*

Brand Name (Generic Name)	Daily Dosage Range	Duration of Action, Onset, Elimination	Comments
Ambien (zolpidem)
Ativan (lorazepam)	0.25-2.0 mg 1-3 times per day	Long acting Slow onset Slow exit	Easiest major tranquilizer to tolerate for patients with liver dysfunction
Centrax (prazepam)	5-60 mg 1-2 times per day	Moderate action Very slow onset Slow exit
Dalmane (flurazepam)	15-30 mg at bedtime	Long action Rapid onset Slow exit	Used only for insomnia
Doral (quazepam)	7.5-15 mg at bedtime	Long acting Very quick onset Moderate exit	For insomnia only
Halcion (triazolam)	0.125-0. 5 mg at bedtime	Short acting Quick onset Ultra-fast exit	Used only for insomnia Associated with amnesia
Klonopin (clonazepam)	0.25-10 mg 1-3 times per day	Moderate duration Intermediate onset Slow exit	Psychologically less addictive than other minor tranquilizers, less likely to cause a ‘high’
Librium (chlor-diazepoxide)	5-25 mg 1-4 times per day	Intermediate acting Moderate onset Slow exit
Paxipam (halazepam)	20-40 mg at bedtime	Long acting Moderate onset Slow exit	Expensive
Prosom (estazolam)	0.5-2.0 mg at bedtime	Moderate action Moderate onset Moderate exit	Used only for insomnia
Restoril (temazepam)	15-30 mg at bedtime	Short acting Fast onset Fast exit	Used only for insomnia
Serax (oxazepam)	15-30 mg 1-3 times per day	Short acting Moderate onset Fast exit	Excellent safety profile
Tranxene (clorazepate)	3.75-30 mg 1-4 times per day	Long acting Rapid onset Slow exit
Valium (diazepam)	2.5-10 mg 1-4 times per day	Long acting Very rapid onset Very slow exit	Slow exit eases withdrawal
Xanax (alprazolam)	0.25-2.0 mg 2-6 times per day	Short acting Quick onset Fast exit	Antipanic activity Withdrawal difficult