8 best means of alarm
There are many drug review sites on the Internet. And, including, you can find information about many drugs that are recommended for anxiety. But, unfortunately, these articles are written by non-specialists, and therefore they often get drugs that have nothing to do with anxiety. For the most part, these reviews are devoted to over-the-counter free-prescription drugs, and therefore, Novopassit, Afobazol, Persen-Forte, valerian tincture and other drugs are the means of treating anxiety.
These are wonderful soothing medications, but the trouble is this: they don’t figure in the world (and domestic) clinical guidelines on the treatment of anxiety disorders. In fact, the global practice of treating anxiety disorders involves the use of completely different drugs, and they are prescribed by a specialist. Before proceeding to the story about these drugs, it is necessary to determine what anxiety is.
And what is anxiety?
The fact is that medicine is a science. And all concepts, and diagnoses, including anxiety, should be clearly defined. And in reviews of drugs written by non-professionals, anxiety medications are replaced by sedatives, anxiety disorder is called stress. Also in this group you can read about drugs for fear, for excitement and so on.
In fact, anxiety is called a special negative emotion of the paint, which is always vague, and is associated with the troubles that await a person in the future. Anxiety can be described as a vague, gnawing unpleasant apprehension. All the events that were in the past and that we have experienced are irrelevant to anxiety. For the past it can be painful, it can be embarrassing, sad, bitter. You may realize that we made a mistake, but we will never feel anxiety for the past. We will not, with only one exception: if the actions we have done in the past can greatly harm us in the future. Here, too, is anxiety.
Anxiety and fear are different conditions. The fear is completely concrete. You can fear death, spiders, motorcycles, dentists, the dark. Anxiety is always abstract, blurred, and therefore is experienced by a person much worse than fear. At least you can avoid the situation when you are scared. It is very difficult to get rid of anxiety on your own.
This drug review is about a form of anxiety called Generalized Anxiety Disorder (GAD). Not every alarm fits these criteria. So, here they are:
- an alarming condition that is difficult to control, and it lasts at least 6 months;
- the nature of the alarm is not caused by anything definite, and it is impossible to name the circumstances exactly, what the alarm is connected with, and what needs to be done to avoid it;
- This unpleasant condition is accompanied by many symptoms: a violation of concentration, irritability appears, insomnia arises, a person is restless, on the verge of collapse. Perhaps trembling appears, it is impossible to relax;
- there are vegetative reactions, such as dry mouth, sweating, memory decreases;
- sometimes alertness and irritability appear;
- however, a person often experiences incomprehensible experiences and feelings of guilt;
- by an effort of will it is in no way possible to suppress this unpleasant anxiety.
Criteria of so-called generalized anxiety disorder were listed in simple words. If there are several of these symptoms, then there is nothing shameful to contact an intelligent psychiatrist, to talk about these problems, the psychiatrist will diagnose and, if necessary, prescribe treatment.
Therefore, in the event that you with these complaints that meet the criteria for GAD, contact another specialist, and he does not advise you to contact a psychiatrist, and appoint a motherwort tincture, then you are looking for a real professional. Addressing a psychiatrist does not mean recognizing oneself as insane. To do this, there are other diagnoses, for example, bipolar disorder, it is a former manic-depressive psychosis, or schizophrenia. What is the treatment of serious anxiety disorder professionals?
Notes before reviewing drugs
There are a lot of unfamiliar names in this drug review. This should not be feared, since all drugs comply with official clinical guidelines. Accordingly, after reading this review, a person will know how to treat anxiety disorder seriously and professionally, and the article is written exclusively for educational purposes.
Since these drugs are sold only with a prescription, this review cannot be called a rating. Rating is a list of popularity. In the treatment of the disease there is no concept of "popular" or "unpopular drugs." There is the concept of "testimony" and "contraindications."
