What non-benzodiazepine treatments exist for anxiety disorders?
January 14, 2013 8:50 AM   Subscribe

What medical treatments exist for anxiety disorders that aren't classified as benzodiazepines?
posted by Ipsifendus to Health & Fitness (30 answers total) 7 users marked this as a favorite
In my experience (IANAD) many antidepressants, such as Lexapro and Zoloft, are used for Generalized Anxiety Disorder (GAD).
posted by walla at 8:52 AM on January 14, 2013 [2 favorites]

There are quite a number. One of the more frequently-prescribed ones is an azapirone-class drug called buspirone/Buspar.
posted by griphus at 8:53 AM on January 14, 2013 [3 favorites]

Buspar is what doctors give you instead of benzos if they think you're a pill seeker. As far as I can tell, that's all it's good for.
posted by DecemberBoy at 8:56 AM on January 14, 2013 [4 favorites]

In addition to the above, cognitive behavioral therapy is a treatment for anxiety disorders, I'm not sure what your definition of "medical" is here (does it have to be drugs?)

I would ignore a response like DecemberBoy's - if you go to your doctor with the attitude that no med aside from benzos has value or works, it would be no surprise if your doctor thought you were a pill seeker. Different people respond differently to different medications, and one person's anecdotal experience is not relevant here as the question is not "which is the best non-benzodiazepine treatment for anxiety" or "what worked for you".... it's "what treatments exist".
posted by treehorn+bunny at 9:00 AM on January 14, 2013 [2 favorites]

As far as meds, my doctor has also tried (off label) propranolol, a beta blocker, and gabapentin (Neurontin), an antiseizure med. For me, the gabapentin works and the propranolol doesn't. And another antidepressant prescribed for antianxiety is Celexa. (IAAPatient, NAD.)
posted by scratch at 9:23 AM on January 14, 2013

Betablockers are frequently prescribed for intermittent and as needed anxiety relief.
posted by OmieWise at 9:34 AM on January 14, 2013 [1 favorite]

Anecdotal and not your doctor etc., but my wife says Celexa works for her.
posted by lungtaworld at 9:36 AM on January 14, 2013

As emergency relief, I've been prescribed hydroxyzine (Atarax), which is an antihistamine, instead of benzos.
posted by fiercecupcake at 9:37 AM on January 14, 2013

With a huge caveat of "your mileage may vary," you might the treatment reviews section on the Social Anxiety Support forum helpful. It contains a fairly comprehensive listing of drugs that have been used to treat anxiety and various members' experiences with them, both in terms of efficacy and side effects.
posted by drlith at 9:40 AM on January 14, 2013 [1 favorite]

Also, valerian root extract may be effective in treating anxiety, but is definitely not a substitute for Rx medication. If you get gelcaps of it, please note that yes, it is supposed to smell like death.
posted by griphus at 9:51 AM on January 14, 2013

Lyrica... at least some US doctors will prescribe it. It's kind of like moderate alcohol without the drunkenness. One plus is that it's not an SSRI (i.e. it's not a sledgehammer). Downsides -- it's not cheap as benzos since it's still under patent. Also seconding mild beta blockers and of course under doctors supervision since it monkeys with blood pressure.
posted by crapmatic at 9:57 AM on January 14, 2013

Tenex (now available generic as Guanfacine). And I wouldn't jump all over that critique of BuSpar....I've had a couple doctors joke it only seems to work as placebo, if that.
posted by availablelight at 10:15 AM on January 14, 2013

I've had a couple doctors joke it only seems to work as placebo, if that.

As is the case for many psychotropic drugs, so the critique is either obviated or upheld at a much broader level.
posted by OmieWise at 10:16 AM on January 14, 2013

Another Celexa vote over here. I'm also on trazodone (another antidepressant) which helps me sleep (and is when I have worsening anxiety). Also Lamictal, but that's for the depression more than anything else.
posted by sperose at 10:23 AM on January 14, 2013

IANAD and YMMV, of course.

