How to choose the best medication for anxiety alongside depression

 Anxiety and depression are two common mental health diagnoses. For some, they occur as comorbidities, meaning they occur at the same time. Many medications treat both conditions, though dosages may differ.

It is normalTrusted Source to experience anxiety every once in a while. Symptoms can include mental distress as well as physical sensations of discomfort. Anxiety disorders develop when anxiety does not lessen as expected, and symptoms may interfere with a person’s daily life. There are multiple types of anxiety disorders.

Depression occurs when an individual experiences symptoms of low mood and changes in motivation, sleeping, eating, working, and habits for at least 2 weeksTrusted Source. The individual may feel sad, hopeless, despairing, and possibly irritable, among other symptoms. There are several types of depression.

This article will explore how often anxiety and depression occur together, which medications treat both conditions, management tips, and more.

Prevalence of depression and anxiety

A 2015 study published in the World Journal of Psychiatry states that generalized anxiety disorder (GAD) is the most commonTrusted Source anxiety disorder. Major depressive disorder (MDD) is the most common depressive disorder.

The study suggests that among people with these conditions, 62% of those with GAD may also experience MDD in their lifetime, and 59% of people with GAD had experienced an episode of MDD within the prior year.

There are two schools of thought about why these conditions often appear together. One theory is that similar biological functions activate anxiety and depression. This may mean that if the chemistry in the brain is in a condition that allows one condition to develop, it may also allow for the other.

Another theory is that anxiety and depression share many of the same symptoms, so it is easy for a person to meet the diagnostic criteria for both conditions.

Medications for anxiety and depression

Several types of medication treat both anxiety and depression. These include:

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are the drug that doctors most commonlyTrusted Source prescribe to treat depression and anxiety disorders. They work by increasing the amount of serotonin, a neurotransmitter or chemical messenger, that circulates in the brain.

SSRIs that doctors prescribe in the US include:

• fluoxetine (Prozac)
• sertraline (Zoloft)
• paroxetine (Paxil)
• fluvoxamine (Luvox)
• citalopram (Celexa)
• escitalopram (Lexapro)

Depending on the type of medication, most SSRIs are available in tablet or capsule form. Some may also be available as a liquid.

SSRIs can have a variety of side effects, including:

• feeling agitated or nervous
• gastrointestinal issues
• loss of appetite
• weight changes
• dizziness
• blurred vision
• dry mouth
• sweating
• trouble sleeping
• headaches
• sexual dysfunction

More serious side effects may include:

• bleeding or bruising easily
• vomiting blood, which may look like coffee grounds
• blood in the stool
• confusion
• movement problems
• hallucinations
• problems urinating

If any of these serious side effects occur, a person should notify a doctor immediately.

Serotonin-norepinephrine reuptake inhibitors

Examples of serotonin-norepinephrine reuptake inhibitors (SNRIs) include venlafaxine (Effexor XR) and duloxetine (Cymbalta). These drugs are similar to SSRIs, but SNRIs prevent both serotonin and norepinephrine from being reabsorbed by nerve cells. They typically come in tablet form.

Side effects of SNRIs may include:

• gastrointestinal issues
• insomnia
• headache
• sexual dysfunction
• weight gain
• a minor blood pressure increase.

Medications people can safely combine

Sometimes, combining one or more medications to treat anxiety and depression is best. A doctor may prescribe the following medications in addition to an SSRI or SNRI or use them on their own.

Benzodiazepines

SSRIs and SNRIs typically take 2–4 weeksTrusted Source to reach full effect. For this reason, a doctor may prescribe a fast-acting benzodiazepine medication for individuals with severe anxiety or panic attacks.

Benzodiazepine medications are habit-forming medications, and people should carefully follow their doctor’s advice in taking them. A doctor will generally prescribe them at the lowest possible dosage and only as necessary.

Benzodiazepines work by slowing the transmission of nerve impulses between the brain and the body.

