8 modern remedies for anxiety

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

There are many drug review sites on the internet. And, among other things, you can find information about many medicines that are recommended for anxiety. But, unfortunately, these articles are written by non-specialists, and therefore, they often contain drugs that have nothing to do with anxiety. For the most part, these reviews are devoted to over-the-counter drugs, and therefore Novopassit, Afobazol, Persen-Forte, valerian tincture and other drugs are the means of treating anxiety.

These are wonderful anti-anxiety drugs, but the trouble is: they do not appear in the world (and domestic) clinical guidelines on the treatment of anxiety disorders. In fact, the world 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.

What is anxiety?

The point is that medicine is a science. All concepts and diagnoses, including anxiety, must be clearly defined. And in layman drug reviews, anxiety drugs are substituted for anti-anxiety drugs, anxiety disorder called stress. Also in this group you can read about drugs for fear, anxiety, and so on.

In fact, anxiety is called a special emotion of negative paint, which is always vague, and is associated with the troubles that await a person in the future. Anxiety can be characterized as a vague, gnawing unpleasant feeling. All the events that were in the past and that we experienced have nothing to do with anxiety. For the past it can be painful, it can be ashamed, insulting, bitter. You can realize that we have made a mistake, but we will never feel anxiety about 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. In this case, too, anxiety.

Anxiety and fear are different states. The fear is very specific. You can be afraid of death, spiders, motorcycles, dentists, darkness. Anxiety is always abstract, blurred, and therefore experienced by a person is much worse than fear. At the very least, you can avoid the situation when you are afraid. It is very difficult to get rid of anxiety on your own.

This drug review focuses on a specific form of anxiety called generalized anxiety disorder (GAD). Not every alarm fits these criteria. So, here they are:

1. anxiety that is difficult to control and lasts at least 6 months;
2. the nature of the anxiety is not caused by anything definite, and it is impossible to accurately name the circumstances with which the anxiety is associated, and what needs to be done to avoid it;
3. this unpleasant condition is accompanied by many symptoms: impaired concentration, irritability appears, insomnia occurs, the person is restless, is on the verge of collapse. Perhaps there is a trembling, there is no way to relax;
4. autonomic reactions occur, such as dry mouth, sweating, memory loss;
5. sometimes there is alertness and irritability;
6. at the same time, often a person experiences incomprehensible experiences and feelings of guilt;
7. an effort of will does not succeed in suppressing this unpleasant anxiety.

In simple terms, the criteria for the so-called generalized anxiety disorder were listed. If there are several of the listed symptoms, then there is nothing shameful to go to a sensible doctor – psychiatrist, tell about these problems, the psychiatrist will diagnose and, if necessary, prescribe treatment.

Therefore, if you are with these complaints that meet the GAD criteria, contact another specialist, and he will not advise you to contact a psychiatrist, but prescribe a motherwort tincture, then you are looking for a real professional. Going to a psychiatrist does not mean admitting yourself to be crazy. For this, there are other diagnoses, for example, bipolar disorder, it is also a former manic-depressive psychosis, or schizophrenia. How do professionals treat serious anxiety disorder?

Precautions before drug review

There will be many 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 for educational purposes only.

Since these drugs are only sold by prescription, this review cannot be called a rating. Rating is a list of popularity. There is no concept of 'popular' or 'unpopular drugs' in the treatment of a disease. There is a concept of 'indications' and 'contraindications'.

The list of drugs is first given an international non-proprietary name, INN. In brackets are the various commercial varieties of this drug, and usually the original drug, which was developed by the very first, comes first. As a rule, the original drug is always more expensive than its commercial counterparts. But at the same time, the original drug always has the largest evidence base, and it is the drug with the least side effects, and the purest drug substance. The manufacturer of the original drug always strictly monitors its business reputation.

It should be warned that treating generalized anxiety disorder with original and best remedies is not cheap. The drugs are quite expensive by Russian standards, but this is a price for quality, for the minimum number of side effects, and, most importantly, for the result. Of course, the patient always decides which drug to buy. But insisting and advising to choose quality or cheapness is the doctor's task. So, what drugs do professionals use to treat serious anxiety disorders, and what are their pros and cons?

