Some degree of anxiety is natural. In fact, it can even be beneficial in certain contexts, like pre-interview butterflies. Other times, however, anxiety can become so debilitating that it interferes with daily life. Frequent and intense feelings of nervousness may be indicative of an underlying mental health disorder.

Anxiety disorders are the most common type of mental health disorder in the U.S., affecting more than 40 million adults, or about 19%. It is also estimated that 7% of children and adolescents between the ages of 3-17 struggle with symptoms of anxiety.

Over the past few years, as Covid-19 brings much upheaval and change, the number of Americans suffering from anxiety disorders and depression continues to increase. As a result, the U.S. Preventive Services Task Force is now recommending that all adults under the age of 65 be screened for anxiety. 

For many of those with an anxiety disorder, treatment — in the form of medication, psychotherapy, or both — is necessary to manage symptoms and maintain an active and fulfilling life. Below, we explain more about some of the most common treatment options.

Causes and risk factors

Many factors can contribute to anxiety, including genetics, environment, behaviors, and situations. Common causes and risk factors include:

• Trauma

• Stress related to a health condition

• Having another mental health disorder such as depression

• Cumulative stress

• Substance use

• Genetics - having a relative with an anxiety disorder is considered a risk factor

• Certain personality traits such as shyness

Symptoms

Individual experiences of anxiety can vary, so your anxiety symptoms may be different from those of a friend or family member with the condition. Anxiety can cause physical sensations like butterflies in your stomach or a racing heart. It can also bring an overall feeling of fear or unwanted thoughts.

Physical symptoms

• Digestive issues, stomach pain, or nausea

• Headaches

• Difficulty sleeping

• A feeling of weakness or fatigue

• Rapid breathing or shortness of breath

• A racing heart or increased heart rate

• Sweating, trembling, or shaking

• Unexplained muscle aches and pain

Mental symptoms

• Uncontrollable, obsessive thoughts

• Difficulty concentrating

• Irritability

• Nightmares

• Thoughts or flashbacks of a traumatic experience

Treatment

Anxiety disorders are highly treatable with medication and therapy. (A combination of both is necessary for many people with an anxiety disorder.) While it can be difficult to share your feelings with a healthcare provider, it’s an important first step in managing symptoms.

These are some indications that you may benefit from treatment for anxiety:

• Anxiety, fear, or worry has interfered with work and relationships

• You find it difficult to control your anxiety, fear, or worry

• You are concerned about your use of alcohol or other substances

Medication

There are many options for medication to treat anxiety. Some are used on a short-term basis or as needed while others are taken daily in the long term. Your provider will make recommendations based on your specific symptoms.

Though it can be frustrating, finding the right medication for your anxiety symptoms can take some trial and error.

There are several types of medications commonly used to treat anxiety disorders.

Benzodiazepines

Benzodiazepines are sedatives that induce a feeling of calm. They amplify the effects of certain chemicals that act as a messenger between brain cells.

Benzodiazepines commonly prescribed for anxiety include:

• Alprazolam (Xanax®)

• Clonazepam (Klonopin®)

• Diazepam (Valium®)

• Lorazepam (Ativan®)

These medications are typically used for short-term treatment of acute symptoms and may be prescribed on an as-needed basis. They often cause side effects like drowsiness and difficulty with balance and memory.

While benzodiazepines are effective, they have the potential for dependence and misuse. As a controlled substance under the U.S. Drug Enforcement Administration’s guidelines, there are tight regulations for prescribing and dispensing benzodiazepines.

Benzodiazepines are not safe to abruptly discontinue. If you have been taking a benzodiazepine for longer than two weeks, speak with your doctor about slowly tapering off to avoid withdrawal symptoms and lower the risk of seizure.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) increase a person’s levels of serotonin, a chemical in the brain that affects mood. Increased serotonin levels can alleviate symptoms of anxiety. These medications are considered a frontline treatment option for anxiety disorders and are also used to treat depression.

SSRIs commonly prescribed for anxiety include:

• Escitalopram (Lexapro®)

• Fluoxetine (Prozac®)

• Paroxetine (Paxil®)

• Sertraline (Zoloft®)

While SSRIs are very effective for many people with anxiety, it typically takes several weeks to experience their benefits. Even if you don't feel like the medication is working, continue to take it as prescribed so that you can achieve a therapeutic level. If you still have concerns several weeks into treatment, speak with your doctor.

Always consult your doctor before stopping an SSRI. It is not recommended to frequently start and stop SSRIs, and they should not be taken on an as-needed basis.

SSRIs have been linked to the following side effects, though they are mild in the majority of cases. Speak with your doctor about any concerns.

• Nausea

• Dry mouth

• Diarrhea

• Dizziness

• Drowsiness

• Sexual dysfunction

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase levels of serotonin — just like SSRIs — but they also increase norepinephrine, which boosts energy and focus. These medications may increase your energy levels in addition to alleviating symptoms of anxiety.

SNRIs commonly prescribed for anxiety include:

• Venlafaxine extended-release (Effexor® XR)

• Duloxetine (Cymbalta®)

Other medications

There are additional medications used to treat anxiety that do not belong to the medication classes above.

• The antihistamine hydroxyzine (Atarax®, Vistaril®) blocks histamine and boosts the effects of serotonin. As the only antihistamine that offers this effect, it is the only antihistamine used to treat anxiety. This is typically an option for those who experience side effects with SSRIs or SNRIs, or who have concerns about the addictive potential of benzodiazepines.

• Buspirone (Buspar®) is another alternative to SSRIs and SNRIs. While it isn’t entirely understood how buspirone works, the medication likely activates certain areas of the brain to make serotonin more active.

Each person metabolizes medications differently. Open communication with your provider can help identify the medication that works best for you. Your doctor should know:

• Any other medications you are prescribed and their dosages

• Your experience of anxiety symptoms after taking the prescribed medication — do you feel like it’s working?

• Any side effects you experience

Therapy

Medication for anxiety disorders is often combined with psychotherapy, which helps you understand and manage your emotional and behavioral responses to sources of anxiety.

Cognitive behavioral therapy (CBT) is considered one of the most effective types of therapy for anxiety disorders. It helps you recognize the underlying thoughts and behaviors that fuel uncomfortable or debilitating emotions. Shifting your thoughts and behaviors then alleviates symptoms of anxiety.

Finding the right therapist can take time. If you have insurance coverage of therapy sessions, check your insurance company’s provider network as a starting point. You can also look through reputable online databases like Psychology Today or the American Psychological Association (APA)’s psychologist locator. Some therapists offer sliding scale fees to make sessions more affordable.

A flexible and reliable pharmacy partner

Maintaining good mental health is easier with a reliable pharmacy on your side. Our pharmacists can answer any questions you may have about your medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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