Treatment Considerations For Comorbid Anxiety And Depression
Resolving anxiety quickly should be the first goal of treatment in patients with anxiety and depression.61 Once this objective is accomplished, patients are much more likely to remain compliant with their antidepressant regimen and to continue their therapy for the full duration necessary to achieve complete remission of their depression.
One choice for pharmacotherapy in patients with comorbid anxiety and depression is the combination of a BZD or buspirone with an antidepressant. Alternatively, some patients may respond to antidepressant therapy alone, provided a drug that is effective in treating both disorders is used. Because the traditional anxiolytics will have little if any effect on depression, an adequate course of therapy with an antidepressant is imperative.62 On the other hand, in patients treated with an antidepressant plus an anxiolytic, the clinician may consider tapering the anxiolytic slowly, then discontinuing it when the symptoms of acute anxiety have resolved.61 Because of their well-documented withdrawal effects, the BZDs should be tapered gradually over the course of at least several weeks, depending on the dosage and duration of BZD therapy.
Antipsychotics For Ordinary Depression
“I’m taking an antidepressant, but I’m still not where I want to be with my symptoms.”
If that line sounds familiar, it’s because you might have heard it in recent television commercials for the powerful psychiatric drug aripiprazole . Originally approved to treat the disabling mental illnesses of schizophrenia and bipolar disorder, Abilify is now, with permission from the Food and Drug Administration, being pitched to people with depression who haven’t gotten relief from milder drugs such as SSRIs.
In December 2009, Abilify’s competitor quetiapine succeeded in winning the same approval as an add-on for depression.
The mass marketing of hard-core psychiatric drugs is worrisome, said Julie Donohue, Ph.D., an assistant professor at the University of Pittsburgh Graduate School of Public Health. “People might think from the commercial that everybody’s going to get better, when really it’s a minority of patients who respond to the treatment,” she said.
Another issue is that the studies conducted to secure Abilify’s approval as a depression add-on lasted only six weeks. “That means we don’t know the long-term benefits or harms of the drug for this use, which is a problem because people will take Abilify for monthsand probably years,” said Steven Woloshin, M.D., a professor of medicine at Dartmouth Medical School.
Something else the ads don’t mention is the cost of the drugs: up to 45 times as much as many antidepressants.
Bottom line
Why Antidepressants Are Preferred Over Benzodiazepines For Anxiety
There are many reasons why a doctor may prefer to prescribe an antidepressant as opposed to a benzodiazepine for anxiety. Although benzodiazepines are highly effective and arguably the most potent anxiolytic drugs on the market, they should be reserved for only the most extreme cases of anxiety. Unlike benzodiazepines, antidepressants have a low potential for addiction, arent associated with neurodegeneration, and are safer in regards to both usage and withdrawal.
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Whats The Best Natural Antidepressant Supplement
There is no one best supplement for people with depression. Although some supplements have been shown to benefit certain populations with depression, not everyone will benefit from the same supplements.
Every person with depression has different needs and should work with a healthcare professional to create an individualized care plan, which may or may not involve dietary supplements.
Supporting Someone With Anxiety Or Depression
There are ways that you can help someone with anxiety or depression. It may be helpful to:
- let them know if youve noticed a change in their behaviour
- spend time talking about their experiences and let them know youre there to listen without being judgmental
- help them to get information from a website, library or community health centre
- suggest they go to a doctor or health professional, and help them to make an appointment
- offer to go with them to their appointment and follow up with them afterwards
- encourage them to get enough sleep, to exercise and to eat well
- encourage family and friends to invite them out and keep in touch, but dont pressure them to participate in activities
- contact a doctor or hospital if they become a threat to themselves or others.
It is unhelpful to:
- put pressure on them by telling them to snap out of it or get their act together
- stay away or avoid them
- tell them they just need to stay busy or get out more
- pressure them to party more or wipe out how theyre feeling with drugs and alcohol
- assume the problem will just go away.
If you or someone you know needs support, talk to a doctor or other health professional about getting appropriate treatment.
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I Need Relief And I Need It Now
So where does that leave you if youre suffering? Even when anxiety relief comes with side effects and dangers, that can still sound like a fair trade when panic and fear are ruling your life.
