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Anxiety and Depression Medications in the Global Crisis

By Rosanna Sutherby, PharmD

May 26, 2020

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The current COVID-19 pandemic has affected the physical health and the mental health of millions worldwide. Nearly half of American adults report in a recent poll that their mental health has been negatively affected by stressors related to COVID-19, and the use of support hotlines and other mental health resources has drastically increased compared to a year ago.

If you are experiencing new or resurgent symptoms of anxiety or depression due to the current global crisis, you are not alone. Reaching out to a healthcare provider can help you obtain the care and support needed during these difficult times.

A conversation with your provider will help you determine if you need medication to help relieve your symptoms. The following are some common medicines used to treat anxiety and depression.

Medications That Treat Anxiety

The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes, like increased blood pressure.” If you need medication to treat your anxiety, your doctor may prescribe any of the following:

antidepressants
buspirone (Buspar)
benzodiazepines

Antidepressants

Antidepressants are the first line of treatment for anxiety disorder. Two types of antidepressants used to treat anxiety are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs and SNRIs work by increasing the amount of chemicals in your brain that help regulate your mood. SSRIs increase the amount of serotonin in your brain, and SNRIs increase both serotonin and norepinephrine.

SSRIs used to treat anxiety include the following:

escitalopram (Lexapro)
paroxetine (Paxil)

SNRIs used for anxiety include the following:

duloxetine (Cymbalta)
venlafaxine (Effexor)

There are some common side effects seen with antidepressants, including:

nausea
dizziness
dry mouth
headache
restlessness
changes in appetite
problems with sleep
problems with orgasms or decreased interest in sex

If you are taking antidepressants to treat your anxiety, let your healthcare provider know if your symptoms worsen or if you do not feel better. It may take a few weeks before you feel the effects of SSRIs or SNRIs. Call your doctor if you suddenly feel agitated, anxious, or aggressive while taking your medication.

You should avoid drinking alcohol while taking antidepressants because it can interfere it the action of the medication.

Buspirone

Buspirone (Buspar) is an antianxiety medication that your doctor may prescribe for long-term treatment of anxiety. The most common side effects reported by those taking buspirone include:

dizziness
nausea
headache
nervousness
lightheadedness

Be sure to maintain your regular appointments with your healthcare provider to evaluate your progress while taking this medication.

Benzodiazepines

Benzodiazepines are generally used for short-term treatment of anxiety symptoms. They work quickly at reducing anxiety but should not be used regularly or long-term since they can be habit-forming.

Benzodiazepines used to treat anxiety include:

alprazolam (Xanax)
clonazepam (Klonopin)
lorazepam (Ativan)

Side effects related to benzodiazepines include the following:

drowsiness
blurred vision
headache
dizziness
nausea or vomiting
confusion

You should not drive or engage in activities that require alertness while you are taking benzodiazepines. Do not drink alcohol or take other medications that cause drowsiness if you are taking benzodiazepines.

Medications That Treat Depression

According to the World Health Organization (WHO), depression is a leading cause of disability around the world. Over 264 million people worldwide, including 16 million Americans, are living with depression.

Depression is a condition that causes prolonged feelings of sadness, hopelessness, and loss of interest. Treatment for depression includes several modalities of psychotherapy and, in some cases, medication.

Medicines that your doctor may prescribe to treat depression include the following:

SSRIs
SNRIs
Atypical antidepressants
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs)

SSRIs

Healthcare providers usually begin medication treatment of depression with SSRIs. These newer medications have fewer side effects than older drugs and are generally safer to use.

Drugs in the class of SSRIs include the following:

fluoxetine (Prozac)
citalopram (Celexa)
sertraline (Zoloft)
paroxetine (Paxil)
escitalopram (Lexapro)

SNRIs

SNRIs are similar to SSRIs; they work by increasing the amount of norepinephrine as well as serotonin in your brain. Examples of SNRIs include:

venlafaxine (Effexor)
duloxetine (Cymbalta)

SSRIs and SNRIs have similar side effects, which include the following:

nausea
dizziness
dry mouth
headache
restlessness
changes in appetite
problems with sleep
problems with orgasms or decreased interest in sex

You may not feel the effects of SSRIs or SNRIs during the first few weeks of treatment. This is normal. It generally takes at least two weeks before the medication starts working. Seek immediate help if your depressive symptoms worsen or if you have feelings or thoughts of hurting yourself.

Atypical Antidepressants

Other antidepressants work by different pathways and are sometimes added to treatment with SSRIs or SNRIs. Some atypical antidepressants include:

bupropion (Wellbutrin)
mirtazapine (Remeron)
nefazodone (Serzone)
trazodone (Desyrel)

Tricyclic Antidepressants

Tricyclic antidepressants include medications such as:

imipramine (Tofranil)
nortriptyline (Pamelor)
protriptyline (Vivactil)

These are older antidepressants that have been largely replaced by SSRIs. Due to the high incidence of severe side effects, these medications are generally used only if treatment with SSRIs was unsuccessful.

MAOIs

MAOI antidepressants, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan), are used rarely because they have dangerous interactions with foods and other medications. MAOIs cannot be combined with SSRIs or SNRIs.

How to Get the Lowest Prescription Price for Your Anxiety and Depression Medication

Whether you are taking one prescription or several to treat your symptoms of anxiety or depression, always compare prescription prices before heading to a pharmacy near you. You can use your prescription savings card to obtain the best price for your medication.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

https://www.wellrx.com/news/may-is-mental-health-awareness-month/

https://www.apa.org/topics/anxiety/

https://www.wellrx.com/escitalopram%20oxalate/drug-information/

https://www.wellrx.com/paroxetine%20hcl/drug-information/

https://www.wellrx.com/duloxetine%20hcl/drug-information/

https://www.wellrx.com/venlafaxine%20hcl%20er/drug-information/

https://www.wellrx.com/buspirone%20hcl/drug-information/

https://www.wellrx.com/alprazolam/drug-information/

https://www.wellrx.com/clonazepam/drug-information/

https://www.wellrx.com/lorazepam/drug-information/