In this article, we will describe what are the best 10 tablets for anxiety (and panic attacks).
All humans have a degree of anxiety. This is normal. But this article is about when it becomes an illness, and needs treatment.
A bit of background first.
What is anxiety?
Anxiety is normal. Anxiety is a natural response to feeling fearful or threatened.
Fear is normal and has advantages, as it helps you deal with life challenges and stresses. Whereas anxiety is defined as unreasonable fear.
Anxiety can become a problem, if we start worrying excessively about relatively harmless situations.
When that occurs often it is called a generalised anxiety disorder or GAD. When our anxiety feels intense or overwhelming, it starts to interfere with our daily life.
An anxiety disorder is different. If you have been diagnosed with one, you may need help managing anxiety. Treatment typically consists of talking therapy (including psychotherapy) and/or medication.
Whereas normal ‘life anxiety/stress’ does not need treatment.
What is a panic attack?
Panic attacks are a rapid type of fear response. They are an exaggeration of your body’s normal response to danger, stress or excitement. Doctors consider them an anxiety disorder.
Anxiety treatment principles
Many types of medications are available. Because every person is different, you and your doctor may have to try several medications to find the right one for you.
In many people, the first medication you will be offered will be a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI; see below). If this is not effective other medications may be considered.
Benzodiazepines are a type of sedative that may sometimes be used as a short-term treatment during a particularly severe period of anxiety. They are not usually great drugs for long-term usage.
We will now describe the 10 most common and best tablets for anxiety and panic attacks.
1. Benzodiazepines – diazepam, lorazepam, alprazolam, clonazepam and chlordiazepoxide
These are prescribed as ‘crisis medications’ and provide quick relief from a current state of severe anxiety.
They are usually prescribed as short-term medications (prescribed for days to weeks) due to the potential for dependency, addiction and tolerance to the medication. Only a very small number of patients may benefit from longer term treatment.
These drugs mainly act by increasing the levels of a chemical substance (neurotransmitter) in the brain and spinal cord called gamma-aminobutyric acid or GABA. Raised GABA levels have a calming effect on nerve cells that relieve anxiety symptoms.
2. Antihistamines – promethazine and hydroxyzine
Antihistamines are often prescribed for short term treatment of anxiety states. They have a calming effect by blocking certain types of receptors in the brain (histamine) and can lead to a sense of relaxation and possible drowsiness. They are also prescribed for hay fever and itching.
The following medications are considered when planning longer term daily treatment:
3. SSRIs – including sertraline, citalopram, escitalopram and fluoxetine
They increase the levels of serotonin in the brain by blocking its reuptake by the nerve cells. Increased serotonin levels help to improve mood and relieve anxiety. You may feel only small benefits initially (in the first 6 weeks) with further improvements coming later.
4. SNRIs – duloxetine and venlafaxine
They increase the brain levels of the two hormones called serotonin and norepinephrine. These hormones are types of ‘feel-good’ hormones that improve mood. SNRIs act by blocking or reducing the reuptake of these two hormones by the nerve cells, thus increasing their activity in the brain.
Again, improvements in anxiety may be seen gradually at first. They are started at a low dose and increased slowly, in order to minimise side effects.
5. Pregabalin
If SSRIs and SNRIs are not suitable for you, you may be offered pregabalin.
This medication is an anticonvulsant and pain modulating drug. But it has also been found to be beneficial in treating anxiety.
You may notice improvements earlier in treatment but it is prescribed less frequently than the above medications due to potential side effects and risk of withdrawal symptoms (including seizure) if stopped suddenly.
6. Agomelatine – atypical antidepressant
Agomelatine increases levels of both serotonin and melatonin in certain areas of the brain. As well as improving mood and reducing anxieties this medicine can help with sleep.
7. Beta-blockers – including propranolol and atenolol
These block the effect of the hormone adrenaline. This results in lowering the rate and force of contraction of the heart. These medications are prescribed with the aim of relieving the physical symptoms of anxiety such as a racing heartbeat or palpitations.
8. Buspirone
The exact mechanism of action for buspirone is not known. But it is believed to balance the level of serotonin and dopamine within the brain. It is helpful in reducing the symptoms of anxiety. It is prescribed more often in the US than the UK.
9. Tricyclic antidepressants – including amitriptyline, imipramine and clomipramine
These medications act by restoring the balance of certain neurotransmitters in the brain. They do this by increasing the levels of serotonin and norepinephrine, whilst reducing the levels of another neurotransmitter called acetylcholine.
Medications such as clomipramine show good evidence and are often prescribed as a second-line treatment in Obsessive-Compulsive Disorder.
10. Quetiapine
Quetiapine is an antipsychotic medication which can also be prescribed in anxiety disorders and depression.
It changes the levels of multiple neurotransmitters in the brain, including dopamine, serotonin, histamine and adrenaline.
As quetiapine affects several different neurotransmitters it can help to reduce several anxiety symptoms including paranoia, low mood, sleep and physical symptoms (including sweating and palpitations).
Despite these benefits, it is often not prescribed as first line treatment for anxiety due to the potential side effects a patient may experience.
Non-tablet treatment of anxiety and panic attacks
Each patient is different and medications are not always necessary or helpful for those with anxiety. Often anxiety and panic attacks are treated with talking therapies alone, this may or may not be combined with medications.
Things like exercise, massage, breathing techniques and yoga can also help.
Summary
We have described what are best medications for anxiety and panic attacks. We hope it has been helpful.
