Mental Health
Performance Anxiety
Occasional feelings of anxiety and panic attacks are normal and, to a degree, a healthy biological response of our brains to sudden changes and difficulties we face in our lives. In everybody’s life, there will be such episodes. The anxiety or panic are meant to make you alert and focus on solving or escaping the situation. Once that is accomplished, the anxiety eases, the nerves cool down, and you can carry on with your normal life. That’s the healthy sort of anxiety and something most people are very familiar with.
It’s only when anxiety becomes chronic or panic attacks excessively frequent that doctors may diagnose a clinical condition that requires some form of treatment. This typically is the case when the anxiety is negatively affecting your daily life, work and social relationships. The five primary forms of anxiety disorder are:
Most people with anxiety disorder don’t exactly fit into one type but rather combine two or three types. Panic attacks can accompany any of these five categories of anxiety. There also is a panic disorder (characterized by repeated sudden but short-lasting panic attacks), which is classified as an anxiety disorder in its own right. However, it often appears associated with one or more other forms of anxiety disorder. For example, panic disorder is estimated to occur together with a general anxiety disorder in nearly 70% of cases.
Anxiety disorder is more common than you may think — one in every five U.S. adults will experience such clinical anxiety at least once in life. Often, the disorder disappears on its own, as anxiety-triggering factors and situations go away or change. For many other people, though, an anxiety disorder can become a long-term issue that needs treatment. The longer a person waits before seeking help, the more difficult it will be to treat and stop the anxiety.
Typically, the first line of treatment is anxiety therapy, where cognitive behavioural therapy (CBT) is the most commonly used method. It takes time but can be very effective, especially with mild and moderate cases of anxiety. A CBT therapist will teach to replace anxious thoughts with constructive thinking and show you other coping strategies.
However, in more severe anxiety cases, therapy often is combined with medications in a joint treatment approach. Your psychiatrist will determine what medication will be the most effective for you. Each case of anxiety disorder has unique circumstances and thus requires customized treatment. That said, doctors generally choose from the following lists of anxiety treating prescription medication options:
Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro, Paxil, Prozac, and Zoloft are a common choice of doctors for treating generalized anxiety disorder, social anxiety and OCD. Over the course of 5-6 weeks, SSRIs gradually increase serotonin levels in the brain, which has a dampening effect on anxiety, mood swings, and the occurrence of panic attacks. In fact, SSRIs are the most common prescription for treating panic disorder.
SSRIs not only are fairly effective but also relatively well tolerated by the body and brain. As with any drug, there, of course, are side effects, but these tend to be mild and moderate and limited to the first couple of months of treatment. Patients most often complain about a reduced libido, dizziness and loss of appetite. However, more severe side effects are rare.
Benzos, whose best-known representatives are Xanax and Valium can alleviate anxiety disorder, muscle spasms, and panic attacks. They used to be a popular medication option for treating anxiety and panic in the past, but their relatively strong potential side effects — including addiction, withdrawal symptoms, fatigue and memory loss — have caused them to fall out of favour. Particularly so as today several other options, like the above mentioned SSRIs, are available. If they are still prescribed, it’s typically for the medium-term of up to four months and not longer, in order to reduce the chances of forming a physical addiction.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta and Effexor have also been found to effectively treat general anxiety disorder. Because SNRIs came on the market much later than SSRIs, there still aren’t as many distinctly branded medications. Although SNRIs are now at par with SSRIs in the treatment of depression, in the treatment of anxiety disorders they aren’t quite as common yet.
SNRIs function through raising serotonin levels just like SSRIs. They thus also require at least one month of treatment before their full effect on reducing anxiety becomes apparent. Moreover, SNRI side effects also are similar to SSRIs.
Propranolol is a beta-blocker originally intended as blood pressure medication but later on found to also effectively treat a range of other conditions, including performance anxiety. It can be prescribed as an ad-hoc single-use medication that’s taken before an event that causes you anxiety or panic, such as a public speech, job interview, or important test. Propranolol only needs half an hour to show the first positive effects. As long as it’s only used occasionally on a single-use basis, propranolol has relatively few side effects.
It’s very likely that your psychiatrist will choose one of the four drug options introduced above when prescribing a treatment for your anxiety or panic attacks. Since every case is unique, there’s no one-fits-all medication that delivers the best results for everybody. It’s also possible that your doctor has you start out on one drug but later on may recommend changing to another or even combining two drugs for best results.
Your health record, family history, and other regular medications you may take also influence the decision of which medication you’ll get. As with every prescription, the ultimate aim is to carefully weigh and balance the drug’s effectiveness and side effect risks.
It’s important to bear in mind that most anxiety medications take several weeks before you’ll notice the first effects and improvement. During that time, as well as later on, anxiety therapy can be very helpful and effective.
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