In the list of drugs initially given the international non-proprietary name, INN. In brackets are the various commercial varieties of this medicine, and usually the original drug that was developed by the very first comes first. As a rule, the original drug is always more expensive than its commercial copies. But at the same time, the original drug always has the largest evidence base, and it is the remedy with the least amount of side effects and the purest drug substance. The manufacturer of the original drug is always strictly monitors its business reputation.
It should be warned that the treatment of generalized anxiety disorder with original, the best means is not a cheap occupation. Drugs are by Russian standards quite expensive, but this is a fee for quality, for the minimum number of side effects, and, most importantly, for the result. To choose which drug to buy, of course, the patient always decides. But to insist and advise you to choose quality or cheapness is the task of the doctor. So, what drugs do professionals use to treat serious anxiety disorders, and what are their pros and cons?
Rating the best means of anxiety
| Nomination | a place | Name of product | price |
| Top SSRIs - selective serotonin reuptake inhibitors | 1 | Paroxetine (Paxil, Rexetine, Adepress) | 322 ₽ |
| 2 | Escitalopram (Tsipraleks, Selectra, Lenuksin, Elycea) | 437 ₽ | |
| 3 | Sertralin (Zoloft, Aleval, Center, Serenata, Serlift, Stimoton) | 1 149 ₽ | |
| Best SSRIs and tricyclic antidepressants | 1 | Klopyramine (Anafranil) | 317 ₽ |
| 2 | Duloxetine (Simbalta) | 3 234 ₽ | |
| 3 | Venlafaksin (Velaksin, Vellafaks, Venlaksor, Neweloong, Efevelon) | 1 174 ₽ | |
| Top Benzodiazepines | 1 | Diazepam (Relanium, Seduxen, Sibazon, Valium) | - |
| Do you have an over-the-counter anxiety remedy? - There is! | 1 | St. John's Wort - (Gelarium, Neuroplant, Negrustin, Deprim) | 1 436 ₽ |
SSRIs - selective serotonin reuptake inhibitors
Drugs with such a complex name are a group of real antidepressants, modern third-generation drugs.They are specifically designed to treat depression and serious forms of anxiety. In world practice, considerable experience has been gained in treating these diseases with the help of SSRIs, and they have replaced the old drugs from the group of tricyclic antidepressants.
Their predecessors had side effects associated with drug sedation. There was a drop in blood pressure with a sharp rise, or orthostatic hypotension, and anticholinergic side effects were also expressed. These included difficulty urinating, dry mouth, constipation, tachycardia, and erectile disorders. These side effects are remembered by everyone who used to take old antihistamines, such as Diphenhydramine, Suprastin or Pipolfen.
Antidepressants from the group of SSRIs do not have such roughly expressed side effects. The mechanism of action of these drugs is that they keep serotonin, which is called the “hormone of good mood” between neurons in the synaptic cleft, and prevent it from collapsing. Therefore, the “good mood hormone” acts longer than under physiological conditions. This allowed the use of these tools, including for the treatment of anxiety disorders.
Paroxetine (Paxil, Rexetine, Adepress)
Rating: 4.9
Rexetine is a typical representative of serotonin reuptake inhibitors, and has a psychostimulating effect. In addition to the treatment of generalized anxiety disorder, it is also used in panic attacks, and especially when a person is afraid to be in an open and crowded place, or in a crowd. This phenomenon is called agoraphobia. It helps Rexetin also to cope with the syndrome of obsessive thoughts and actions, that is, OCD (obsessive-compulsive disorder), as well as depressions of various origin, when they are accompanied by anxiety. The use of Rexetine helps prevent relapses of anxiety disorders.
In anxiety disorder, which is so long and generalized in nature, the recommended dose of the drug begins with a single pill, that is, 20 mg. In some cases, it can be doubled, but naturally, by decision of a psychiatrist. The maximum daily dose that a person can take with this kind of anxiety is 2 and a half tablets, or 50 mg per day. Rexetin is produced by the Hungarian company Gedeon Richter, and the cost of a package of 30 tablets of 20 mg is 765 rubles.