Anxiety remedy overview

Nomination	a place	Name of product	price
SSRI Review – Selective Serotonin Reuptake Inhibitors	1	Paroxetine (Paxil, Reksetin, Adepress)	322 r
	2	Escitalopram (Cipralex, Selektra, Lenuxin, Elicea)	437 r
	3	Sertraline (Zoloft, Aleval, Asentra, Serenata, Surlift, Stimuloton)	RUB 1,149
Overview of SNRIs and tricyclic antidepressants	1	Clopiramine (Anafranil)	317 r
	2	Duloxetine (Simbalta)	RUB 3,234
	3	Venlafaxine (Velaxin, Velafax, Venlaxor, Newvelong, Ephevelon)	RUB 1,174
Benzodiazepines	1	Diazepam (Relanium, Seduxen, Sibazon, Valium)	–
Is there an OTC remedy for anxiety? – There is!	1	St. John's wort – (Gelarium, Neuroplant, Negrustin, Deprim)	RUB 1,436

SSRIs – selective serotonin reuptake inhibitors

Medicines 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 accumulated in the treatment of these diseases using SSRIs, and they have replaced the old drugs from the group of tricyclic antidepressants.

Their predecessors had significant side effects associated with drug sedation. There was a drop in blood pressure with a sudden rise, or orthostatic hypotension, and cholinolytic side effects were also expressed. These included difficulty urinating, dry mouth, constipation, tachycardia, and erectile dysfunction. These side effects are remembered by everyone who at one time took old antihistamines, such as Diphenhydramine, Suprastin or Pipolfen.

Antidepressants from the SSRI group do not have such severe side effects. The mechanism of action of these drugs is that they trap serotonin, called the 'good mood hormone' between neurons in the synaptic cleft, and prevent it from being destroyed. Therefore, the 'good mood hormone' lasts longer than under physiological conditions. This made it possible to use these funds, including for the treatment of anxiety disorders.

Paroxetine (Paxil, Reksetin, Adepress)

Popularity rating: 4.9

Reksetin is a typical representative of serotonin reuptake inhibitors, and has a psychostimulant effect. In addition to treating generalized anxiety disorder, it is also used for 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. Reksetin also helps to cope with the syndrome of obsessive thoughts and actions, that is, OCD (obsessive-compulsive disorder), as well as with depression of various origins, when they are accompanied by anxiety. The use of Reksetin helps prevent relapse of anxiety disorders.

For anxiety disorder, which is of such a long and generalized nature, the recommended dose of the drug starts with one tablet, that is, 20 mg. In some cases, it can be doubled, but naturally, by the decision of a psychiatrist. The maximum daily dose a person can take for this type 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 each is 765 rubles.

Advantages and disadvantages

The advantage of Reksetin and Paxil is the fact that, compared to tricyclic antidepressants, they are much smaller and less likely to cause 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, tremors, sweating. Therefore, after a long course of use, the doctor must warn that a period of slow dosage reduction begins. Every second day the dose is reduced. In some cases, there may be side effects, but, as a rule, they disappear over time, and only occur at high enough doses. Most often, the patient experiences nausea, but not more often than 12% of cases. Sometimes there is sweating, in 9% of cases, and dry mouth is noted by 7% of all subjects.

Escitalopram (Cipralex, Selektra, Lenuxin, Elicea)

Popularity rating: 4.8

Cipralex is also an SSRI antidepressant, and is indicated for the same disorders. With the help of Cipralex, depressive episodes of any severity are treated, and this drug should usually be prescribed for anxiety disorder, 10 mg once a day. In some cases, depending on the patient's perception, the drug can be doubled by the patient, but this will already 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 relapses of chronic anxiety, you can use the remedy for six months, according to the decision of the psychiatrist. This drug is produced by the Lundbeck company from Denmark, and its price is quite high: for a package of 14 tablets, which is enough for two weeks of treatment, you should, on average, pay 2,200 rubles. If such a price is not affordable, then you can choose a domestic analogue, escitalopram produced by Canonpharm production. Then a pack of 28 tablets, designed for a whole month of admission, will cost 551 rubles. But the question of comparative effectiveness remains open.

