Often, new patients are relieved when they receive a diagnosis of generalized anxiety disorder (GAD), panic disorder, or another anxiety disorder. They knew something was wrong, and now they have a name and way to tackle the symptoms that are disrupting their life. Once I explain the initial treatment plan to my patients, I get this question about as often as the sun sets in beautiful El Paso, Albuquerque, or Las Cruces: “Wait, I’m anxious, not depressed. Why are you prescribing me an antidepressant?”

Once a patient has been diagnosed with an anxiety disorder, they are often expecting to be treated with a benzodiazepine (benzo for short) that they’ve heard of before, like Xanax or Klonopin. It’s my job to educate patients that the standard treatment for many anxiety disorders is an antidepressant, like Paxil, plus a supplemental medication such as hydroxyzine, propranolol, Xanax, or Klonopin.

The antidepressant will help decrease the frequency and the severity of the patient’s anxiety symptoms.

The as-needed benzo or other anxiolytic (anti-anxiety) medications will be used in situations in which breakthrough anxiety symptoms are interfering with the patient’s functioning.

Diagnosis of Anxiety

Patients may suspect that they have an anxiety disorder if they find that excessive worry and nervousness are interfering with their work, school, or family life. Sometimes, patients don’t realize that the symptoms they are experiencing could be anxiety. Instead, they might assume that they’re just an angry person, or they attribute their headaches or other body pains to a physical cause. Because of the different ways an anxiety disorder can present itself, it’s most useful to be evaluated by a behavioral health professional with expertise in anxiety disorders.

When a behavioral health expert is screening a patient for generalized anxiety disorder, for example, they will ask the patient about any symptoms they may have noticed, such as:

• Tiredness
• Sleep trouble
• Excessive worry
• Being restless or edgy
• Imagining scenarios in which things will go wrong, even if these thoughts are not realistic
• Aches and pain
• Stomach issues/nausea

The provider will discuss your current symptoms and how they might be impacting your ability to function in daily life. The behavioral health expert will likely also ask about your medical history and your family mental health history. If your provider determines that you have an anxiety disorder, you will then discuss treatment options with your provider.

Antidepressants in the Treatment of Anxiety

While antidepressants in the selective serotonin reuptake inhibitor (SSRI) class were initially used to treat depression, they have also been found to be an effective treatment for generalized anxiety disorder, obsessive-compulsive disorder, and many other anxiety disorders. Patients can experience nausea, sleeping problems, and sexual side effects when taking SSRIs such as Paxil or Celexa. However, these side effects may get better as you continue to take the medication. You can also work with your provider to switch to a different antidepressant if you experience bothersome side effects.

Serotonin is a neurotransmitter (brain chemical) that helps brain cells communicate with one another. When serotonin is less available to your brain, the disruption in the communication between cells seems to lead to the mood changes that cause people to feel stressed, anxious, and depressed. SSRIs work for depression and anxiety by helping more serotonin be available to your brain, and possibly also by assisting your neurons (brain cells) to be more flexible. This neuroplasticity impact is still being researched; however, it could help to explain why it takes a few weeks for SSRIs to become fully effective for patients.

What About Breakthrough Anxiety Symptoms?

Your antidepressant medication will be the daily medication that you take to relieve your symptoms of anxiety. As noted before, it takes several weeks for your antidepressant medication to fully work. Once you and your provider feel that you have found the correct medication and dose, your daily antidepressant medication will remain consistent; you will have routine check-ins with your behavioral health provider to make sure the medication is still helping you. When I am talking with my patients with an anxiety disorder, we always review how they feel their SSRIs are working for them.

However, there may be times in your life when your anxiety symptoms increase. You might be experiencing a stressful time, like a death in the family or international travel. You might even just have a bad day due to physical illness, hormone fluctuations, or an unknown factor.

For times when your anxiety symptoms spike, it can be useful to have an emergency/as-needed medication on hand.

Your provider may prescribe a benzo like Xanax or Klonopin, or they may give you a prescription for a different type of anxiolytic, like hydroxyzine or propranolol.

Regardless of the type of breakthrough anxiety medication that’s prescribed to you, it’s important to understand that this is not a medication that is intended for you to take daily.

If you find yourself trying to refill your emergency medication more often than your prescriber has written it for, your daily antidepressant medication dose may need to be adjusted. In that case, your anxiety may not be sufficiently controlled by your maintenance medication. This scenario is one in which having a behavioral health provider who is versed in anxiety disorders is key; your expert provider can help you determine if you need to change your antidepressant dose, switch to another SSRI, or change your treatment plan in another way.

If you live in or near Las Cruces, El Paso, Albuquerque, or one of the other cities we serve, and you’re ready to meet with an experienced anxiety professional, check out Upper Valley Behavioral Health. Click here to fill out our application for treatment today.

Disclaimer: This post is for informational purposes only. It does not replace instructions from your licensed prescriber. Please consult your healthcare provider for guidance on your specific medication regimen.

Tags: anxiety

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