using anti-anxiety drugs to treat GAD, SAnD, PTSD, OCD, PD, and other initialisms




1.  Define Your Terms

Just to clear up some of the terminology used. Anxiolytic is the technical term for an anti-anxiety medication. It’s also a lot shorter. Tranquilizer and sedative are interchangeable terms for a type of anxiolytic that also puts you to sleep, or relaxes you so much you may as well be sleeping, such as a benzodiazepine. “Major tranquilizer” is a holdover from the days when consumers didn’t know shit about the meds they were taking and often refers to an antipsychotic - usually a first generation antipsychotic - that is being used to treat anxiety and insomnia. Sedatives is a class of medications that includes barbiturates, chloral hydrate, benzodiazepines, and some modern hypnotics such as Ambien (zolpidem tartrate).

2.  Anxiety Spectrum Conditions

When most people think of anxiety conditions they think of conditions such as generalized anxiety disorder (GAD), social anxiety disorder (SAnD) / social phobia, and various panic disorders, especially agoraphobia. Other conditions in the anxiety spectrum include obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Most of the time anxiety conditions can be treated without medication. When medication is required it is usually for a short duration and/or used as needed (PRN). As with depression, meds should be reserved for when someone isn’t, or is barely able to function due to their condition. Let’s take social anxiety/phobia, as it’s really easy to determine if you need medication for SAnD or not.

  • If you can leave you house, hold down a job (even one that involves as little contact with people as possible), and otherwise function, no matter how little interaction you have with anyone else, you can probably overcome the condition with therapy.1 Drugs, if needed, would be used for a very short time.
  • If the only time you can leave your house is when you know there will be as few people around as possible, and you’ve adjusted your life so you do your shopping at 3:00 a.m., and only for stuff you can’t get online, then you need meds. Maybe not forever, but probably for more than six-to-eight weeks.

3.  First-Line Pharmacological Treatments

  • Benzodiazepines are the traditional pharmacological treatment for most of these conditions. These days they are mostly prescribed for someone who needs to be medicated only occasionally.
  • SSRIs, along with some of the more serotonergic antidepressants from other classes, are usually the first meds of choice for anyone with an anxiety spectrum condition who needs to be medicated every day, either in the short term as part of psychological therapy, or in the long term.
  • SNRIs - for a lot of people too much norepinephrine is the cause of anxiety, but there are a lot of people who can use a little boost in the adrenergic receptors to help them with their anxiety.
  • BuSpar (buspirone), which is in a class all its own2, is the best first choice for GAD when someone is in that nebulous area of too anxious too often for therapy alone with a PRN drug, but not so anxious for an SSRI.
    • Technically Luvox (fluvoxamine) is in a class of its own as well, as it is approved by the FDA to treat OCD and nothing else. But it is an SSRI, and approved as an antidepressant everywhere else in the world, so I classify it as an antidepressant.

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4.  Second-line Pharmacological Treatments

  • Antipsychotics, either by themselves or to augment antidepressants or BuSpar, are also used to treat anxiety disorders.
  • Antihistamines. In addition to treating severe allergic reactions, new antihistamines were being developed in the 1950s to deal with two problems prior to surgery: anxiety and anesthesia-induced vomiting3. They’ve been used to treat anxiety ever since. While the more potent ones like Vistaril - which you’ll probably find only in hospitals - are FDA-approved to treat anxiety, OTC antihistamines like Benadryl (diphenhydramine) can work as needed for mild panic/anxiety attacks.
  • Beta blockers, like benzodiazepines, are good for when you only need to take a drug PRN. They are mostly used for SAnD, specifically in situations like public speaking or other cases of performance anxiety4.

5.  Medications Used for Anxiety Spectrum Conditions

5.1  Drugs discussed on this site with FDA-approval to treat anxiety spectrum conditions

5.2  Drugs discussed on this site used off-label to treat anxiety spectrum conditions


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5.3  Other drugs with FDA-approval to treat anxiety spectrum conditions

  • Benzodiazepines:
    • Ativan (lorazepam)
    • Klonopin (clonazepam)
    • Librium (chlordiazepoxide hydrochloride)
    • oxazepam
    • Tranxene (clorazepate dipotassium)
    • Valium (diazepam)
    • Xanax (alprazolam)
  • Antidepressants:
    • Anafranil (clomipramine hydrochloride)
    • Etrafon (perphenazine and amitriptyline hydrochloride) - combination antidepressant & antipsychotic
    • Nardil (phenelzine sulfate)
    • Parnate (tranylcypromine sulfate)
    • Sinequan (doxepin hydrochloride)
  • Antipsychotics:
    • Compazine (prochlorperazine)
    • Loxitane (loxapine succinate)
    • Orap (pimozide): Tourette Syndrome
    • Stelazine (trifluoperazine hydrochloride)
  • Antihistamines:
    • Atarax (hydroxyzine hydrochloride)
    • Vistaril (hydroxyzine pamoate)
  • Beta blockers:
    • acebutolol hydrochloride
    • metoprolol
    • propranolol hydrochloride
    • sotalol hydrochloride
    • timolol
  • Miscellaneous:
    • droperidol
    • mephobarbital
    • meprobamate

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1 Assuming you want to in the first place. I won't go anywhere to deal with stuff like grocery shopping for two, three, sometimes four weeks at a time. Solitude has done wonders for my mental health.

2 In the US at any rate. BuSpar is an azapirone, a class of meds that are mostly anxiolytics and nothing else. A few are also antipsychotics. As of this writing most of them are still in the clinical trial stages everywhere.

3 Not only that, some of the original antipsychotics, like promethazine and Thorazine (chlorpromazine), were originally developed as super antihistamines for pre-operative sedation and to prevent puking. Thorazine was so effective that some people didn't need anesthesia.

4 But not "performance anxiety," or being too nervous or otherwise unable to respond sexually. Which is often a side effect of many crazy meds, especially SSRIs. Although BuSpar is used off-label as an add-on to help with SSRI-induced sexual dysfunction.


Anxiolytics - Anxiety Spectrum Disorders Treatment Options by Jerod Poore is copyright © 2011 Jerod Poore

Last modified on Saturday, 29 March, 2014 at 14:18:48 by JerodPoorePage Author: Jerod PooreDate created: 15 April 2011

All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.





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All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]

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