Medication decisions for Anxiety and depression

Guidance on Medications for Depression, Anxiety, and Stress

Medications for depression, anxiety, and stress are typically considered only after non-medical treatments like lifestyle adjustments and talking therapies have been tried.

Many people benefit from these approaches, which can effectively manage symptoms without medication.

Non-Medical Treatment Approaches

Before medications are considered, it’s recommended to explore:

• Lifestyle Changes: Regular exercise, balanced nutrition, adequate sleep, and stress reduction can all support mental health.
  • Resources: NHS: 10 Stress Busters and NHS: Exercise and Mental Health.
• Talking Therapies: These include cognitive behavioural therapy (CBT) and other counselling approaches, which are often highly effective for treating both anxiety and depression.
  • Resources: NHS: Talking Therapies and NHS IAPT Services.

If these approaches don’t sufficiently relieve symptoms, medications may be considered.

When Medications May Be Considered

Medication might be appropriate when:

1. Symptoms Are Severe: Daily life is significantly disrupted by anxiety, depression, or stress.
2. Non-Medical Approaches Don’t Provide Enough Relief: Symptoms persist despite lifestyle changes and therapy.
3. Medication Can Facilitate Therapy: For some, reducing symptoms with medication makes therapy more effective.

Medication Options for Depression, Anxiety, and Stress

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are often the first-line treatment for both depression and anxiety. They work by increasing serotonin levels, which helps regulate mood.

• Common SSRIs: Sertraline, Citalopram, Escitalopram, and Fluoxetine.

• How to Take: Typically taken once daily, at the same time each day (morning or evening). Starting with a low dose that may gradually increase.

• Common Side Effects:

  • Nausea or upset stomach
  • Headaches
  • Drowsiness or fatigue
  • Sexual side effects
  • Temporary increase in anxiety (usually resolves within 1-2 weeks)

• Treatment Duration: A minimum of 6 to 12 months is often recommended after symptoms improve. Stopping medication too soon can increase the risk of relapse. SSRIs should be tapered off gradually with guidance from your doctor to avoid withdrawal symptoms.

  • Resources: NHS: Sertraline and NHS: Citalopram

2. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are used when SSRIs are not effective. They boost both serotonin and norepinephrine, which helps regulate mood and anxiety.

• Common SNRIs: Mirtazepine and Venlafaxine .

• How to Take: Usually taken once daily, preferably in the morning. Starting with a low dose, which may be gradually increased.

• Common Side Effects:

  • Nausea or upset stomach
  • Increased sweating
  • Constipation
  • Dry mouth
  • Headache
  • Initial increase in anxiety (usually resolves within a few weeks)

• Treatment Duration: Similar to SSRIs, SNRIs are generally taken for 6 to 12 months after improvement. Gradual tapering is recommended when stopping to prevent withdrawal symptoms.

  • Resources: NHS: Venlafaxine and NHS: Mirtazapine

Sedative Medications: Benzodiazepines and Z-Drugs

Benzodiazepines

Benzodiazepines (e.g., Diazepam, Lorazepam) provide fast relief by enhancing GABA, a calming brain chemical. However, they are not recommended for long-term use due to their risks.

• Why Avoid Long-Term Use: With prolonged use, benzodiazepines can cause dependence and tolerance, requiring higher doses for the same effect. Stopping suddenly can lead to withdrawal symptoms, and they can make it difficult to manage anxiety without medication.

• When Benzodiazepines Are Used: Short-term use (typically 2-4 weeks) may be helpful during periods of intense anxiety, especially if other medications haven’t taken effect.

  • Resources: NHS: Diazepam

Side Effects:

• Drowsiness and sedation
• Dizziness
• Memory impairment
• Risk of falls, particularly in older adults

Z-Drugs (Zopiclone and Zolpidem)

Z-drugs are sedatives generally prescribed for sleep issues. They may be used short-term to address sleep disturbances related to anxiety but are also best avoided for long periods.

• Why Avoid Long-Term Use: Like benzodiazepines, Z-drugs carry risks of dependence, tolerance, and withdrawal symptoms. They may also lead to worsening sleep quality over time.

• When Z-Drugs Are Used: Z-drugs may be prescribed briefly (generally under 2 weeks) when severe sleep disturbances are affecting daily functioning.

  • Resources: NHS: Zopiclone and NHS: Zolpidem

Side Effects:

• Drowsiness and fatigue
• Dizziness or light-headedness
• Dry mouth
• Headache
• Unusual behaviors during sleep (e.g., sleepwalking, sleep-eating)

Summary of Key Points

1. Non-Medical Approaches First: Lifestyle changes and talking therapies are highly recommended before starting medication.
   • NHS: Tips to Reduce Anxiety
2. Medications for Anxiety and Depression:
   • SSRIs (e.g., Sertraline, Citalopram) are often the first choice, with treatment lasting at least 6-12 months.
   • SNRIs (e.g., Venlafaxine, Duloxetine) may be used if SSRIs aren’t effective.
3. Sedative Medications:
   • Benzodiazepines and Z-drugs (like Zopiclone) are reserved for short-term use only due to risks of dependence.

If you’re considering or starting medication, it’s essential to discuss the risks, benefits, and treatment timeline with your healthcare provider. Monitoring symptoms, working with your provider, and accessing support services are all important steps to ensure effective treatment.

Further Resources:

• Royal College of Psychiatrists: Antidepressants
• NHS: Mental Health Conditions
• Patient.info: Depression