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Doctors frequently hear complaints about anxiety.
Most sufferers of anxiety come in seeking fast relief of their symptoms without regard for what has caused it.
What can a doctor do for a patient with such a request within just a 10- to 15-minute appointment time slot? Prescribe a drug, of course! Like any medication, these are best used to reduce symptoms while you address the underlying causes.
I’ll explain the main prescription drug options along with their pros and cons.
- Benzodiazepines (Xanax, Klonopin, Valium): These are the classic sedating anxiolytic drugs that will surely make you feel good, relaxed, happy and care-free. However, these are quite common drugs of abuse because they are very effective and addictive. They easily cause drowsiness similar to drunkenness. And if combined with alcohol, they are potentially lethal. (You may stop breathing.) Withdrawal symptoms are terrible: Severe anxiety (the opposite of its treatment effect) can always be expected when discontinuing them abruptly after one month or longer of consistent use, even to the point of seizures.
- SSRI antidepressants (Lexapro, Paxil, Zoloft, etc.): These are usually a first choice by physicians because they are not sedating, but getting past the first few weeks of side effects is the challenge for many patients. They often require four weeks’ of treatment until you see the desired effect. Side effects are less common after the first two weeks. When side effects occur, they commonly include insomnia, feeling “zoned out” emotionally (but less anxious), reduced sexual function and even weight gain. Almost all patients feel increased anxiety, confusion or dizziness if they go off the medication suddenly. (A two-week taper is best.) Children and adolescents using these reportedly have had increased risk of suicidal ideation and suicide attempts, although the scientific literature indicates otherwise in recent studies  .
- Other antidepressants (Anafranil, Desyrel, Wellbutrin): Similar in efficacy to the SSRIs, these other antidepressants each have their typical side effects. Anafranil (like the other tricyclic antidepressants, or TCAs) can be sedating and may also cause dry mouth, blurred vision, urinary retention or constipation. Desyrel is known for causing sedation. (I used to prescribe it as a first-line treatment for insomnia). A rare side effect is cause priapism (sustained painful erection). Wellbutrin does not cause sexual function decline, but commonly causes insomnia and dry mouth.
- Buspirone (aka BuSpar): This is a mildly effective non-sedating anxiolytic that works by enhancing brain serotonin levels. (It is a natural, feel-good neurochemical.) Common side effects include nervousness (the opposite effect than intended!), dizziness, nausea, headache or insomnia.
- Beta-blocker antihypertensives (Inderal, Tenormin): These block the effects of adrenaline that causes the fight-or-flight response to stress, especially performance-anxiety effects like racing heart, muscle tension and trembling. Side-effects are often fatigue and sedation and sometimes depression.
- Alpha-blocker antihypertensives (Minipress, Catapress): These are used to treat post-traumatic stress disorder (PTSD), especially to reduce nightmares. Beware of dizziness due to low blood pressure at first. Other side effects include dry mouth, headache, nausea, sedation, constipation or weight gain.
- The antihistamine hydroxyzine (Atarax, Vistaril): This is very sedating, so it calms anxiety quite quickly. However, the sedation and the typical dry mouth effect make it less valuable for treating chronic anxiety.
- The anticonvulsant gabapentin (aka Neurontin): This works fairly quickly for anxiety, but is mainly used to treat nerve pain. It is a GABA analogue and, therefore, stimulates GABA receptors somewhat like benzodiazepines (see natural GABA supplementation discussed below), so it can be sedating. The other anticonvulsants such as Topamax, Lamictal and Depakote have too many serious side effects for my comfort level.
- Antipsychotics (Risperdal, Zyprexa): I would use these only as a last resort because of the small possibility of causing horrible side effects such as irreversible tardive dyskinesia (involuntary movements) or neuroleptic malignant syndrome.
All of these drugs will potentially (and do) interact with other prescription medications. That’s because these are all unnatural to your body and they go through your liver’s detoxification system, creating more unnatural metabolites.
Who really knows how much unnatural metabolites stay in your body tissues (mostly fat) and how much you eliminate? Patients are known to release unnatural chemicals during deep-cleanse sauna treatments, indicating that most all of us are still holding unnatural chemicals in the body known as xenobiotics, which are likely major causes for chronic inflammation that goes largely unrecognized.
Nutrient And Herbal Supplements
Now that you know the pros and cons of prescription medications used for anxiety, you should know the safe and effective nutrient and herbal options that are available. Remember that nutrients and herbal supplements have natural metabolites in your body that pose little if any long-term health risk. They can decrease or increase prescription medication effects.
