Medications

Medication Therapy Foreword

As with all medication therapy, the medications for each of these conditions will vary from person to person. You should regularly discuss your medication therapy with your physician and pharmacist to ensure they are safe and effective. The following information about medications is meant to inform the reader and help create conversation with their healthcare provider to find the best fit for medication therapy. This information should not be used to diagnose or self-treat.

Simplified Guide to Medication for Anxiety Disorders

SSRIs (Selective Serotonin Reuptake Inhibitors): These medications help increase the amount of serotonin, a chemical that helps regulate mood, in your brain.

• How do they work?
  • SSRIs increase serotonin levels in the brain, which can help improve your mood.
• When will I feel the effects?
  • It usually takes 4-6 weeks to feel the full effects, but some symptoms may start to improve after 1-2 weeks.
• What are the possible side effects?
  • Low sodium levels: If you feel dehydrated or tired, tell your doctor right away.
  • Activation of mania: This could happen if you have bipolar disorder. Notify your doctor immediately if this happens.
  • Eye issues: Let your doctor know if you experience eye pain, vision changes, or redness.
  • Heart problems: Notify your doctor if you feel irregular heart rhythms.
  • Serotonin Syndrome: Symptoms include anxiety, agitation, and tremor. Go to the doctor immediately if these occur.
  • Sexual dysfunction and withdrawal syndrome: Discuss these with your doctor if they occur.

SSRI Medications:

• Fluoxetine (Prozac): A good option for people who forget to take their medication regularly.
• Escitalopram (Lexapro): Generally well tolerated, great first choice for GAD.
• Paroxetine (Paxil): It is effective, but can have sexual side effects; and it is not typically recommended for patients under 18 years of age.
• Sertraline (Zoloft): It’s very effective; might cause mild stomach upset and sleepiness at the start.
• Citalopram (Celexa): A good option if other medications haven’t worked.

SNRIs (Selective Serotonin and Norepinephrine Reuptake Inhibitors): These medications help increase the amount of serotonin and norepinephrine, chemicals that help regulate mood, in your brain.

• How do they work?
  • Like SSRIs, but they also increase norepinephrine levels.
• When will I feel the effects?
  • Just like SSRIs, it takes 4-6 weeks to feel the full effects, but some relief may be felt after 1-2 weeks.
• What are the possible side effects?
  • Similar to SSRIs, but also includes increased blood pressure. Monitor this if you already have high blood pressure.

SNRI Medications:

• Duloxetine (Cymbalta): It is effective for GAD, but can increase blood pressure.
• Venlafaxine (Effexor): Also effective, but it can increase blood pressure as well.

Benzodiazepines: These medications are often used for short-term relief from acute symptoms of anxiety. They produce a calming effect.

• How do they work?
  • They calm the brain and nerves by targeting a specific part of your brain cells.
• What are the possible side effects?
  • They can cause drowsiness, so avoid driving or operating machinery while taking them. They can also lead to addiction if not used as prescribed.

Benzodiazepine Medications:

• Diazepam (Valium): It works quickly and stays in the system for a long time.It is useful for acute anxiety, but not for those with liver disease.
• Lorazepam (Ativan): It typically works quickly and is safe for those with liver disease.
• Alprazolam (Xanax): It works quickly but does not last as long in the system.
• Clonazepam (Klonopin): It takes effect moderately quickly and lasts about half a day.

One common tricyclic antidepressant is Imipramine (Tofranil). It works similarly to SSRIs and SNRIs, but tends to have more side effects.

Other Medications:

• Buspirone (Buspar): It works on serotonin and dopamine, and it can be used with other medications.
• Hydroxyzine (Atarax): It has an anti-anxiety effect, but it can cause drowsiness.
• Pregabalin (Lyrica): It affects several neurotransmitters and can cause drowsiness.

The most common medications prescribed for hypochondria are SSRI’s. SSRIs (Selective Serotonin Reuptake Inhibitors) are medications that help increase the amount of serotonin, a chemical that helps regulate mood, in your brain.