Advantages and disadvantages
A plus of Rexetin and Paxil is the fact that, compared with tricyclic antidepressants, they cause much less and less of their side effects, such as drowsiness and dry mouth, but you cannot suddenly cancel the drug. This can cause a variety of unpleasant symptoms, such as fear, tingling in the fingers, tremor, sweating. Therefore, after a long course of use, the doctor necessarily warns that a period of slow dosage begins. Every second day the dose is reduced. In some cases, there may be side effects, but, as a rule, they pass with time, and occur only at fairly high doses. Most often the patient feels nauseous, but not more often than in 12% of cases. Sometimes there is sweating, in 9% of cases, and dry mouth is noted 7% of all subjects.
Escitalopram (Tsipraleks, Selectra, Lenuksin, Elycea)
Rating: 4.8
Tsipralex is also an antidepressant from the group of SSRIs, and is indicated for the same disorders. With the help of Tsipraleks, depressive episodes of any severity are treated, and it is necessary to prescribe this drug for anxiety disorder, usually once a day, 10 mg each. In some cases, depending on the perception, the patient of the drug can double the dosage, but this will be the maximum dose.
Cipralex should be treated for a long time, the shortest duration of treatment is 3 months.But in order to avoid a recurrence of chronic anxiety, it is possible to apply the remedy for six months, according to the decision of the psychiatrist. The company Lundbeck from Denmark produces this drug, and its price is quite high: for a package of 14 tablets that will last for two weeks of treatment, you should, on average, pay 2200 rubles. If this price is not affordable, then you can choose a domestic analogue, escitalopram produced by the company Kanonpharma production. Then a pack of 28 tablets for a whole month of administration will cost 551 rubles. But the question of comparative efficiency remains open.
Advantages and disadvantages
Of the advantages of this drug, it is noted that if side effects occur, it is only at the very beginning of treatment, in the first or second week, and then their profile is smoothed out, and they may even disappear altogether. Most often there is a change in appetite, it can be both reduced and elevated. The patient may have unusual dreams, sometimes a slight tingling in the fingers of the type of paresthesias, there may be bouts of yawning. Quite often there may be slight nausea, as well as changes in the stool, increased sweating. Separately, it is noted that if the patient used drugs of Hypericum, it may increase the frequency and severity of side effects. However, escitalopram and tsipralex is a highly effective drug, and is used worldwide for the treatment of severe anxiety disorders.
Sertralin (Zoloft, Aleval, Center, Serenata, Serlift, Stimoton)
Rating: 4.7
The last representative of this group in the review is Zoloft. It is also used to relieve various depressive episodes, to prevent depression, to treat obsessive compulsive disorders, or obsessive-compulsive disorders. This tool perfectly copes with a panic attack, with various forms of social phobia.
Apply the drug should be once a day, regardless of the meal, and, which is especially convenient, do not need to take it at any particular time. So, Paxil and Rexetin need to be taken only in the morning, and Zoloft can already be taken when it pleases, the main thing is not to miss the deadline. The recommended dosage for generalized anxiety disorder begins with a dose of 50 mg per day, and if necessary, according to the decision of the doctor, it can be increased to 150 mg, but this will be the maximum dose.
In this case, the dose increase should be gradual: the interval should be at least a week before the next increase. Pfizer produces Zoloft, and a pack of 28 tablets for a month of administration in an average dosage of 100 mg costs 1250 rubles.
Advantages and disadvantages
Zoloft is reasonably safe, it can also be used in child psychiatry since the age of six. For the treatment of the elderly, it is not necessary to specifically adjust the dose, but if there is a chronic liver disease, then the agent must be taken at a lower dose, or the patient should be supervised. The big plus of sertraline in general, and Zoloft in particular, is the fact that he has almost no symptoms of overdose, even when he is prescribed in large doses.