I've been suffering from general / social anxiety disorders for the greater part of the past decade. It's ranged in severity from day-to-day low level nervousness to panic attacks that have quite literally left me useless for days and caused huge amounts of strain on both my friendships and family. I went through a bunch of different combinations of benzos and SSRIs and while I'd get varying levels of relief, there are most certainly trade-offs (I've had anything from slight amnesia and confusion to severe mania and, of course, severe crippling depression).

I don't mean to presume about your background, because you haven't said much, and again, this is mostly from personal experience, but there's only so far traditional medical routes can take you. At some point, there has to be some level of self-analysis done to determine where the anxiety's coming from. I realize this is a lot easier to say than to actually do - it took me *years* to actually even start scraping the surface. At their best, SSRIs will only even out and gloss over some of the issues that are probably causing that anxiety to flare up, and at their worst, they'll exacerbate it. The same goes for almost any medication, hence, YMMV.

Since you've got a decent list so far, here's some things that have greatly helped me on a day to day basis:
- Exercise: I'm the worst at actually maintaining and keeping a schedule, but when I do, it's great. When I get panic attacks, I run until I'm tired, then run some more, and eventually your body gets too tired to be anxious. Plus, the usual exercise stuff (seratonin and whatnot).
- Yoga: I know it sounds sort of like double duty on the physical activity, but having a physical activity with a meditative component really did a number on lowering my GAD level (not so much on the SAD stuff, though). If you don't like the idea of bending and stretching in front of a ton of people, there are loads of resources and free videos out there. Try something like Yin - nice, slow, easy, and contemplative.
- Don't freaking drink alcohol: This took me too long to learn and I wish I learned it earlier. If you drink, don't. Just... don't. Anxiety and downers may seem like a great coupling, but if you're anything like most people, at some point it's just going to feed back into your anxiety and you'll feel even worse. I realize this comes with it's own caveats of adding social pressure, but your friends and family should understand that it's just not a thing for you.
- Stop being so serious: I can't make assumptions about your life. This one may not apply. In the long run, however, whatever's giving you anxiety isn't that big. The more you think about it being a monolith, the less of an ant hill it becomes, and vice versa. Take a breath. Get some perspective. Find something funny. Whatever you do, don't dwell on it.
- Find some people to talk to: For me, it was a therapist. It took me about eight therapists before I found one I liked, and she helps immensely. You can't (and shouldn't!) do this alone. If you're not comfortable face to face, hit up some forums about it. If you're not comfortable posting publically, send me some MefiMail and I'm happy to talk any time.
- Incremental progress: Don't try to tackle it all at once. It doesn't have to be black and white. You'll feel better if you set small milestones for it.

It's a long, bummer road, and medication can definitely help. I know plenty of people who gain huge benefits from being on a low dose antidepressant. I also know it didn't freaking work at all for me, and that there are alternatives out there.

(edit: I didn't notice how rambly this got, but I'm hoping there's some info in here that'll help someone who comes across the topic.)
posted by Mali at 10:36 AM on January 14, 2013 [11 favorites]

I've always been prescribed antidepressants (Celexa and Lexapro) for my anxiety.
posted by joan_holloway at 10:38 AM on January 14, 2013 [1 favorite]

OP here...thanks for the kind responses. We are definitely not in pill-seeker territory. The problem is sort of the opposite of that...we've nearly exhausted the list of more commonly know benzodiazepines and haven't had much luck getting the panic attacks under control. We'll be heading back to the doctor's office shortly and I wanted to be able to ask about alternatives without sounding foolish.
posted by Ipsifendus at 10:45 AM on January 14, 2013

I took hydroxyzine and it worked pretty well for my anxiety.
posted by tristeza at 11:45 AM on January 14, 2013

In my experience (as a layperson, not a medical professional), SSRI antidepressants are often used in the treatment of anxiety disorders.
posted by snowmentality at 12:19 PM on January 14, 2013

Have you dosed the benzos high enough? Benzos like Klonopin and Xanax will control most panic attacks if they're dosed appropriately. Oftentimes they're underdosed because of addiction fears, though (which is a real shame).
posted by professor plum with a rope at 12:53 PM on January 14, 2013

Well, when my Klonopin wasn't powerful enough to deal with the severe anxiety I was having, my doctor has prescribed Seroquel (an antipsychotic). It sure makes the anxiety go away, but in my case I only dare take it at night because I find it extremely strong (I'm afraid of not being able to function if I take it while at work). I take just a third of the pill. Also, I wake up with a major brain fog hangover that lasts until noon, so I only use it in very rarely. My doctor says that it works beautifully for some people and they can take it during the day without a problem. Others, no.

