We all get anxious sometimes. It is perfectly normal to feel anxiety on some occasions-giving a talk, dealing with a phobia such as flying, going for a job interview. It is when we feel anxious for no apparent reason and this anxiety attack persists and interferes with our normal life, that it becomes a disorder. That is when we need to seek the help of a doctor.



Doctors have found that different types of anxiety attacks respond to different types of medication. The clinician has a major responsibility in two areas: before prescribing, to carry out a thorough assessment of the patient's condition; and after prescribing, to monitor the response and whether side effects occur.

So which drugs might the doctor suggest? Broadly, they fall into two categories: anti-depressant drugs and anti-anxiety drugs.

There are three main types of anti-depressants. The first is SSRIs (selective serotonin reuptake inhibitors). These are often the drug of choice for anxiety disorders because they correct the chemical imbalance in the brain that is the cause of anxiety attacks. They can include Calexa, Paxil, Prozac and Zoloft. They can have side effects-mainly nausea, vomiting, diarrhea, nervousness and sexual dysfunction. Most of these do not persist, but if they do, the dose needs to be adjusted.

The second type of anti-depressant is Tricyclics. These work by helping neurotransmitters such as serotonin work more effectively in the brain, and are especially effective for panic attacks. They are more likely to have side effects than SSRIs-the most noticeable being weight gain. Others can be drowsiness, dry mouth and dizziness.

The third main type of anti-depressant is MAOIs (monoamine oxidose inhibitors). These involve dietary restrictions so doctors prefer to try the others first. Anyone taking an MAOI must avoid wine and beer and any food containing tyramine such as cheese. They must also be very careful before taking any other medications, as these can interact with the drug to cause a sudden dangerous rise in blood pressure.

The other category is anti-anxiety drugs.

For an acute anxiety attack, the first choice is often short-term treatment with benzodiazepines. These relieve this condition by acting on the limbic system- the part of the brain from which our deepest emotional responses come. Common benzodiazepines include Ativan, Valium and Librium. Possible side effects can include agitation, confusion, drowsiness and impaired memory, though many patients escape these. However, the main problem is that some patients can become dependent or addicted. If a patient is known to have had a problem with addiction, such as drugs or alcohol, doctors sometimes prefer to prescribe a different medication such as BuSpar (not a benzodiazepine but an effective anti-anxiety agent that is not addictive).

It is essential that the patient understands that taking any sedative, particularly alcohol, in combination with benzodiazepines is potentially lethal. Of course, suffering from an anxiety attack makes it very tempting to drink alcohol and many do, resulting in serious and costly problems. Consequently the prescribing of benzodiazepines is restricted or monitored in many states.

For some patients, physicians may prefer to prescribe beta-blockers. These are drugs that are often used for heart and circulatory conditions like hypertension. However, because they work by preventing stress chemicals from increasing the heart rate, they are effective for patients with symptoms like palpitations, sweating and tremors. They are also helpful for social phobias and are useful when facing stressful social situations like public speaking.

If you think you are suffering from an anxiety attack disorder and feel the need to consult a physician for a prescription, remember that you have some responsibility, too. Do not just leave it all to the doctor. Do your own homework. Find out the drug's potential side effects and consider whether you could live with them. Be sure that your doctor is aware of other medications you are taking, including over-the-counter medicines. And take your doctor's advice on continuing or stopping the drug and what not to take in combination with it.

Finally, remember that solutions to anxiety attacks do not all reside in a bottle. There are other ways you can be helped-counseling, talk therapy, group therapy. Ask yourself if your lifestyle has contributed to the problem-for instance, diet, irregular sleep patterns or overwork.

And do not lose heart. Most anxiety attack disorders have a solution. Your doctor can help you find the one that is right for you.

Summary:

We all get anxious sometimes due to some reason or the other. But if you get an anxiety attack without any apparent reason, it spells trouble. Then you know that you have to consult your doctor and start taking anti-anxiety prescription drugs to help you deal with the problem.