But it is strictly forbidden to use alcohol during the treatment of anxiety disorder sertraline, since this can lead to the development of severe poisoning, up to a comatose state. If the patient is taking sertraline, then he should not take other drugs that affect the metabolism of serotonin. The case may end in a malignant neuroleptic syndrome. These drugs include triptans, which are used to treat migraine, as well as monoamine oxidase inhibitors.
Malignant neuroleptic syndrome is a very serious disorder that can be fatal, which is why treatment with serious prescription drugs that are highly effective must necessarily be prescribed by a doctor and under the supervision of a physician.
Best SSRIs and tricyclic antidepressants
Tricyclic antidepressants have long been used in the treatment of serious anxiety disorders. Although they have given up their place to SSRIs, they still apply. They have accumulated a very solid evidence base, the therapeutic power of dx is quite high. Previously, this was the main group of antidepressants, but gradually they were supplanted by more modern means, but some of them did not lose their value, especially in the treatment of prolonged and severe anxiety.
Tricyclics are relatively inexpensive, they can be purchased at any pharmacy, naturally with a prescription, and we remind you that by law, the prescription remains at the pharmacy, and it isn’t issued back to your hands. Also, tricyclic antidepressants (TCAs) are convenient because it is well known at what concentrations they are treating and at what concentrations they can show toxic effects. In addition, many laboratories carry out the determination of the concentration of tricyclic antidepressants in the blood and even their metabolites. Of these drugs, clopyramine, better known as Anafranil, is used to treat severe anxiety.
Another group of drugs is the so-called selective inhibitors of reuptake not only of serotonin, which has already been mentioned, but also of norepinephrine (NRIs). Otherwise, they are also called double-acting antidepressants. The advantage of this group is a rather low severity of side effects, good tolerability and great strength of action. They even exceed the strength of the drugs from the first group (SSRIs), but do not hold out to tricyclic antidepressants. They are used as drugs with a higher level of safety. According to current recommendations, such drugs include venlafaxine and duloxetine. These three tools will be discussed below.
Klopyramine (Anafranil)
Rating: 4.9
Tricyclic antidepressant Anafranil is indicated for the treatment of anxiety and depression, including in old age. It is used for the treatment of chronic pain, and in children over 5 years of age - for the treatment of nocturnal enuresis.
In case of anxiety, Anafranil is prescribed first in the minimum dosage - 75 mg, and the maximum daily dose is 200 mg. Moreover, the dose increases in a few days, and not more than 25 mg. Daily dose can not be increased. When the condition improves, then switch to a maintenance dose, going lower in a dose. The average duration of treatment is about 6 months. Anafranil company Novartis Pharma produces, and a package of 30 tablets of 25 mg costs, on average, 326 rubles. Therefore, with an average dosage of 100 mg per day, such a package is enough for a week or more.
Advantages and disadvantages
Anafranil has all the standard side effects of tricyclic antidepressants. There are many of them, and not everyone is well tolerated by this medicine. In case of overdose, symptoms of intoxication may occur, and in the elderly there are a large number of contraindications for prescribing TCAs. It is strictly prohibited during pregnancy, as it can cause congenital deformities of the fetus. Finally, there is the phenomenon of cross-resistance. If a patient had an ineffective tricyclic antidepressant that he had taken before, Anafranil would not help him either. But if it helps, it really does away with anxiety, since the strength of the therapeutic effect in TCAs is one of the highest.
Duloxetine (Simbalta)
Rating: 4.8
This drug is used not only for depression and anxiety, but also for patients with diabetes mellitus, if they have very bad legs due to diabetic polyneuropathy.It is necessary to take Simbalt in the beginning on one tablet once a day, and according to the decision of the doctor - the dose can be doubled, 120 mg is the maximum dose. Simbalta capsules should be swallowed whole, not to chew or crush. The fact is that the drug is absorbed only when it enters the intestine, and the gastric juice destroys this expensive drug. Simbaltu is produced by the Swiss company Eli Lilly, and one blister out of 14 tablets of 60 mg costs 1,850 rubles. Thus, two weeks of treatment with the original duloxetine will cost almost 2000 rubles. But peace is more precious ...
