Reviewed By: Pramod Kerkar, MD, FFARCSI

Common fear or worry to a stressful situation is acceptable and does not pose any problem. However, when there is overwhelming and abnormal sense of fear and apprehension that leads to various physical symptoms, it becomes worrisome and needs medical help. These symptoms become frequent and persistent and may interfere with the person’s daily activities and take a toll on relationships, school work or job performance. Anxiety is very common of mental health condition and may affect nearly 30% of the total population.

People may present with anxiety at different levels and different scenarios. The common types of anxiety are generalized anxiety disorder, panic disorder, phobias, agoraphobia, social phobia and separation anxiety.

What Is The Best Mood Stabilizer For Anxiety?

Anxiety can be treated with psychotherapy; cognitive behavior therapy; body, mind and soul therapy; breathing techniques and medications. Medications to treat anxiety include anxiolytics, such as benzodiazepines; antidepressants, including SSRIs, SNRIs, MAOIs and tricyclic antidepressants; buspirone and beta blockers. Choosing the right medication is important for effective management of symptoms.

Mood stabilizers are commonly used to treat mood disorders, such as bipolar disorder and schizoaffective disorder. They help stabilize mood swings and reduce the associated symptoms. Mood stabilizers can be divided into lithium, anticonvulsants (carbamazepine, valproic acid, lamotrigine, gabapentin, topiramate) and antipsychotics (olanzapine, clozapine, risperidone). Lithium is the most common drug prescribed.

There are times when anxiety can co-exist with other mental disorders, as in conjunction with depression, bipolar disorders or OCD. When present in combination with depression, antidepressants can be used to treat both anxiety and depression; however, when anxiety is present with bipolar disorder, the medication prescription becomes a little complicated.

Mood stabilizers need to be prescribed for bipolar disorder, which helps regulate mood and prevent from mood fluctuations, either too euphoric (mania) or too low (depression). When anxiety and bipolar co-exist, the approach is to first treat bipolar symptoms with a mood stabilizer. If anxiety is treated first with an antidepressant; it may trigger manic episodes worsening bipolar symptoms. Benzodiazepines can be used to treat anxiety, which do not seem to affect bipolar symptoms negatively in patients suffering from anxiety and bipolar at the same time. However, one should be wary of the side-effects of benzodiazepines and avoid prescribing them for long term use due to the development of tolerance and physical dependence. They should not be prescribed in patients with OCD or who have a history of substance abuse.

Benzodiazepines may be ineffective or intolerable for some patients with anxiety, so there is no other option but to treat with antidepressant. SSRIs such as paroxetine and bupropion can be used to treat anxiety in cases where it co-exists with bipolar disorder. They are known to cause less side-effect of acute mania; however, they should be prescribed in lower doses. They should be used for short term only as some patients bipolar may worsen if used for long term treatment.

It is worth noting that, in many cases benzodiazepines and antidepressants are not required for the additional treatment of anxiety in bipolar patients who have co-existing anxiety, as their anxiety symptoms improve after treatment with mood stabilizers. For this reason, it is logical to treat bipolar first when anxiety and bipolar co-exist, as further need of anxiety medication may not be needed. Antianxiety medications should only be added, if anxiety symptoms persist despite treatment with mood stabilizers. The exception to this approach includes treating panic attacks, as they need to be settled first hand and immediately.

Based on the mechanism of action, some mood stabilizers have more pronounce antianxiety effect than others. Divalproex is one such mood stabilizer that stimulates GABA receptors, thus helping ease anxiety. Gabapentin is another mood stabilizer that has profound antianxiety effect; however, its mood stabilizing effects are weak, thus it is not prescribed alone for mood stabilization, but used in combination with other mood stabilizers to help achieve antianxiety effect in bipolar patients.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: February 25, 2019

This article does not provide medical advice. See disclaimer

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