The bottom line is that theres a time and place for anxiety medication. If you have severe anxiety thats interfering with your ability to function, medication may be helpfulespecially as a short-term treatment. However, many people use anti-anxiety medication when therapy, exercise, or other self-help strategies would work just as well or better, minus the drawbacks.
Anxiety medications can ease symptoms, but theyre not right for everyone and theyre not the only answer. Its up to you to evaluate your options and decide whats best for you.
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Antipsychotic And Anticonvulsant Medications
Other medications used for GAD include anticonvulsant medications, such as pregabalin, and antipsychotics that fall into the category of atypical antipsychotics, such as vortioxetine. These treatments may be considered if you do not improve with traditional therapies or if you experience intolerable side effects.
If you or a loved one are struggling with anxiety, contact the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
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Best Ssris For Anxiety Include: Paxil Lexapro Zoloft
Below is a list of various SSRIs that have been used specifically for the purpose of treating anxiety. Although Paxil, Lexapro, Zoloft, and Luvox are the only ones FDA approved for various types of anxiety, others have been found effective as well. Additionally it should be mentioned that the SNRI drug Effexor is also approved to treat anxiety.
SNRI: This class of drugs works by inhibiting the reuptake of both serotonin and norepinephrine in the brain. The serotonin reuptake inhibition can create a sense of anxiety, but the norepinephrine reuptake inhibition can actually increase anxiety. For this reason, SNRIs are not as commonly used to treat anxiety disorders. Of all SNRIs, the drug Effexor is the only one that is approved to treat generalized anxiety disorder.
- Effexor : This is the only SNRI approved to treat generalized anxiety disorder. It is likely effective due to the fact that it acts on serotonin significantly more than other SNRIs. The ratio of serotonin to norepinephrine reuptake inhibition is approximately 30:1. Most other SNRIs have ratios 10:1 or less in favor of serotonin.
Anxiety And Depression: Why Dont We Want To Take Medication
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Depression and anxiety are commonly talked about these days, yet many people still hesitate to address it all, let alone take prescription medication for it. Its not unusual to have concerns about treating your mental health concerns with medication. If youre dealing with anxiety or depression, maybe you face issues and thoughts like these:
Ideas of self-control Sometimes we think maturity should mean emotions are constantly in balance, but emotional maturity actually involves many things, including knowing when to ask for help. If youve got an infection, you may need an antibiotic and if you break a bone you may need a cast. In the same way, biology, genetics or circumstances may trigger a need for extra mental health support.
Fear of being labeled Theres a tendency to view emotional health differently than other health conditions. Maybe you believe your condition lacks legitimacy or worry that people will think less of you if youre treated for anxiety or depression. In truth, the conditions are much more common than many people realize, and the unspoken understanding much more widespread. The National Alliance on Mental Illness reports that one in five adults in the United States experiences a mental illness in a given year.1
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Mental Health Conditions: Depression And Anxiety
Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:1
- Feeling sad or anxious often or all the time
- Not wanting to do activities that used to be fun
- Feeling irritable easily frustrated or restless
- Having trouble falling asleep or staying asleep
- Waking up too early or sleeping too much
- Eating more or less than usual or having no appetite
- Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
- Having trouble concentrating, remembering details, or making decisions
- Feeling tired even after sleeping well
- Feeling guilty, worthless, or helpless
- Thinking about suicide or hurting yourself
The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.
The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental, and psychological factors.2 Everyone is different but the following factors may increase a persons chances of becoming depressed:1
Medication For Anxiety And Depression
There are many medications for anxiety and depression that are available for patients experiencing both disorders. The antidepressants below can treat panic disorder, social anxiety disorder, generalized anxiety disorder, or phobias, in addition to depression. Antidepressants increase the activity of certain neurotransmitters, such as serotonin or norepinephrine, in the brain.
The best treatment depends on which anxiety disorder a patient has. For generalized anxiety disorder , both SSRIs and SNRIs are first in line, says Danielle Plummer, Pharm.D. She adds that the most commonly prescribed medications to treat both depression and anxiety are SSRIs and SNRIs.
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Actions For This Page
- Anxiety and depression in men are common, and effective, evidence-based treatments are available.
- Anxiety and depression are mental health conditions, not weaknesses.
- Taking action may seem difficult but help and support is readily available.
- Its important to seek support for anxiety and depression early the sooner the better.
- With the right treatment, most people recover from anxiety and depression.
