using anti-anxiety drugs to treat GAD, SAnD, PTSD, OCD, PD, and other initialisms

1.  Define Your Terms

Just to clear up some of the terminology used. Anxiolytic is the technical term for an anti-anxiety medication. It’s also a lot shorter. Tranquilizer and sedative are interchangeable terms for a type of anxiolytic that also puts you to sleep, or relaxes you so much you may as well be sleeping, such as a benzodiazepine. “Major tranquilizer” is a holdover from the days when consumers didn’t know shit about the meds they were taking and often refers to an antipsychotic - usually a first-generation antipsychotic - that is being used to treat anxiety and insomnia. Sedatives is a class of medications that includes barbiturates, chloral hydrate, benzodiazepines, and some modern hypnotics such as Ambien (zolpidem tartrate).

2.  Anxiety Spectrum Conditions

When most people think of anxiety conditions they think of conditions such as generalized anxiety disorder (GAD), social anxiety disorder (SAnD) / social phobia, and various panic disorders, especially agoraphobia. Other conditions in the anxiety spectrum include obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Most of the time anxiety conditions can be treated without medication. When medication is required it is usually for a short duration and/or used as needed (PRN). As with depression, meds should be reserved for when someone isn’t, or is barely able to function due to their condition. Let’s take social anxiety/phobia, as it’s really easy to determine if you need medication for SAnD or not.

  • If you can leave you house, hold down a job (even one that involves as little contact with people as possible), and otherwise function, no matter how little interaction you have with anyone else, you can probably overcome the condition with therapy.1 Drugs, if needed, would be used for a very short time.
  • If the only time you can leave your house is when you know there will be as few people around as possible, and you’ve adjusted your life so you do your shopping at 3:00 a.m., and only for stuff you can’t get online, then you need meds. Maybe not forever, but probably for more than six-to-eight weeks.

3.  First-Line Pharmacological Treatments

  • Benzodiazepines are the traditional pharmacological treatment for most of these conditions. These days they are mostly prescribed for someone who needs to be medicated only occasionally.
  • SSRIs, along with some of the more serotonergic antidepressants from other classes, are usually the first meds of choice for anyone with an anxiety spectrum condition who needs to be medicated every day, either in the short term as part of psychological therapy, or in the long term.
  • SNRIs - for a lot of people too much norepinephrine is the cause of anxiety, but there are a lot of people who can use a little boost in the adrenergic receptors to help them with their anxiety.
  • BuSpar (buspirone), which is in a class all its own2, is the best first choice for GAD when someone is in that nebulous area of too anxious too often for therapy alone with a PRN drug, but not so anxious for an SSRI.
    • Technically Luvox (fluvoxamine) is in a class of its own as well, as it is approved by the FDA to treat OCD and nothing else. But it is an SSRI, and approved as an antidepressant everywhere else in the world, so I classify it as an antidepressant.

4.  Second-line Pharmacological Treatments

  • Antipsychotics, either by themselves or to augment antidepressants or BuSpar, are also used to treat anxiety disorders.
  • Antihistamines. In addition to treating severe allergic reactions, new antihistamines were being developed in the 1950s to deal with two problems prior to surgery: anxiety and anesthesia-induced vomiting3. They’ve been used to treat anxiety ever since. While the more potent ones like Vistaril - which you’ll probably find only in hospitals - are FDA-approved to treat anxiety, OTC antihistamines like Benadryl (diphenhydramine) can work as needed for mild panic/anxiety attacks.
  • Beta blockers, like benzodiazepines, are good for when you only need to take a drug PRN. They are mostly used for SAnD, specifically in situations like public speaking or other cases of performance anxiety4.

5.  Medications Used for Anxiety Spectrum Conditions

5.1  Drugs discussed on this site with FDA-approval to treat anxiety spectrum conditions

5.2  Drugs discussed on this site used off-label to treat anxiety spectrum conditions

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5.3  Other drugs with FDA-approval to treat anxiety spectrum conditions

  • Benzodiazepines:
    • Ativan (lorazepam)
    • Klonopin (clonazepam)
    • Librium (chlordiazepoxide hydrochloride)
    • oxazepam
    • Tranxene (clorazepate dipotassium)
    • Valium (diazepam)
    • Xanax (alprazolam)
  • Antidepressants:
    • Anafranil (clomipramine hydrochloride)
    • Etrafon (perphenazine and amitriptyline hydrochloride) - combination antidepressant & antipsychotic
    • Nardil (phenelzine sulfate)
    • Parnate (tranylcypromine sulfate)
    • Sinequan (doxepin hydrochloride)
  • Antipsychotics:
    • Compazine (prochlorperazine)
    • Loxitane (loxapine succinate)
    • Orap (pimozide): Tourette Syndrome
    • Stelazine (trifluoperazine hydrochloride)
  • Antihistamines:
    • Atarax (hydroxyzine hydrochloride)
    • Vistaril (hydroxyzine pamoate)
  • Beta blockers:
    • acebutolol hydrochloride
    • metoprolol
    • propranolol hydrochloride
    • sotalol hydrochloride
    • timolol
  • Miscellaneous:
    • droperidol
    • mephobarbital
    • meprobamate

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1 Assuming you want to in the first place. I won't go anywhere to deal with stuff like grocery shopping for two, three, sometimes four weeks at a time. Solitude has done wonders for my mental health.

2 In the US at any rate. BuSpar is an azapirone, a class of meds that are mostly anxiolytics and nothing else. A few are also antipsychotics. As of this writing most of them are still in the clinical trial stages everywhere.

3 Not only that, some of the original antipsychotics, like promethazine and Thorazine (chlorpromazine), were originally developed as super antihistamines for pre-operative sedation and to prevent puking. Thorazine was so effective that some people didn't need anesthesia.

4 But not "performance anxiety," or being too nervous or otherwise unable to respond sexually. Which is often a side effect of many crazy meds, especially SSRIs. Although BuSpar is used off-label as an add-on to help with SSRI-induced sexual dysfunction.

Anxiolytics Anxiety Spectrum Disorders Treatment Options by Jerod Poore is copyright © 2011 Jerod Poore

Last modified on Friday, 05 June, 2015 at 00:00:00 by JerodPoorePage Author: Jerod PooreDate created: 15 April 2011

All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.

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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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