Azaspirones
U.S. Brand Names: BuSpar®
Use: Used primarily to treat generalized anxiety disorders.
Pregnancy Risk Factor and Implications: Do not use when pregnant or nursing.
Contraindications: Do not use if you have hepatic or renal impairment. Do not use with MAO inhibitors.
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Benzodiazepines
U.S. Brand Names: Ativan®, Librium®, Tranxene®, Centrax®, Klonopin®, Paxipam®, Serax®, Valium®, Xanax®
Use: Used to treat generalized anxiety disorder, panic disorder, and social phobia.
Adverse Reactions: Reactions include increased aggressiveness (some individuals exhibit violent behavior), depression (with or without suicidal thoughts or intentions), sometimes personality changes, hallucinations, depersonalization, derealization, and other psychotic symptoms, (Ativan in particular may produce dissociation and other psychiatric effects). Long term effects include depression, querulousness or aggression, subtle personality changes, and fatigue. Passivity and symptoms of memory and cognitive impairment may ensue.
Benzodiazepines usually cause dependence and possible withdrawal symptoms when the drug is discontinued. Dependence can cause patients to deteriorate socially.
Other long term side effects include phobias, obsessive compulsive disorder, chronic depression, personality changes, and tinnitus. The risk of acute amnesia is more pronounced with the short-acting drugs (Ativan and Xanax). Benzodiazepines can impair memory, especially the ability to store acquired knowledge in long-term memory.
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Beta-Blockers
Nutrients Depleted:
Coenzyme Q10
U.S. Brand Names:Betapace®; Betimol® Ophthalmic; Betoptic® Ophthalmic; Betoptic® S Ophthalmic; Blocadren® Oral; Brevibloc® Injection; Cartrol® Oral; Coreg®; Corgard®; Kerlone® Oral; Lopressor®; Normoldyne®; Ocupress® Ophthalmic; Sectral®; Tenormin®; Timoptic®; OcuDose®; Timpotic® Ophthalmic; Timoptic-XE® Ophthalmic; Toprol XL®; Trandate®; Zebeta®
Use: Treatment of hypertension, angina, IHSS, and arrhythmias. Treatment and prevention of myocardial infarction, and migraine. Use may be specific to individual agent. Selected agents are used in the management of congestive heart failure and supraventricular arrhythmias. Additional unlabeled uses include management of esophageal varices, essential tremor, performance anxiety, hyperthyroidism, panic disorder, akathisia, and alcohol withdrawal.
Pregnancy Risk Factor and Implications: C. Acebutolol, atenolol, betaxolol (oral), bisoprolol, labetalol, metaprolol, nadolol, pindolol, propranolol, sotalol, timolol: Enters breast milk/use caution. Carteolol, esmolol: Excretion in breast milk unknown/use caution. Carvedilol: Excretion in breast milk unknown/contraindicated.
Contraindications: Hypersensitivity to beta-blockers, uncompensated congestive heart failure, bradycardia, or heart block, cardiogenic shock, pulmonary edema, severe hyper-reactive airway disease. Raynaud's disease.
Warnings/Precautions: Use with caution in patients with peripheral vascular disease, diabetes mellitus, asthma, chronic obstructive pulmonary disease, bradycardia, and hypotension.
Adverse Reactions: Individual agents may vary in their potential to cause specific adverse effects. The listing below provides only a general indication of the spectrum and frequency of adverse reactions to beta-adrenergic blockers. Beta-blockers with intrinsic sympathomimetic activity are less likely to cause bradycardia and alterations in cholesterol. Beta-blockers with alpha-adrenergic blocking potential may cause increased hypotensive responses.
Less than 10% experience:
Cardiovascular: Bradycardia.
Central nervous system: Mental Depression
Endocrine and metabolic: Decreased sexual ability
1% to 10% experience:
Cardiovascular: Congestive heart failure, reduced peripheral circulation
Central Nervous System: Confusion, hallucinations, dizziness, insomnia, fatigue
Dermatologic: Rash
Gastrointestinal: Diarrhea, nausea, vomiting, stomach discomfort
Neuromuscular and skeletal: Weakness
Respiratory: Wheezing
Less than 1% experience: Chest pain, hypotension, impaired myocardial contractility, worsening of A-V condition disturbances, nightmares, vivid dreams, lethargy, red, scaling or crusted skin; hypoglycemia, hyperglycemia, GI distress, leukopenia, thrombocytopenia, agranulocytosis, bronchospasm, cold extremities
Overdose/Toxicology:Symptoms of intoxication include cardia disturbances, CNS toxicity, bronchospasm, hypoglycemia, and hyperkalamia. The most common cardia symptoms include hypotension and bradycardia. Atrioventricular block, intraventricular conduction disturbances, cardiogenic shock, and asystole may occur with severe overdose, especially with membrane-depressant drugs (eg, propranolol). CNS effects include convulsions and coma. Respiratory arrest (commonly seen with propranolol and other membrane-depressant and lipid-soluble drugs). Treat symptomatically. Cardiac and hemodynamic monitoring may be necessary.
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Ticyclics
U.S. Brand Names:Adapin®, Anafranil®, Elavil®, Janimmine®, Ludiomil®, Pamelor®, Pertofrane®, Sinequan®, Surmontil®, Tofranil®, Vivactil®
Use: These drugs are primarily used to treat panic attacks, post-traumatic stress disorder and obsessive-compulsive disorder.
