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

I am writing to give you an update regarding your student, who is coping with an Anxiety Condition. Individuals with anxiety are sensitive and may be easily triggered to feel unsafe. The good news, is that many things that can be done to help those with anxiety feel safer. When students with anxiety can participate in the school environment, they can bring an incredible sense of empathy, sensitivity and kindness to the environment that benefits everyone. 

• Meet with the student and family to talk about the student's needs.
  • Develop a coping plan, which include:

    • Student’s strengths

    • Potential problems, stresses or issues

    • Strategies and solutions to try

  • Self-regulation programs such as "Zones of Regulation" can be helpful.
     
• Make efforts to connect to the student such as: 

  • Having check-ins at the beginning of the day when the student arrives.
  • Understand that the student may arrive late, without being critical or blaming of this. 
  • Accepting and validating the student’s anxiety, e.g. “I wonder if you’re feeling anxious… I appreciate it can’t be easy.”

  • Don’t invalidate the anxiety, e.g. don’t say: “That’s a silly thing to be worried about.” 

  • Showing an interest in the student, e.g. spending time to get to know the student, his/her hopes and dreams, interests, strengths, etc. 
     
• Has the student had a stressful incident? After the student has calmed down, try to find a time to meet with the student / parents and problem-solve. What were the triggers? What might help next time?


Recommendations for the Daily Schedule 

• Allow breaks as needed in a designated “chill out space”. Some students may need regular breaks as a preventive measure for stress buildup.  Ensure that there are also opportunities for the student to let you know when things are stressful, and then the student can have a break as needed (i.e., break card). The “chill out space” is a space in a calmer (i.e. less sensory input), relatively private place at school where the student can use different coping strategies until the student is feeling calmer. Examples vary depending on the student and the school, but may include a corner in the classroom; resource room where there are less students; the library.




• 


Does the student have sensory issues or needs? E.g. fidgets for tactile stimulation/distraction; hearing protectors for sensitivity to loud noises, etc.

Workload accommodations 

• Set clear expectations and try to check if the student understands. Some students have anxiety because they want to please the teacher, yet they are uncertain about their teacher’s expectations, but are too anxious to let the teacher know that they don’t understand.
   
• Chunk work. Be prepared to “chunk” larger work into smaller manageable pieces and provide ongoing feedback, or offers to help.



   
• Expose the student to challenges step by step. For example, with performance anxiety, the student can initially present material only to the teacher or in small groups. If the student is successful with this, they can move towards presenting to larger and larger numbers of students, until it is the full class.



   
• For older students, a reduced course load may be needed.  The possibility of a resource period, or learning skills course, should be explored.

• Is the student having troubles following a teacher's instruction in the classroom? Look beyond the behaviour, and explore why the student is unable to follow the instruction. Most likely, the student is not being 'oppositional', but likely struggling. Students do well if they can.
  
• Don’t put him/her on the spot by calling on them to answer a question in front of the class. Even though the student may be perfectly capable of answering a question, the student may still be anxious with being the centre of attention.


   
• Allow the student to choose a partner during group work and, when possible, allow him/her to work only with one partner (as opposed to a larger group).
• Consider having a classroom lesson about anxiety, and ways of coping, which helps all students be more understanding with anxiety. Do not single out students with anxiety by mentioning their names, but rather make the lesson about anxiety in general.



   
• Model self-compassion. For many students, anxiety is about feeling unsafe due to not measuring up to expectations around them. Teach self-compassion by ensuring that the classroom models the following:

  • Mindfulness: Teach students how to be in the moment, rather than distracted.

  • Kindness and compassion to others: Have a classroom that values kindness over competition.

  • Kindness and compassion to ourselves: When you hear students being self-critical, reframe the criticism in a positive and forgiving manner.



  • Gratitude: Consider incorporating gratitude into school routines, such as at the end of the classroom day.



     
• Stop stigma and teasing. Deal immediately with any negative behavior by peers towards more sensitive students.


Testing Accommodations

• For tests and exams, consider a separate testing room and extra time if needed.




• Building Resilient Students with Positive Mental Health
  
http://smh-assist.ca/blog/2016/03/15/building-resilient-students-with-positive-mental-health-flip-book-cdsbeo/ 



   
• Supporting Minds
  
https://www.edu.gov.on.ca/eng/document/reports/SupportingMinds.pdf


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