Advantages and disadvantages
Simbalta is, of course, better tolerated than Anafranil, and side effects most often show slight dizziness, sometimes dry mouth, possibly drowsiness or, on the contrary, insomnia. In no case can not take this drug with monoamine oxidase inhibitors (MAO), and this must be followed by the attending physician.
Venlafaksin (Velaksin, Vellafaks, Venlaksor, Neweloong, Efevelon)
Rating: 4.7
Velaksin is another drug from this group. It is shown in pure form for the treatment of anxiety disorders and depression, as well as for the prevention of their relapses. It is recommended to take the drug one capsule 1 time per day with meals. In some cases, it is possible to increase the daily intake to 2, and even up to 3 (maximum) capsules, but only by a doctor’s decision due to a severe anxiety disorder, and the dose should be increased no more than after 2 weeks. After clinical improvement and regression of anxiety have been achieved, the dose is again slowly reduced to a maintenance one.
In the case of depression, the continuation of treatment is at least 6 months; in the case of anxiety disorders, at least 3 months. The Hungarian company Egis is releasing the drug Velaksin, and a pack of 28 capsules of prolonged action costs 1110 rubles.
Advantages and disadvantages
Patients who take this medication should tell the doctor about all thoughts related to suicide (with depression), and in some cases, taking it may cause the need to move, anxiety and inability to sit still. Such a peculiar form of psychomotor arousal may be within the first few weeks after the start of therapy. There are also side effects. Patients often have unusual dreams, sometimes - rapid heartbeat, excessive sweating, in some cases, pain in the joints. Therefore, treatment should be carried out under the close supervision of a physician.
Top Benzodiazepines
Benzodiazepines are a long-known and widely used group of drugs that act on gamma-aminobutyric acid receptors (GABA). Many people know them as so-called tranquilizers or hypnotics. But including they are used to treat anxiety, panic attacks, some types of epilepsy, and, in particular, to treat anxiety.
Among them are drugs diazepam, lorazepam and weaker phenazepam. Phenazepam has already been described in a drug review of anti-insomnia drugs (read here), so the data on phenazepam will not be repeated here. It should only indicate that the recommended dose of phenazepam for the treatment of generalized anxiety disorder is from 1 to 3 mg daily, but at the same time, unlike all previous drugs described in this article, it has the lowest level of evidence. This does not mean that phenazepam does not cure anxiety. He treats, but still worse than the above drugs. Since both diazepam and lorazepam are drugs of the same group, we will describe diazepam as a typical representative.
Diazepam (Relanium, Seduxen, Sibazon, Valium)
Rating: 4.9
Diazepam, or Relanium, is widely used, ranging from the treatment of muscle cramps in tetanus, to psychomotor agitation of various etiologies. It is used for the treatment of neurosis with anxiety.In this case, the drug is prescribed in a dosage of 5 to 15 mg, with a gradual increase in dose. In case anxiety is combined with depression, and the patient talks about his suicidal thoughts, he should completely trust the doctor and be in constant contact with him. In the case of an acute anxiety attack, you can repeat the pill in three to four hours, but by the decision of the doctor. Diazepam (Sibazon) is produced by Organic, a domestic enterprise, and a pack of 20 tablets of Sibazon, 5 mg each, costs only 22 rubles. This, of course, is immeasurably cheaper than expensive imported antidepressants. By the way, diazepam is not an antidepressant.
Advantages and disadvantages
Dignity - low cost and speed of action. In general, at present, diazepam in its various forms is not the main way to relieve anxiety disorder and for long-term therapy tries not to apply, despite the high level of evidence and the great strength of the recommendations. He really stops anxiety, but most likely in emergency situations. For routine therapy, it is not suitable, because after taking diazepam tablets, you can not get behind the wheel, as well as work with dangerous machines and mechanisms.