- GABA (gamma-aminobutyric acid): The main neurotransmitter in the brain that blocks nerve excitability and, therefore, has anti-anxiety and nerve-calming effects. At 750 mg twice daily, it helps lower anxiety and can also help block nerve pain. There are many natural and prescription medications that have “GABA-like effects.”
- L-theanine An amino acid derived from green tea (Camellia sinensis) known to reduce the emotional and physical response to stress . The usual dose is 200 mg once or twice daily.
- Ashwagandha (Withania somnifera): An antioxidant herb that can help reduce anxiety, panic attacks, phobia and depression. In one study, ashwagandha for five days had anxiety-relieving effects similar to the benzodiazepine medication lorazepam and antidepressant effects similar to the TCA antidepressant medication imipramine .
- Kava kava (Piper methysticum), valerian root (Valeriana officinalis), and passionflower (Passiflora incarnate): Herbs that are relaxing and sedating. They have GABA-like effects. They are used to treat both insomnia and anxiety.
- Lemon balm (Melissa officinalis): At 600 mg daily, lemon balm has been shown to improve mood and calmness in one 2004 study.  In another study, it lowered anxiety when combined with valerian root. 
- Brahmi (Bacopa monnieri): An herb that supports your ability to handle stress. A study using 300 mg daily for 12 weeks in elderly patients without dementia reduced anxiety and improved cognition. 
- Tryptophan: An essential amino acid precursor to 5-HTP (5-hydroxy-tryptophan) which, in turn, is a precursor to serotonin, the known neurotransmitter that calms mood in the brain. Niacin helps this conversion process.
- Magnesium: Deficiency of this mineral within the standard American diet (SAD) is a growing concern. Magnesium deficiency is a known cause of anxiety. Magnesium 500 mg daily is a safe starting dose. At higher dosages it will induce diarrhea.
- Vitamins B1, B3, B5, B6 and B12: These support the process of serotonin production in the brain. Low vitamin B is linked to anxiety, restlessness and emotional instability. Therefore, vitamin B complex supplementation is recommended, especially if you do not eat animal meat.
- Essential oils: A calming, safe and effective option.  Choose from these: lavender, sweet marjoram, chamomile, sandalwood, ylang ylang, neroli, bergamot, frankincense and vanilla bean extract.
- Teas: You can calm anxiety with brews made from chamomile, peppermint, lemon balm, kava kava, passionflower or valerian root.
- SAMe or St. John’s wort: If your anxiety is related to depressed mood, consider these. Use 750 mg twice daily of SAMe (an amino acid) or St. John’s wort (herb).
- Adrenal extract (natural cortisol) and the supportive herbs L-theanine and lemon balm: These support adrenal health. Eventually, worry and anxiety will lead to adrenal fatigue.
In summary: Fear, worry and stress responses are causes of anxiety disorders. It’s possible to unlearn the fears and stress responses that cause the physical symptoms of anxiety. There are mental strategies and other techniques to do this. And you can use prescription or natural medications to reduce anxiety.
 Wijlaars LP, Nazareth I, Whitaker HJ, Evans SJ, Petersen I. Suicide-related events in young people following prescription of SSRIs and other antidepressants: a self-controlled case series analysis. BMJ Open. 2013 Sep 19;3(9):e003247.
 Björkenstam C, Möller J, Ringbäck G, Salmi P, Hallqvist J, Ljung R. An Association between Initiation of Selective Serotonin Reuptake Inhibitors and Suicide – A Nationwide Register-Based Case-Crossover Study. PLoS One. 2013 Sep 9;8(9):e73973.
 Kimura, Kenta; Ozeki, Makoto; Juneja, Lekh Raj; Ohira, Hideki (2007). “L-Theanine reduces psychological and physiological stress responses”. Biological Psychology 74 (1): 39–45.
 Bhattacharya SK, Bhattacharya A, Sairam K, Ghosal S. Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study. Phytomedicine. 2000 Dec;7(6):463-9.
 Kennedy DO, et al. Attenuation of laboratory induced stress in humans after acute administration of Melissa officinalis (lemon balm). 2004. Psychosomatic Medicine. 66:607-613.
 Kennedy DO, et al. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress. Phytotherapy Research. 2006 (20):96-102.
 Calabrese C, Gregory WL, Leo M, Kraemer D, Bone K, Oken B. Effects of a standardized Bacopa monnieri extract on cognitive performance, anxiety, and depression in the elderly: a randomized, double-blind, placebo-controlled trial. J. Altern Complement Med. 2008 Jul;14(6):707-13.
 Mi-Yeon Cho,Eun Sil Min, Myung-Haeng Hur, Myeong Soo Lee. Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units. Evid Based Complement Alternat Med. 2013; 2013: 381381. Published online 2013 February 17 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588400/