Generally speaking, psychological therapies are recommended in the first instance, as these have a really strong success rate, can teach solutions that can last a lifetime and don’t come with the possibility of side effects associated with medication.
However, for some, taking medication is a necessary precursor to being able to engage in psychological treatment. If you are highly anxious, struggling to leave the house or unable to concentrate, it can be incredibly hard to get to your therapy session, let alone engage fully in it. For some, talking therapy simply isn’t enough to overcome their anxiety, and that can be due to the complex neurochemical processes that occur in the brain of those with anxiety.
Drugs that act primarily to reduce feelings of anxiety are called ‘anxiolytics’. The most common class of anxiolytics is benzodiazepines. These drugs target GABA receptors in the brain, which are associated with anxiety. However, the nervous system adapts to the presence of anxiolytics very quickly, meaning that benzodiazepines are highly addictive, and the long-term outcomes are generally poor. As such, they are rarely prescribed for regular use, and are generally only used at times of crisis.
Instead, the National Institute of Health and Care Excellence (NICE) recommend using SSRIs (selective serotonin reuptake inhibitors). You may know that these are primarily used as antidepressant medications; however, they have also been found to be very useful in managing anxiety. This is because the chemical pathways they affect in the brain happen to be the same for both anxiety and depression. These are not thought to be addictive, but they do need to be taken regularly to take full effect, and you may be advised to continue treatment long-term to prevent symptoms returning.
As with depression, it is possible that the first SSRI that you try might not be the right fit for you, so it is important to monitor the effects – and side effects – and to stay in regular contact with your prescribing doctor over the first few months. If you are finding the medication ineffective, or you are struggling to cope with unpleasant side effects, then your doctor might suggest that you try a different SSRI, which might be a better fit for you, or an SNRI (serotonin-noradrenaline reuptake inhibitor), which is another form of antidepressant medication. Alternatively, they might suggest a drug called pregabalin, which was traditionally used as an anticonvulsant. If your doctor recommends this, don’t be alarmed: pregabalin also has strong anxiolytic properties and is increasingly prescribed to treat anxiety.
Medication is not the right choice for everyone, and your doctor should be able to offer an opinion as to whether medication might help with your particular symptoms and circumstances. They should also explain the likely benefits and risks of your chosen medication before you begin treatment; and how long you should expect to wait before seeing an improvement, as this can often be a week or more. Note that all medications can have side effects, including, in some cases, withdrawal effects, and if you are experiencing symptoms that you think could be related to your medication, it is important to speak to tell your prescribing physician as soon as possible.
If you are suffering from anxiety and would like to speak to a psychiatrist about medical treatment, call our knowledgeable triage team on 0203 326 9160.
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