Neuroleptics
Neuroleptics, or antipsychotics, is the classic "big psychiatry." With their help, psychosis is stopped, these drugs treat schizophrenia, hallucinations, delusional disorder, agitation, mania. However, according to the indications, atypical apsychotics can be used to treat generalized anxiety disorder. The advantages and disadvantages of each drug will not be listed here, since antipsychotics are particularly serious means, and this information will give nothing to a person without medical education. It is enough to list those antipsychotics that are used to treat serious anxiety disorders. This Seroquel company Astrazeneca, Truksal, or chlorprothixen production Lundbek. This is Azaleptin (Leponex).
It should be understood that neuroleptics are always “heavy” artillery, and are used not only in patients with a generalized anxiety disorder, but only with a disorder that is resistant to antidepressant therapy and other treatments (psychotherapy). Sometimes experts combine antidepressants and antipsychotics in therapy. But here everything is not so simple.
Recent studies have shown that these antipsychotics can upset the balance of satiety, appetite and hunger, leading to an increase in body weight. This side effect is often expressed in their application. Some studies show that atypical antipsychotics can cause changes in carbohydrate metabolism and insulin resistance. In addition to such metabolic complications, the risk of heart rhythm disturbances is not excluded, since all atypical antipsychotics can potentially prolong the electrocardiographic QT interval.
Therefore, when anxiety drugs from the group of antipsychotics are used very rarely. What to do? All drugs listed in the article are extremely serious, prescription, and only a psychiatrist working with such patients can write them out. Neither the therapist, nor even the neurologist can write them out. Is there no way out? Is it really necessary to go only to a psychiatrist? With severe and prolonged anxiety disorder - naturally, yes.
Do you have an over-the-counter anxiety remedy? - There is!
Above it was enough talked about serious drugs that doctors prescribe for the treatment of serious anxiety disorders. But what to do in the event that anxiety does not reach the symptoms mentioned at the beginning? If she does not really interfere with life, but only sometimes "rolls up"? In this case, there is an excellent way out, namely: the herbal preparation is St. John's wort.
St. John's Wort - (Gelarium, Neuroplant, Negrustin, Deprim)
Rating: 4.9
There are many herbal preparations of Hypericum, and in our country you can purchase Gelarium, Neuroplant, Negrustin, Deprim, and even Doppelgerz nervotonik. In fact, the vegetable raw material of Hypericum is known for its anti-depressive and anti-anxiety effect since ancient times, and in Ancient Greece and Rome, Hypericum was used to treat depression and anxiety. These were various decoctions, tinctures and extracts. Currently, these funds are still used for these purposes.
Since 1998, in Western European countries, these drugs have received a formal license, and a large evidence base. With mild to moderate depression and anxiety, their effect was comparable to the effect of the above listed antidepressants from the SSRI group. Of course, Hypericum preparations are safer than prescription benzodiazepines, antidepressants, and especially antipsychotics. They are well tolerated, and repeal the St. John's wort accounts for much less. How to take these "plant anti-anxiety"?
So, Gelarium is applied in a dosage of 1 tablet three times a day with meals, and the course of administration must be at least a month. An improvement should take place just in a month (a quick change in mood should not be expected), and the same period applies to all Hypericum preparations.
Advantages and disadvantages
However, there are downsides. One of them will be photosensitivity. If the drug is taken in the summer, you can not be in the open sun, because you can get serious burns. By the way, this is why this grass was named St. John's Wort. Overdose can cause fatigue, dry mouth, redness of the skin and gastrointestinal disorders. However, this is really the way out for mild anxiety disorder.
Of course, there is no such medicine that does not have side effects. There is no good without a blessing. Therefore, if a patient with a depressive episode or an anxiety disorder wants to be treated completely without side effects, then psychotherapy courses are also shown, which are also included in the clinical guidelines for treating anxiety.
Attention! This rating is subjective, is not advertising and does not serve as a guide to the purchase. Before buying, you should consult with a specialist.