• How do they work?
  • SSRIs increase serotonin levels in the brain, which can help improve your mood.
• When will I feel the effects?
  • It usually takes 4-6 weeks to feel the full effects, but some symptoms may start to improve after 1-2 weeks.
• What are the possible side effects?
  • Low sodium levels: If you feel dehydrated or tired, tell your doctor right away.
  • Activation of mania: This could happen if you have bipolar disorder. Notify your doctor immediately if this happens.
  • Eye issues: Let your doctor know if you experience eye pain, vision changes, or redness.
  • Heart problems: Notify your doctor if you feel irregular heart rhythms.
  • Serotonin Syndrome: Symptoms include anxiety, agitation, and tremor. Go to the doctor immediately if these occur.
  • Sexual dysfunction and withdrawal syndrome: Discuss these with your doctor if they occur.

Hypochondria Medication Options:

Fluoxetine (Prozac)

• Used for: Hypochondria and other anxiety disorders.
• Dose: May start with 10 to 20 mg per day. Your doctor might gradually increase the dose each week up to 60 mg/day, depending on how you respond.
• Recommended for: People who sometimes forget to take their medication as it lasts a long time in the body.

Paroxetine (Paxil)

• Used for: Generalized Anxiety Disorder (GAD).
• Dose: May start with 10 mg per day. Your doctor may increase the dose each week up to 50 mg/day, depending on your response.
• Note: This medication might cause sexual side effects, so it's not usually the best choice for younger people.

Fluvoxamine (Luvox)

• Used for: Various anxiety disorders.
• Dose: May start with 50 mg per day. Your doctor may increase the dose every 3 or more days, depending on your response, up to a maximum of 300 mg/day.
• Note: While not as popular as other SSRIs, it can be an alternative if other medications aren't effective.

Venlafaxine (Effexor)

• Used for: GAD.
• Dose: Initially 37.5 to 75 mg once daily. Your doctor may increase the dose as needed, with a usual dose of 75 to 225 mg/day.
• Note: This medication can potentially increase blood pressure, and should be used with caution in people with high blood pressure.

Duloxetine (Cymbalta)

• Used for: GAD.
• Dose: May start with 60 mg once daily. Your doctor may increase the dose based on your response and tolerability, up to a maximum of 120 mg/day.
• Note: Like Venlafaxine, this medication may increase blood pressure.

Imipramine (Tofranil)

• Used for: GAD.
• Dose: May start with 10 mg per day. The dose can be increased gradually over 3 to 5 weeks up to 100 to 300 mg/day.
• Note: This medication can have side effects like dry mouth, dry skin, and heart palpitations.

Pregabalin (Lyrica)

• Used for: Anxiety disorders.
• Dose: May start with 150 mg/day in 2 to 3 divided doses. Your doctor may increase the dose every week up to a usual dose of 300 mg/day.
• Note: This medication can make you drowsy or dizzy when you first start taking it, but these side effects should subside with time.

Gabapentin (Neurontin)

• Used for: Anxiety disorders.
• Dose: May start with 300 mg/day. Your doctor may increase the dose every 3 or more days, up to a maximum of 2.4 g/day.
• Note: Like Pregabalin, this medication can also make you drowsy or dizzy when you first start taking it. However, these side effects should subside with time.

When dealing with Obsessive Compulsive Disorder (OCD), there are several medications that your doctor might suggest. Here is a simple breakdown of each one:

Fluoxetine (Prozac)

• Typical starting dosage is 10-20 mg per day. Depending on how you respond to it, your doctor might gradually increase this by 10-20 mg each week, up to a maximum of 60 mg/day.
• This medication might be a good choice for you if you have difficulty remembering to take your medication regularly, as it stays in your system for a long time and doesn't cause severe withdrawal symptoms.

Paroxetine (Paxil)

• Typically starts at 10 mg per day. Based on how you feel, the dose may be increased by 10 mg each week, up to 50 mg/day.
• While this medication is effective for Generalized Anxiety Disorder (GAD), it can have sexual side effects. Therefore, it's not generally recommended for younger patients.

Fluvoxamine (Luvox)

• Typically starts at 50 mg per day. Your doctor might increase this by 25 to 50 mg every three days or so, up to a recommended dose of 100 mg/day. After 4-6 weeks, your doctor may continue to increase the dose by 50 mg every 1-2 weeks, up to a maximum of 300 mg/day.
• This medication might be a good choice if other, more common SSRIs haven't worked for you. However, it does have some side effects, so keep that in mind.