Common initial side effects include anxiety, brainfog, inability to concentrate normally, feverish feeling, increased perspiration, restlessness, sleep difficulties, and trembling. Other common side effects of this class of drugs include blurred vision, constipation, dilation of pupils, dizziness when standing up quickly, dry eyes, dry mouth, palpitations, rapid heartbeat, sedation, sensitivity to light, sexual dysfunction, urinary hesitancy, and weight gain. Side effects of each individual drug are listed below.
Contraindications: Do do use these medicines if you have heart problems, if you drink alcohol, while you are taking other sedatives and tranquilizers, and while you are taking some cold medicines and stomach remedies.
- Adapin® and Sinequan® (Doxepin): Dry mouth, blurred vision, urinary retention, constipation, drowsiness, and weight gain are relatively common side effects of these drugs. Orthostatic hypotension and cardiac arrhythmias are rare side effects.
- Anafranil® (Clomipramine): Dry mouth, blurred vision, urinary retention, constipation, drowsiness, weight gain, and cardiac arrhtymias are relatively common side effects. Orthostatic hypotension and gastrointestinal distress are rare side effects.
- Elavil® (Amitriptyline): Dry mouth, blurred vision, urinary retention, constipation, drowsiness, orthostatic hypotension, and weight gain are all relatively common side effects. Cardiac arrhythmias are rare side effects.
- Janimine® and Tofranil® (Imipramine): Weight gain, cardiac arrhythmias, dry mouth, blurred vision, urinary retention, constipation, drowsiness, and cardiac arrhythmias are relatively common side effects. Gastrointestinal distress is a rare side effect.
- Ludiomil® (Maprotiline): Drowsiness is a relatively common side effect. Dry mouth, blurred vision, urinary retention, constipation, orthostatic hypotension, weight gain, and cardiac arrhythmias are rare side effects.
- Pamelor® (Nortiptyline): Drowsiness, weight gain, cardiac arrthymias, dry mouth, blurred vision, urinary retention, constipation, and orthostatic hypotension are rare side effects.
- Pertofrane® (Desipramine): Dry mouth, blurred vision, urinary retention, constipation, drowsiness, weight gain, cardiac arrthymias, and orthostatic hypotension are rare side effects.
- Surmontil® (Trimipramine): Dry mouth, blurred vision, urinary retention, constipation, drowsiness, weight gain, cardiac arrthymias, and orthostatic hypotension are relatively common side effects.
- Vivactil® (Protriptyline): Cardiac arrthymias are relatively common side effects. Drowsiness, orthostatic hypotension, dry mouth, blurred vision, urinary retention, and constipation are rare side effects.
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Monoamine Oxidase Inhibitors (MAOs)
U.S. Brand Names:Eldepryl®, Marplan®, Nardil®, Parnate®
Use: Used to treat panic disorder, social phobia, PTSD, and OCD.
Contraindications: MAO inhibitors require strict dietary restrictions and can have potent drug interactions.
Adverse Reactions: Common side effects include dry mouth, light-headedness, dizziness, low blood pressure, headache (mild), sleepiness, tiredness, weakness, trouble sleeping, muscle twitching during sleep, shakiness, trembling, restlessness, blurred vision, weight gain, reduced tolerance for alcohol, decreased amount of urine, decreased sexual ability, increased appetite (especially for sweets) and weight gain. Less common side effects include high blood pressure (which may occur if you eat restricted foods or take certain medications). Stop using the MAO inhibitor and get emergency help if you experience signs of dangerously high blood pressure including: severe chest pain, fast or slow heartbeat, severe headaches, severe dizziness or lightheadedness, increased sweating (possibly with fever or cold, clammy skin), nausea or vomiting, stiff or sore neck, swelling of feet or lower legs, increased sensitivity to light, and enlarged pupils. Rare side effects include dark urine, fever, skin rash, slurred speech, sore throat, staggering walk, yellow eyes or skin.
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Serotonin Reuptake Inhibitors (SRIs)
U.S. Brand Names:Celexa®, Desyrel®, Effexor®, Luvox®, Paxil®, Prozac®, Serzone®, Zoloft®
USE: Used to treat panic disorders, often effective against obsessive-compulsive disorder.
Common side effects of this class of drugs includes mild nausea, sexual dysfunction (primarily ejaculatory delay), headaches, excessive sweating, upset stomach, diarrhea, sleep disturbances, drowsiness, and tremor. Side effects of each individual drug are listed below.
Contraindications: These drugs are extremely expensive, and there are no generic forms available. Do not drink alcohol while taking these drugs.
- Celexa® (Citalopram): Gastrointestinal distress is a relatively common side effect.
- Desyrel® (Trazodone): Drowsiness and orthostatic hypotension are relatively common side effects. Weight gain, cardiac arrthymias and gastrointestinal distress are rare side effects.
- Effexor® (Venlafaxine): Gastrointestinal distress is a relatively common side effect. Dry mouth, blurred vision, urinary retention, constipation, drowsiness, and cardiac arrthymias are rare side effects.
- Luxox® (Fluvoxamine): Gastrointestinal distress is a relatively common side effect.
- Paxil® (Paroxetine): Gastrointestinal distress is a relatively common side effect. Drowsiness, weight gain, dry mouth, blurred vision, urinary retention, and constipation are rare side effects.
- Prozac® (Fluoxetine): Gastrointestinal distress is a relatively common side effect.
- Serzone® (Nefazodene): Gastrointestinal distress, drowsiness, dry mouth, blurred vision, urinary retention, and constipation are rare side effects.
- Zoloft® (Sertraline): Gastrointestinal distress is a relatively common side effect.
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Coverage of Anxiety Disorder Drugs and Their Side Effects