Advantages and disadvantages

Of the advantages of this drug, it is noted that if side effects occur, then 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 either decreased or increased. The patient may have unusual dreams, sometimes a slight tingling sensation in the fingers like paresthesias, and yawning attacks may occur. Quite often, slight nausea can be noted, as well as changes in stool, sweating increases. It is separately noted that if the patient used St. John's wort preparations, then this can increase the frequency and severity of side effects. However, escitalopram and Cipralex are highly effective drugs and are used worldwide for the treatment of severe anxiety disorders.

Sertraline (Zoloft, Aleval, Asentra, Serenata, Surlift, Stimuloton)

Popularity rating: 4.7

The last representative from this group in the review is Zoloft. It is also used to relieve various depressive episodes, to prevent depression, to treat obsessive-compulsive disorder, or obsessive-compulsive disorders. This remedy is great for dealing with panic attacks and various forms of social phobia.

It is necessary to use the drug once a day, regardless of food intake, and, which is especially convenient, you do not need to take it at any specific time. So, Paxil and Reksetin need to be taken only in the morning, and Zoloft can already be taken at will, the main thing is not to miss the deadline. The recommended dosage for generalized anxiety disorder starts with a dose of 50 mg per day, and if necessary, by the decision of the doctor, it can be increased to 150 mg, but this will already be the limiting dose.

In this case, the dose increase should be gradual: the interval should be at least a week before the next increase. Zoloft is produced by Pfizer, and a pack of 28 tablets, designed for a month of administration at an average dosage of 100 mg, costs 1250 rubles.

Advantages and disadvantages

Zoloft is safe enough, it can be used in child psychiatry, starting from 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 in a lower dose, or the patient must be monitored with extreme caution. A big plus of sertraline in general, and Zoloft in particular, is the fact that he has practically 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 with sertraline, since this can lead to the development of severe poisoning, up to a coma. If the patient is taking sertraline, then he should not take other drugs that affect the exchange of serotonin. The case may end with neuroleptic malignant syndrome. These drugs include triptans, which are used to treat migraines, and monoamine oxidase inhibitors.

Neuroleptic malignant syndrome is a very serious disorder that can be fatal, which is why treatment with serious prescription drugs that are highly effective must be prescribed by a doctor and under the supervision of a doctor.

Overview of SNRIs and tricyclic antidepressants

Tricyclic antidepressants have long been used in the treatment of serious anxiety disorders. Although they gave way to SSRIs, they are still being used. They have developed a very solid evidence base, the therapeutic power of dx is quite high. Previously, it was the main group of antidepressants, but gradually they were replaced by more modern means, but some of them have not lost their importance, especially in the treatment of long and severe anxiety.

Tricyclics are relatively inexpensive, they can be purchased at any pharmacy, naturally with a prescription, and we remind you that, according to the law, the prescription remains in the pharmacy and is not returned to your hands. Also, tricyclic antidepressants (TCAs) are convenient in that it is well known at what concentrations they treat, and at what concentrations they can show toxic effects. In addition, many laboratories determine the concentration of tricyclic antidepressants in the blood and even their metabolites. Of these drugs, clopyramine, better known as Anafranil, is used in the treatment of severe anxiety.

Another group of drugs is the so-called selective inhibitors of the reuptake of not only serotonin, which has already been mentioned, but also norepinephrine (SNRI). Otherwise, they are also called dual-acting antidepressants. The advantage of this group is the rather low severity of side effects, good tolerance and high strength of action. They are even superior in strength to drugs from the first group (SSRIs), but they do not quite reach the tricyclic antidepressants. They are used as drugs with a higher level of safety. These drugs, according to current recommendations, include the drugs venlafaxine and duloxetine. These three means will be discussed below.

Clopiramine (Anafranil)

Popularity rating: 4.9

The tricyclic antidepressant Anafranil is indicated for the treatment of anxiety and depression, including in old age. It is also used to treat chronic pain, and in children over 5 years old, to treat nocturnal enuresis.