On And Off Label Uses
The off-label use of an approved drug is used to treat a condition that it is not intended for. Physicians who prescribe a medication that the FDA has approved for a given condition are considered to be using it on-label.
Some doctors are more likely to prescribe off-label medications than others. Your doctor will try to find one with the fewest side effects. Remember that Off-label does not mean that medication will not be helpful.
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F Anxiety Or Panic With Depression
For those suffering from a combination of depression and anxiety or panic, certain antidepressant medications can help reduce the depressive symptoms while simultaneously helping to control the panic attacks. The physician can prescribe one of the tricyclic antidepressants with sedating effects, such as imipramine or one of the MAOIs. It is also possible to combine the use of a tricyclic antidepressant with buspirone or the benzodiazepine alprazolam.
Other Herbs And Natural Medicines For Anxiety
Many other natural medications have been prescribed for anxiety, but their success rates vary and are not entirely clear. St. John’s Wort, for example, is an herb meant for depression but believed to have an effect on anxiety. Nevertheless, the research hasn’t backed up this claim. The three above have been successfully used for anxiety for years with minimal side effects, and research has often supported their success as a natural treatment for anxiety.
Still, you need to remember that you should never depend on medication alone, otherwise your mind will lose out on its ability to cope further. That’s why you need to make sure you’re complimenting your natural medicine with some type of medication free anxiety reduction strategy. And always consult your doctor before considering any of these options.
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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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Comorbid Anxiety And Depression
Although the interrelationship between anxiety states and depression has long been recognized in psychiatry, extensive exploration of the clinical significance of this relationship has begun only recently. Data are accumulating to suggest that these 2 conditions occur together even more frequently than they do as distinct clinical entities.58 Some investigators have concluded that these disorders may reflect a continuum of the clinical expression of a single disease. Because patients with chronic anxiety often develop depressive disorders over time, it also has been hypothesized that anxiety disorders actually may be, in some cases, a prodrome for depression.59 Contrasting data suggest that GAD, in particular, is an anxiety disorder that should be considered an independent entity, rather than as a prodrome, residual, or severity marker of depression.60 Nevertheless, the coexistence of anxiety and depression in the same patient negatively affects his or her clinical outcome substantially. Such patients typically have more severe manifestations of these illnesses and respond less robustly to treatment than do patients with either disorder alone.61 Fortunately, with the wide array of new antidepressants available today that can provide robust efficacy, these patients now have access to new agents that can treat both mood and anxiety disorders effectively.
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Other Antidepressants Used For Anxiety
Although the SSRI class is considered a first-line treatment option for anxiety disorders, other classes of drugs such as atypicals, tricyclics, and MAOIs can act as anxiolytics. Below are several drugs from other classes that are thought to be effective for various types of anxiety.
Atypical antidepressants: There are a couple atypical antidepressants that have anxiolytic properties. In the United States, the two most commonly used atypical antidepressants to treat anxiety include Trazodone and Remeron.
- Trazodone: It is approved to treat anxiety disorder, depression, and insomnia. Functions as a serotonin antagonist and reuptake inhibitor. It is noted as having significant anxiolytic and sleep-inducing effects.
- Remeron: Although only approved to treat depression, it is commonly prescribed off-label for generalized anxiety disorder, social anxiety disorder, OCD, panic attacks, and PTSD.
Tricyclic Antidepressants : This is an older class of medications that tends to affect various neurotransmitters. These compounds are noted for their tricyclic structure, containing three atomic rings. There are only a couple TCAs that are effective for anxiety.
- Clomipramine: An older TCA that is utilized to treat OCD, panic disorder, and agoraphobia.
- Doxepin: This is a TCA that is commonly used to treat anxiety disorders and insomnia.
MAOI : These work by increasing levels of neurotransmitters in the brain. There are several MAOIs that are effective for managing anxiety.
Which Benzodiazepines Are Used For Anxiety
They can also be used with antidepressants initially while antidepressants take time to work.
“They’re a powerful tool,” says Duckworth, “but you have to be really smart about their use.”
- Light-headedness
- Trouble sleeping
Beta-blockers can be very helpful but in a limited way, says Dr. Salcedo. They are most commonly used for performance anxiety. They are really good for the physical symptoms such as heart racing, sweating, shakiness, but they work less well for the anxious thoughts that might be causing the symptoms.
Additional reporting by Carlene Bauer.
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