What medications are used to treat anxiety disorders?

Antidepressants, anti-anxiety medications, and beta-blockers are the most common medications used for anxiety disorders.

Anxiety disorders include:

• Obsessive compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Generalized anxiety disorder (GAD)
• Panic disorder
• Social phobia.

Antidepressants

Antidepressants were developed to treat depression, but they also help people with anxiety disorders. SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are commonly prescribed for panic disorder, OCD, PTSD, and social phobia. The SNRI venlafaxine (Effexor) is commonly used to treat GAD. The antidepressant bupropion (Wellbutrin) is also sometimes used. When treating anxiety disorders, antidepressants generally are started at low doses and increased over time.

Some tricyclic antidepressants work well for anxiety. For example, imipramine (Tofranil) is prescribed for panic disorder and GAD. Clomipramine (Anafranil) is used to treat OCD. Tricyclics are also started at low doses and increased over time.

MAOIs are also used for anxiety disorders. Doctors sometimes prescribe phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). People who take MAOIs must avoid certain food and medicines that can interact with their medicine and cause dangerous increases in blood pressure. For more information, see the section on medications used to treat depression.

Benzodiazepines (anti-anxiety medications)

The anti-anxiety medications called benzodiazepines can start working more quickly than antidepressants. The ones used to treat anxiety disorders include:

• Clonazepam (Klonopin), which is used for social phobia and GAD
• Lorazepam (Ativan), which is used for panic disorder
• Alprazolam (Xanax), which is used for panic disorder and GAD.

Buspirone (Buspar) is an anti-anxiety medication used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone to begin working.

Clonazepam, listed above, is an anticonvulsant medication. See FDA warning on anticonvulsants under the bipolar disorder section.

Beta-blockers

Beta-blockers control some of the physical symptoms of anxiety, such as trembling and sweating. Propranolol (Inderal) is a beta-blocker usually used to treat heart conditions and high blood pressure. The medicine also helps people who have physical problems related to anxiety. For example, when a person with social phobia must face a stressful situation, such as giving a speech, or attending an important meeting, a doctor may prescribe a beta-blocker. Taking the medicine for a short period of time can help the person keep physical symptoms under control.

What are the side effects?

See the section on antidepressants for a discussion on side effects. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:

• Upset stomach
• Blurred vision
• Headache
• Confusion
• Grogginess
• Nightmares.

Possible side effects from buspirone (BuSpar) include:

• Dizziness
• Headaches
• Nausea
• Nervousness
• Lightheadedness
• Excitement
• Trouble sleeping.

Common side effects from beta-blockers include:

• Fatigue
• Cold hands
• Dizziness
• Weakness.

In addition, beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms.

How should medications for anxiety disorders be taken?

People can build a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may become dependent on them. To avoid these problems, doctors usually prescribe the medication for short periods, a practice that is especially helpful for people who have substance abuse problems or who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may get withdrawal symptoms, or their anxiety may return. Therefore, they should be tapered off slowly.

Buspirone and beta-blockers are similar. They are usually taken on a short-term basis for anxiety. Both should be tapered off slowly. Talk to the doctor before stopping any anti-anxiety medication.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 08-3929
Revised 2008

There are many ways that schools can help a child with obsessive-compulsive disorder succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom.

Examples of some accommodations, modifications, and school strategies include the following:

• Check in on arrival to see if the child can succeed in certain classes that day
• Allow more time to complete certain types of assignments
• Accommodate late arrival due to symptoms at home
• Identify ways for teachers to assist the child in breaking out of an obsession or compulsion
• Offer strategies for the child to resist uncomfortable thoughts
• Allow the child to tape record homework if the child cannot touch writing materials
• Give the child a choice of projects if the child has difficulty beginning a task
• Suggest that the child change the sequence of homework problems or projects ( for example, if the child has fears related to odd-numbers, start with even-numbered problems )
• Adjust the homework load to prevent the child from becoming overwhelmed. Academic stressors, along with other stresses, aggravate symptoms.
• Anticipate issues such as school avoidance if there are unresolved social and/or academic problems
• If the child insists on certain OCD rituals at school, work with the child to identify less intrusive rituals (such as tapping one desk rather than tapping every desk)
• Assist with peer interactions in order to alleviate concerns for both the child and peers
• Be aware that transitions may be particularly difficult for the child. Negotiate reasonable expectations for transitions within school hours. When a child with obsessive-compulsive disorder refuses to follow directions or to transition to the next task, for example, the reason may be anxiety rather than intentional oppositionality.
• Support and reinforce behavioral strategies developed by the clinician. This should be discussed with the child's parents and behavior therapist. Please refer to "Psychological Interventions" above, for details regarding behavior therapy.
• Encourage the child to help develop interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child's ability to problem-solve.

Flexibility and a supportive environment are essential for a student with obsessive-compulsive disorder to achieve success in school. School faculty and parents together may be able to identify difficult situations and develop remedies to reduce a child's challenges at these times.

Special thanks to Dr. Bostic and the School Psychiatry Program at Massachusetts General Hospital for permission to reproduce these recommendations.

For more information, visit www.schoolpsychiatry.org.

Examples of Common Workplace Accommodations

Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:

• Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be from within the organization.

• Flexible scheduling to accommodate effects of medications, time for appointments, more frequent breaks, switch to temporary part-time hours without fear of losing job.

• Changes in supervision, for example how feedback and instruction are given, or having weekly supervision appointments to check in and prevent problems before they can happen.

• In training, allowing more time for tasks to be learned, or allowing for individualized, one-on-one training.

• Appropriate technology like a tape recorder to tape instructions, head phones to block out loud noise, etc.

• Modifying work space or changing location so it is quieter, fewer distractions; allowing an employee to work at home.

• Allowing an employee to exchange minor job tasks with others.

Rights and Responsibilities of the Employer & Employee

The Employer Should:

• Create and maintain an atmosphere where people feel comfortable asking for accommodation, including providing information about the organization’s policies and creating ways for requests to happen confidentially.

• Assume that the employee’s request for accommodation is made in good faith.

• In a timely manner, work with the employee (and a professional, if necessary), to explore all options for accommodation.

• Maintain records of the request and steps taken to deal with the request.

• Maintain and respect confidentiality issues.

• Pay the cost of the accommodations, including fees for any medical certificates required.

• Request only information that is directly related to developing an appropriate accommodation.

• Ensure that managers and supervisory staff will not tolerate any discrimination or harassment as a result of an illness or an accommodation.

The Employee Should

• Tell the employer you need an accommodation, due to a disability, and give them the information they need to understand what the limitations are and what accommodations would address them.

• If requested, provide supporting documentation or medical certificates.

• Meet all relevant job requirements and standards once the accommodation has been provided.

• Continue to work with the employer to ensure that the accommodation remains effective and to check in with how you are doing.

SOURCE

Adapted from “Employment” , in “From Rollercoaster to Recovery”.

ADDITIONAL INFORMATION

• The Alberta Human Rights Commission has additional information on responsibilities for employers around employees with addictions issues
  http://www.albertahumanrights.ab.ca/publications/bulletins_sheets_booklets/ sheets/protected_grounds/drug_and_alcohol_dependencies.asp