In case of anxiety, Anafranil is first prescribed in a minimum dosage of 75 mg, and a maximum daily dose of 200 mg. Moreover, the dose is increased in a few days, and no more than 25 mg. Do not increase the daily dose. When the condition improves, they switch to a maintenance dose, going down in a lower dose. The average duration of treatment is about 6 months. Anafranil is produced by Novartis Pharma, and a pack of 30 25 mg tablets costs an average of 326 rubles. Therefore, with an average dosage of 100 mg per day, such a package will be enough for a week or more.

Advantages and disadvantages

Anafranil has all the standard side effects of tricyclic antidepressants. There are a lot of them, and not everyone tolerates this medicine well. In case of an overdose, symptoms of intoxication may occur, and in the elderly there are a large number of contraindications to the appointment of TCAs. The remedy is strictly prohibited during pregnancy, since it can cause congenital malformations of the fetus. Finally, there is the phenomenon of cross-resistance. If any tricyclic antidepressant that he has taken before is ineffective in the patient, then Anafranil will not help him either. But in the event that it helps, it really relieves anxiety, since the strength of the therapeutic effect of TCA is one of the highest.

Duloxetine (Simbalta)

Popularity rating: 4.8

This drug is used not only for depression and anxiety, but also in patients with diabetes mellitus, if their legs are very sore due to diabetic polyneuropathy. It is necessary to take Simbalta at first one tablet once a day, and by the decision of the doctor, the dose can be doubled, 120 mg is the maximum dose. Simbalta capsules should be swallowed whole, in no case chewed or crushed. The fact is that the drug is absorbed only after entering the intestines, and gastric juice destroys this expensive drug. Simbalta is produced by the Swiss company Eli Lilly, and one blister of 14 60 mg tablets costs 1,850 rubles. Thus, two weeks of treatment with the original duloxetine will cost almost 2,000 rubles. But peace is more expensive …

Advantages and disadvantages

Simbalta is certainly better tolerated than Anafranil, and of the side effects, mild dizziness, sometimes dry mouth, possibly drowsiness or, on the contrary, insomnia are most often noted. In no case should this drug be taken together with monoamine oxidase (MAO) inhibitors, and the attending physician must be sure to monitor this.

Venlafaxine (Velaxin, Velafax, Venlaxor, Newvelong, Ephevelon)

Popularity rating: 4.7

Velaxin is another drug from this group. It is indicated in its pure form for the treatment of anxiety disorders and depression, as well as for the prevention of their recurrence. 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, or even up to 3 (maximum) capsules, but only by the decision of the doctor in connection with severe anxiety disorder, and the dose should be increased no more than 2 weeks later. After clinical improvement and regression of anxiety have been achieved, the dose is slowly reduced again to a maintenance dose.

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 produces the drug Velaxin, and a package of 28 capsules of prolonged action costs 1110 rubles.

Advantages and disadvantages

Patients taking this drug should tell the doctor about all thoughts of suicide (for depression), and taking it can in some cases cause the need to move, anxiety and inability to sit still. This peculiar form of psychomotor agitation can be present during the first few weeks after the start of therapy. There are also side effects. Patients often have unusual dreams, sometimes rapid heartbeat, excessive sweating, and in some cases joint pain. Therefore, treatment should be carried out under the close supervision of a physician.

Overview of benzodiazepines

Benzodiazepines are a well-known and widely used group of drugs that act on the receptors for gamma-aminobutyric acid (GABA). Many people know them as so-called tranquilizers or sleeping pills. But they are also used to treat anxiety, panic attacks, some types of epilepsy, and, in particular, to treat anxiety.

