Anxiety Treatments - Doctor Review

By Dr. Jeff Chamberlain, MD

As you will have learned in my blogs “Emotional Stress and Physical Health” and “What is Social Anxiety?” Social anxiety, panic attacks and anxiety in general put an enormous strain on you emotional, mental and physical health. Additionally, because many come to rely on alcohol or drugs to feel comfortable in social situation, having an anxiety disorder greatly increases the risk of substance dependence. If you believe you or someone you know is suffering from anxiety disorder, it’s extremely important that treatment is received.

No one should have to face the problem alone or just accept that anxiety is just something they will always need to deal with.

Here are some treatment options for anxiety:

SEEK COUNSELING. If you think you, or someone you know may be dealing with anxiety, my first advice would be counseling. While there are prescription drugs and natural supplements that may help “take the edge off”, what is really needed is for the root cause/s of the anxiety problem to be addressed and for coping mechanisms to be learned.
PRACTICE MEDITATION. Meditation is a great, natural way to relieve anxiety – both during an anxiety crisis and as a long-term approach to reducing anxiety levels over time. For more information please read my blog “Meditation for Anxiety”
AVOID ANXIETY-INDUCING SUBSTANCES. Certain substances have been known to increase anxiety levels:
- Caffeine
- Cigarettes
- Weight loss pills
- Long-term marijuana and other recreational drug use.

In regards to all of these, my advice would be to stop using them. There are also certain prescription drugs that may make anxiety symptoms worse for some people:

Albuterol - Commonly used for Asthma and COPD.
Pseudophedrine - Commonly found in cold and allergy medicines.
Methylphenidate - Commonly used for ADD/ADHD, Autism, Narcolepsy and Dementia.
Any Stimulant Drug or ADD/ADHD medication

As always, different people respond to different medications differently. If you are currently being prescribed any of these medications, please consult your doctor before discontinuing their use.

Prescription Medication for Anxiety

BETA BLOCKERS
- How it Works: Works against the sympathetic or “fight or flight” response which causes the body to rev things up (a response that is being signaled inappropriately in the case of social anxiety or panic attacks).
- Pros: Blunts the “fight of flight” response that is being triggered inappropriately. Beta-blockers were originally prescribed as blood pressure medication and have been shown to protect the heart.
- Cons: Fatigue is a common side effect of beta blockers, so they may not be ideal for athletes that rely on the sympathetic drive for peak performance.

SSRI & SNRI
- How it Works: Addresses the imbalanced levels of norepinephrine and serotonin that occur with anxiety or panic attacks.
- Pros: Increases the levels of norepinephrine and serotonin that naturally occur in the body. Shown to help people with depression, anxiety, obsessive compulsive disorder and panic attacks.
- Cons: Different people might experience different side effects, the most common side effect is nausea. People taking SSRI and SNRI medications for extended periods of time must be slowly weaned off the medication to avoid side effects from stopping the medication. In some people, SSRIs can make anxiety worse.

BENZODIAZEPINE
- How it Works: Enhances the effect of the neurotransmitter gamma-aminobutyric (GABA) creating a sedative effect.
- Pros: Works quickly on panic attacks. Make people feel good.
- Cons: Works similarly to alcohol, so it depresses everything – mental and physical functioning included. High potential for abuse and dependency – Xanax in particular is one the most addictive prescription medications available. If you are going to go the benzodiazepine route, I would recommend avoiding Xanax if at all possible.

Natural Medicine for Anxiety

ST. JOHN’S WORT
- How it Works: Works similarly to SSRI medications.
- Pros: A natural SSRI. A good option if a person is not on any other medications.
- Cons: Like SSRIs, St. John’s Wort can increase anxiety in rare cases. It often interferes with other medications. Might decrease the effectiveness of birth control pills.
SAMe
- How it Works: Effects levels of dopamine, norepinephrine and serotonin, so again, it works similarly to SSRI or SNRI medications.
- Pros: MRI studies show it works similarly to an anti-depressant on the brain.
- Cons: No good studies on SAMe for anxiety, although based on its mechanism of action there is a chance it could be helpful for cases of anxiety.
5-HTP & L-TRYPTOPHAN
- How it Works: Metabolized into serotonin. (Increases serotonin levels in the brain.)
- Pros: Both have studies that show they may be helpful for depression, new studies on 5-HTP and L-Tryptophan for anxiety look promising.
- Cons: Linked with eosinophilia–myalgia syndrome cases a long while ago. No great safety studies have been done on these since. Because of the safety concern, I would not recommend either.
KAVA
- How it Works: Works similarly to the benzodiazepine. Has a sedative effect.
- Pros: Commonly served in tea. People report it has a calming effect. Studies show it may work as well as a low dose of benzodiazepine.
- Cons: Can stay in the body for up to 8 weeks. Slow-acting – you wouldn’t get the same fast-acting effect of the benzodiazepine. Rare cases of liver problems have been associated with the use of Kava. Those who metabolize kava slowly, are at a higher risk for this side effect. If you chose to use Kava, you should first consult your doctor. You should also be receiving regular liver labs to ensure if a problem occurs, it is caught quickly. For these safety concerns, Kava has been banned in Canada and a few other countries.
PASSION FLOWER
- How it Works: Binds the same receptor as benzodiazepine.
- Pros: Like Kava, passion flower is usually taken as a tea. People usually take it at bedtime.
- Cons: There are not very many clinical safety studies on it.
VALERIAN
- How it Works: Works similarly to the benzodiazepine.
- Pros: Like kava and passionflower, valerian is commonly taken in tea. Has been shown to decrease generalized anxiety disorder and social anxiety disorder.
- Cons: There are not very many clinical safety studies on it.
SKULLCAP
- How it Works: Similar to benzodiazepine.
- Pros: People say it helps relieves tension and stress. Studies show it helps people feel more relaxed.
- Cons: There aren’t great studies on its effectiveness for anxiety disorders themselves.
THIANINE
- How it Works: Thought to increase levels of serotonin and GABA.
- Pros: The major amino acid found in green tea. Studies show it helps people feel more tranquil.
- Cons: No good studies on its use for anxiety disorders.
MARIJUANA
- How it Works: Mimics or interferes with the normal function of neurotransmitters particularly in the hippocampus (short-term memory), cerebellum (coordination) and basal ganglia (unconscious muscle movements). Produces neurotransmitter, anandamide, which regulates feeding behavior and the neural generation of pleasure. Studies show it can affect norepinephrine and dopamine levels and may alter serotonin and GABA levels.
- Pros: Has a short-term relaxing effect.
- Cons: Wears off relatively quickly. Long-term, frequent use or high-doses have been shown to increase anxiety levels and depression. Smoking anything, including marijuana can cause lung cancer, and also may increase the chances of having a heart attack or stroke. So it should never be smoked. Prescriptions may not be available where you live. Although medical use is legal in some states, the federal government still views it as an illegal drug.