Antidepressants for anxiety? The use of antidepressants for people with anxiety, like a generalised anxiety disorder, depression with anxiety, or sensitivity to psychosis with anxiety, is a much talked about topic in the psychiatric field.

Although medical literature suggests that antidepressants can be effective for treating these conditions, and of course there are people with impressive stories about how these medications have helped them, as a practising psychiatrist I see another picture forming. I wonder more and more if antidepressants are the right choice for anxiety or anxiety disorders, given the struggles I see my clients are facing.

Alleged effectiveness in literature versus practical experience

It is officially recognised that antidepressants can play a part in treating anxiety disorders.  They’re supposed to reduce the symptoms and thus improve the patients’ quality of life. But medical research is limited. Attention is paid only to selected groups of people, and they are only being observed for a very short time. The way in which the research is designed is ‘in favour of’ the medication that’s being researched.

Therefore, everyday practice shows us a whole different picture. It appears that many clients encounter problems when they start on the antidepressants. Especially during the build-up phase serious symptoms occur, like nausea, restlessness, and worsened fear. This happens because people with anxiety disorders are often extremely sensitive to physical side effects of antidepressants.

The vicious circle of symptoms of building up and reducing the medication

When starting on antidepressants, we often see clients being prescribed a tranquilliser as well, like lorazepam, to repress the initial side effects. However, this leads to a complex situation in which clients struggle for a long time to get used to the medication, while the side effects of starting the medication can actually worsen the anxiety.

Antidepressants for anxiety

As well as that, reducing antidepressants can also be a source of big problems. Clients with anxiety disorder seem to not only be sensitive to the symptoms caused by starting, but to reduction symptoms as well. This often causes clients getting stuck in a model in which they keep having to switch medications, every time having to deal with new starting- and reduction symptoms. This creates a cycle of increasing fear and changes in medication, and this cycle is very hard to break.

Alternatives to antidepressants for anxiety

So the question rises whether antidepressants are the right choice for anxiety disorders. In many cases, non-medicamentous treatment can be more effective and sustainable, and the guidelines support this. An important approach is exposure therapy, during which clients are gradually exposed to situations that evoke anxiety. This helps them facing their fears and it reduces the power their fears hold over them.

Furthermore, lifestyle changes can play a crucial part. Meditation, plenty of sleep, healthy food, and regular exercise can be significant factors in reducing anxiety. This approach does require a lot of motivation and dedication but can have positive and lasting effects without the side effects of medication.

Conclusion: Be cautious when using antidepressants for anxiety

My experience in practice made me dubious about routine usage of antidepressants for anxiety disorders. Yes, some people indicate that the antidepressant medication was effective, but this can often be explained by the non-specific placebo effect of the medication. Too often I see people struggle with the serious side effects of building up and reducing the medication. Though antidepressants can be useful in some cases, it’s essential to be really cautious when starting these medications for anxiety. Often, other approaches like exposure therapy and lifestyle changes are safer and more effective.

Therefore, I always advise people during the online consultation to think long and hard, and to consider several options before they start on antidepressants for treating anxiety. It is important to choose a treatment plan, that is not only effective, but also sustainable and bearable for the client.

Translated from Dutch by SGM Taplin