Among them are the drugs diazepam, lorazepam and the weaker phenazepam. Phenazepam has already been described in the drug review of drugs for insomnia (read here), so the data on phenazepam will not be repeated here. It should only be pointed out that the recommended dose of phenazepam for the treatment of generalized anxiety disorder is 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 is not to say that phenazepam does not treat anxiety. It cures, 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)

Popularity 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 also used to treat neuroses with anxiety. In this case, the drug is prescribed in a dosage of 5 to 15 mg, with a gradual increase in the dose. In the event that anxiety is combined with depression, and the patient talks about his suicidal thoughts, then he should completely trust the doctor and be in constant contact with him. In the event of an acute anxiety attack, you can repeat taking the pills after three to four hours, but at the decision of the doctor. Diazepam (Sibazon) is produced by the domestic company Organika, and a package of 20 Sibazon tablets of 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 – cheapness and speed of action. In general, at present, diazepam in its various forms is not the main method for relieving anxiety disorder and is trying not to be used for long-term therapy, despite the high level of evidence and the great strength of the recommendations. It does relieve anxiety, but most likely in an emergency. It is not suitable for routine therapy, because after taking diazepam tablets, you cannot drive, and also work with dangerous machines and mechanisms.

Antipsychotics

Antipsychotics, or antipsychotic drugs, are classic 'big psychiatry'. With their help, psychoses are stopped, these drugs are used to treat schizophrenia, hallucinations, delusional disorder, agitation, mania. However, when indicated, 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 especially serious means, and this information will not give anything to a person without medical education. Suffice it to list those antipsychotics that are used to treat serious anxiety disorders. This is Seroquel from Astrazeneca, Truxal, or chlorprothixene from Lundbeck. This is Azaleptin (Leponex).

It should be understood that antipsychotics are always 'heavy' artillery, and are used not just in patients with generalized anxiety disorder, but only with those disorders that are resistant to antidepressant therapy and other treatments (psychotherapy). Sometimes specialists combine antidepressants and antipsychotics in therapy. But here everything is far from so simple.

Recent studies have shown that these antipsychotics can disrupt the balance of satiety, appetite and hunger, leading to weight gain. This side effect is quite often expressed when using them. Some research suggests 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 lengthen the electrocardiographic QT interval.

Therefore, in case of 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 who works with such patients can prescribe them. Neither a therapist nor even a neurologist has the right to prescribe them. Is there really no way out? Is it really necessary to go only to a psychiatrist? For severe and long-term anxiety disorder, of course yes.

Is there an OTC remedy for anxiety? – There is!

Above, enough has been said about the serious drugs that doctors prescribe for the treatment of serious anxiety disorders. But what if the anxiety does not reach the symptoms that were described 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: a herbal preparation – St. John's wort.

St. John's wort – (Gelarium, Neuroplant, Negrustin, Deprim)

Popularity rating: 4.9

There are many herbal preparations of St. John's wort, and in our country you can buy Gelarium, Neuroplant, Negrustin, Deprim, and even Doppelgerts nervotonik. In fact, the herbal raw material of St. John's wort has been known for its antidepressant and anti-anxiety effects since ancient times, and it was used in ancient Greece and Rome 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 Europe, these drugs have received an official license, and a large evidence base. For mild to moderate depression and anxiety, their effect was comparable to the effect of the above antidepressants from the SSRI group. Of course, St. John's wort preparations are safer than prescription benzodiazepines, antidepressants, and even more so antipsychotics. They are well tolerated, and St. John's wort has to be canceled much less often. How to take these 'herbal anti-anxiety' drugs?

So, Gelarium is used in a dosage of 1 tablet three times a day with meals, and the course of administration should be at least a month. Just a month later, there should be an improvement (you should not wait for a quick change in mood), and the same period applies to all St. John's wort preparations.

Advantages and disadvantages

However, there are also disadvantages. One of them will be photosensitivity. If the drug is taken in the summer, you should not be in the open sun, as you can get serious burns. By the way, that is why this herb was named St. John's wort. Overdose may result in fatigue, dry mouth, skin redness, and gastrointestinal upset. However, this is really the way out for mild anxiety disorder.

Of course, there is no medicine that does not have side effects. There is no good without a thin layer. Therefore, if a patient with a depressive episode or anxiety disorder wants to be treated without side effects at all, then he is shown psychotherapy courses, which are also included in the clinical guidelines for the treatment of anxiety.

The popularity rating is based on the analysis of demand data from the wordstat.yandex.ru service.

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Attention! This rating is subjective and does not constitute an advertisement and does not serve as a purchase guide. Before buying, you need to consult with a specialist.