Examples include:

• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)

Benzodiazepines can have serious side effects, which may include:

• depression
• confusion
• euphoria
• impaired thinking
• memory loss
• headache
• sleepiness
• slurred speech
• blurred vision
• impaired coordination
• nausea
• gastrointestinal issues

Regular use of these medications can lead to dependence and side effects such as:

• increased anxiety
• personality changes
• weakness and lethargy
• drowsiness, sleepiness, and fatigue
• nightmares
• headaches
• rash
• weight gain
• addiction

Buspirone

Buspirone is an anti-anxiety medication doctors use to treat GAD, commonly at a dosage of 15–60Trusted Source milligrams. It comes in tablet form, and people usually take it twice daily.

This medication is an anxiolytic and acts on the levels of serotonin and other neurotransmitters in the brain. Anxiolytic is another name for a substance that reduces anxiety levels.

Side effects of buspirone might include:

• dizziness
• gastrointestinal issues
• nervousness
• confusion
• fatigue
• trouble sleeping
• anger or hostility
• headache
• weakness
• numbness
• sweating

More serious side effects may also occur, such as:

• rash
• hives
• itching
• swelling of the face, eyes, mouth, throat, tongue, or lips
• irregular heartbeat
• blurry vision
• uncontrollable shaking
• agitation
• fever
• sweating and flushing
• confusion
• shivering
• seizures
• hallucinations
• loss of coordination

A person should call a doctor immediately if they experience any of these effects.

Tricyclic antidepressants

An older class of antidepressants, tricyclic antidepressants, are still available for use when SSRIs and SNRIs have failed to work. They are effective in treating anxiety disorders but can have significant side effects.

Examples of tricyclic antidepressants include:

• amitriptyline (Elavil)
• amoxapine (Asendin)
• trimipramine (Surmontil)
• imipramine (Tofranil)
• doxepin (Sinequan)
• nortriptyline (Pamelor)

Side effectsTrusted Source of tricyclic antidepressants include:

• dry mouth
• constipation
• blurred vision
• drowsiness
• low blood pressure
• urinary problems
• confusion
• fainting
• seizures
• irregular heartbeat.

Diagnostic criteria for anxiety

For a diagnosis of GAD, there are a few thingsTrusted Source the doctor will look for.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), the individual should find it difficult to control their worry, and the anxiety should associate with at least three of the following symptoms on more days than not for the previous 6 months:

• restlessness or feeling “keyed up”
• fatigue
• difficulty concentrating
• irritability
• muscle tension
• trouble sleeping

The diagnostic criteria state that the person’s symptoms should cause clinically significant distress or impair important functioning, and substance misuse or another medical or mental health condition should not explain them better.

Diagnostic criteria for depression

To diagnose depressionTrusted Source, a doctor will look for the following:

• depressed mood
• diminished interest or pleasure in most or all activities
• significant weight loss or weight gain
• increased or decreased appetite
• insomnia or hypersomnia, which is when a person sleeps too much
• psychomotor impairment
• fatigue or loss of energy
• feelings of worthlessness or excessive guilt
• a diminished ability to think or concentrate
• indecisiveness
• recurrent thoughts of death or suicidal ideation, with or without planning or an attempt

Current diagnostic criteria state that a person’s symptoms must cause clinically significant distress in a way that interferes with daily functioning. For a doctor to diagnose a major depressive episode, five or more symptoms should be present most of the day for at least 2 weeks in a row.

Symptoms must not be due to substance misuse or a medical condition. They should also not be attributable to a condition on the schizophrenia spectrum, another psychotic disorder, or bereavement.

Other tips and treatments

There are ways a person can try to manage anxiety and depression at home, such as by:

• limiting alcohol and caffeine
• getting enough sleep
• exercising daily
• meditating
• seeking out humor
• eating balanced meals
• planning time out to do yoga, get a massage, or practice deep breathing techniques to clear the mind
• volunteering
• learning about anxiety and depression
• talking with a trusted person about thoughts and feelings

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Summary

Dealing with anxiety and depression can be daunting, but several medications and combinations of medications provide effective treatment.

For most people, newer SSRIs and SNRIs have fewer side effects while providing clinical results. For some, these medications may not provide relief, and older tricyclic antidepressants may be a better option.

Early in treatment, a doctor may also recommend a benzodiazepine if anxiety is a particular challenge. However, these medications are habit-forming and should not be a long-term choice. Instead, they create a bridge while SSRIs and SNRIs take effect.

Source - Medical News Today