Benzodiazepines medication for GAD
Benzodiazepines are most commonly used in the treatment of GAD. Benzodiazepines do not decrease worrying per se, but act to lower anxiety by decreasing vigilance and by eliminating somatic symptoms such as muscle tension. Tolerance to the sedation, impaired concentration and amnesia effects of these drugs develop within several weeks, although tolerance to the anxiolytic effects occurs much more slowly - if at all.
Benzodiazepines Commonly Prescribed for Anxiety Disorders are as follows:
- Alprazolam (Xanax)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Clorazepate (Tranxene)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam (Serax)
All benzodiazepine therapy can lead to dependence - that is, withdrawal symptoms occur once the medications are discontinued.
Withdrawal symptoms include anxiety, irritability and insomnia, and it can be difficult to differentiate between withdrawal symptoms and the recurrence of anxiety. Seizures occur rarely during withdrawal.
Withdrawal symptoms tend to be more severe with higher dosages, with agents that have short half-lives, with rapidly tapered dosages, and in patients with current tobacco use or with a history of illegal drug use.
The risk of dependence increases as the dosage and the duration of treatment increases, but it can occur even when appropriate dosages are used continuously for three months.
When a benzodiazepine is prescribed, the patient should be warned about driving and operating heavy machinery while taking this medication.
The patients most likely to abuse benzodiazepines are those who have a previous history of alcohol or drug abuse, and those with a personality disorder.
Other medication for GAD
Buspirone (BuSpar) is the drug often used in patients with chronic anxiety and those who relapse after a course of benzodiazepine therapy. It is also the initial treatment for anxious patients with a previous history of substance abuse. Buspirone appears to be as effective as the benzodiazepines in the treatment of patients with GAD, and its use does not result in physical dependence or tolerance.
Imipramine (Tofranil) has been shown to be effective in controlling the worrying that is associated with GAD, but whether it is as effective as benzodiazepines or buspirone in those patients who have anxiety without depressive symptoms has not been determined.
Trazodone (Desyrel) is a serotonergic agent, but because of its side effects (sedation and, in men, priapism), it is not an ideal first-line agent.
Nefazodone (Serzone) has a similar pharmacologic profile to trazodone, but it is better tolerated and is a good alternative.
Venlafaxine SR (Effexor) is the first medication to be labeled by the U.S. Food and Drug Administration as an anxiolytic and as an antidepressant; thus, it can be used for the treatment of patients with major depression or GAD, or when they occur comorbidly.
Paroxetine (Paxil), an SSRI, has also been studied as a treatment for patients with GAD, but the trial was small, as has been the case with most of the antidepressants under investigation.
Antihistamines are not potent anxiolytics. Although some antipsychotic drugs have sedating properties, they should rarely be used as therapy for patients with GAD.
I was on Valium for almost 8 years then stopped taking it. I lasted 3 weeks and then had to go back to my psychiatrist as I had severe withdrawal symptoms plus severe rebound anxiety. I am now back on a benzo tablet called Clonazepam. I would not advise anyone to stop benzos "Cold Turkey" the results can be very scary. Even though I was on an anti-depressant all the time it did not make up for the missed benzos I needed to function. It taught me a lesson. - hopeforme