You haven't offered much info, so I don't know what you may be on. I hope you are seeing a psychiatrist and not just a GP. I hope you have been diagnosed correctly and thoroughly. Your anxiety sounds terrible and crippling; I would be very surprised to hear that you are not already on an SSRI. Paxil is often chosen for anxiety. Also, Celexa and Zoloft.

I am not a doctor or expert. Just a person who has generalized anxiety disorder, and bipolar II depression, and who has been on SSRIs, (and now an MAOI), lamictal and klonopin for 7 years.
posted by kitcat at 1:41 PM on January 14, 2013 [1 favorite]

Seconding Lyrica (pregabalin). Very similar to diazepam but without the dependance/tolerance issues. SSRIs did nothing for me, pregabalin started working within a matter of hours, with no side effects. Some reviews here. You should definitely try it.
posted by derbs at 3:04 PM on January 14, 2013 [1 favorite]

@professor plum, that's great and all, but at high enough doses (and depending on the frequency) either k-pin or xanax can cause absolutely horrible rebound anxiety. Not saying it won't work and that there aren't good ways to do it, just please, be careful.
posted by Mali at 4:48 PM on January 14, 2013

Have you tried one of the old tricyclics? My aunt has been taking low dose imiprimine for years for her panic attacks. My mother took it for a while as well, before she switched to Zoloft.

What seems to make a difference in treatment is the kind of anxiety and panic attacks you have. They both have just randomly occurring panic attacks, not related to general anxiety. I have GAD and can sometimes build to a panic attack, so my anxiety is treated differently (a tiny tiny dose of Xanax every night). Either way, it seems to work better to take something all the time than try to just react to each panic attack.

I like Crazy Meds for info about psych drugs from real people who aren't selling anything.
posted by monopas at 5:28 PM on January 14, 2013

Seconding the rec for Crazy Meds.

Here's their page on Anxiety Spectrum Disorders Treatment Options.

And the site's consumer forums can be helpful, too.
posted by virago at 5:49 PM on January 14, 2013

Speaking as another patient, I'm on a Celexa/Wellbutrin combo with weekly psychotherapy (my psychotherapist is also my prescribing psychiatrist). I use immovane to sleep and benzos for breakthrough anxiety. The Celexa was really what helped turn down the anxiety.
posted by Felicity Rilke at 7:10 PM on January 14, 2013

Effexor XR is the only thing that helps my general anxiety disorder. YMMV of course.
posted by blahtsk at 8:41 PM on January 14, 2013

I'm using Wellbutrin and therapy to treat anxiety, PTSD and depression. Wellbutrin initially raised anxiety levels sharply, which is perhaps not ideal if you are already having panic attacks. Playing with levels took about a year, and it wasn't a great year, but things have been pretty smooth since then. Lots of people find Wellbutrin terrible for anxiety, but I wanted to offer a datapoint.

SSRIs (Prozac, Celexa, Cipralex) were a nightmare for me, as was Seroquel, which is also sometimes prescribed for anxiety. Some people swear by it, but I'm not one of them.
posted by looli at 8:50 PM on January 14, 2013

I found that Ativan didn't work for me. I'm on Buspar and a beta blocker, which does help.
posted by Anne Neville at 7:08 AM on January 15, 2013

If cost is an issue, a cheaper alternative to pregabalin (Lyrica) might be gabapentin, which is apparently closely related. It's often used off-label for anxiety. I've heard that the reason it isn't officialy approved is that its effectiveness for anxiety was discovered shortly before it was due to go off patent, so it wasn't worth spending money on the studies. In any case, anecdotally, it does help me with my anxiety.
posted by The pets.com Mascot at 3:00 PM on January 24, 2013

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