Venlafaxine (Effexor)

• For treating GAD, ONLY the extended release (ER) formulation is appropriate. The starting dose is usually 37.5 to 75 mg per day. This can be increased to 75 mg per day after 4-7 days, and then increased again by up to 75 mg every 4 or more days. Typically, patients end up taking between 75-225 mg/day (maximum is 225 mg/day).
• This medication can be effective for GAD, but it's not as proven as some other options. It may also raise blood pressure, but is generally well tolerated.

Escitalopram (Lexapro)

• The starting dose is usually 10 mg per day. After a week or so, your doctor might increase the dose based on your reaction to the medication, up to a maximum of 20 mg/day.
• This is a great first choice for treating GAD, as it works well and has minimal side effects.

Citalopram (Celexa)

• Typically starts at 10 mg per day, and can be gradually increased by 10 mg per week, up to a maximum of 40 mg/day for adults 60 years or younger, or 20 mg/day for adults over 60.
• While this medication is effective for GAD, it's not as proven as some other options. However, it's a good choice if other medications haven't worked for you.

Dextroamphetamine/ amphetamine (Adderall; Adderall XR; Mydayis)

• This medication isn't usually the first choice for treating OCD, but it can be used in addition to other medications if necessary.

For Panic Disorder, Social Anxiety Disorder, and Agoraphobia, medications called SSRI/SNRIs are usually the first choices. These are some options:

Citalopram (Celexa)

• Dose: Start with 10 mg daily. Increase slowly if needed. Maximum is 40 mg for adults under 60 and 20 mg for those over 60.
• Best for: Those who haven't responded to other medications. It's easy to tolerate.

Fluoxetine (Prozac)

• Dose: Start with 10-20 mg daily, can be increased slowly up to 60 mg daily.
• Best for: Those who sometimes forget to take their medication as it lasts a long time.

Paroxetine (Paxil)

• Dose: Start with 10 mg daily, can be increased slowly up to 50 mg daily.
• Best for: People who can handle possible side effects. Not recommended for younger patients due to the risk of sexual dysfunction.

Fluvoxamine (Luvox)

• Dose: Start with 50 mg daily, can be increased slowly up to 300 mg daily.
• Best for: Those who can tolerate its side effects. It's less common but mostly well-tolerated.

Venlafaxine (Effexor)

• Dose: Start with 37.5 to 75 mg daily. It can be increased if needed.
• Best for: Those who can manage potential blood pressure increase.

Escitalopram (Lexapro)

• Dose: Start with 10 mg daily, can be increased to 20 mg daily.
• Best for: First line treatment. It's easy to tolerate and effective.

Secondary options include medications like Alprazolam (Xanax), Clonazepam (Klonopin), and Diazepam (Valium). They work quickly but can cause drowsiness and potentially lead to respiratory problems.

For third options, consider medications like Bupropion (Wellbutrin) and Valproic Acid (Depakote). However, they may cause significant side effects and require regular monitoring.

Beta-blockers, like Propranolol (Inderal), can help with performance-related anxiety. However, it should not be used by people with asthma or certain heart conditions.

Medication isn't the first line of treatment for specific phobias, like claustrophobia (fear of confined spaces) or cleithrophobia (fear of being trapped). Cognitive-behavioral therapy (CBT) is the primary form of treatment.

There are, however, certain medications that can help manage fear or anxiety when an individual is confronted with the situation or object that causes fear. Keep in mind, though, these medications don't cure the phobia, but they can help make it more manageable. If the phobia causes a decreased quality of life and it affects everyday function, medication might be an option to consider.

• One type of medication that may be prescribed is benzodiazepines. Two commonly prescribed medications in this group are diazepam and lorazepam. They work quickly and don't stay in your system for a long time. Their job is to reduce feelings of discomfort in a fear-inducing situation.
• Another medication sometimes used is an SSRI, such as paroxetine. However, the evidence supporting their effectiveness for specific phobias is not very strong.

https://www.healthyplace.com/anxiety-panic/articles/medications-for-anxiety-disorders

https://www.everydayhealth.com/drugs/ - Enter the name of the medication.

https://www.webmd.com/drugs/2/conditions/index - Search medications by condition.

https://www.webmd.com/drugs/2/index - Click on the medication name.

https://health.usnews.com/drugs - Enter the name of the medication

The Merck website has scholarly medication and trial information - www.merck.com

GoodRX website and phone app allows you to compare the prices of medications - https://www.goodrx.com/

Most companies have special pricing for low income individuals. See the manufacturer websites and medication websites for patient assistance programs that are offered.