Medicines for anxiety

People experience anxiety in different ways. Anxiety can include feelings of fear, dread, unease, or even tight muscles. Some of these symptoms can contribute to physical pain during breast cancer treatment.

If you are concerned about anxiety, let your healthcare team know. There are many ways you can take care of yourself if you're feeling anxious. But sometimes, more is needed. One option to treat these symptoms is prescription medicine. Medicine is often used in combination with psychotherapy to help relieve anxiety. It is OK, and very common, to take medicine while you are learning new coping skills!

Doctors use many different medicines to manage anxiety that results from cancer or its treatment. These medicines work differently, and all can cause side effects. Side effects sometimes lessen over time.

Choosing a medicine depends on many factors, including other medicines you take and your unique needs. Some can take several weeks to start working, so don’t give up! Continue taking them as prescribed, even if you don’t feel better right away. And if you don’t like the way a medicine makes you feel, let your doctor know. There are many options.

We know that a breast cancer diagnosis and treatment can bring many different emotions, and we're here for you. Below, we'll talk about some of the medicines used to treat anxiety. You can also visit our pages on anxiety, depression, and finding emotional support to learn about additional ways to feel better.

Antidepressants

Antidepressants were developed to treat depression, but they can also help treat symptoms of anxiety that may be triggered by a breast cancer diagnosis or its treatment. There are different types of antidepressants, including selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the standard therapy to treat anxiety and depression together. They include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Although SSRIs are relatively safe, they can cause some short-term side effects, including:

• Anxiousness or agitation
• Diarrhea or constipation
• Dizziness
• Dry mouth
• Headache
• Insomnia or drowsiness
• Nausea and vomiting
• Changes in sexual function, such as difficulty reaching orgasm or loss of interest in sex
• Weight loss or gain

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs may also be used to treat anxiety and pain. These medicines include:

• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)
• Levomilnacipran (Fetzima)
• Venlafaxine (Effexor)

Side effects are usually short-term. The most common are:

• Dizziness
• Dry mouth
• Excessive sweating
• Changes in sexual function, such as difficulty reaching orgasm and loss of interest in sex

Antidepressants used to treat anxiety are usually started at low doses that will be increased over time. They take about 3 to 6 weeks to start working, so don't worry if you don't feel better right away.

Antidepressants and tamoxifen

If you're taking tamoxifen to help reduce the risk of early-stage breast cancer coming back or to treat metastatic breast cancer, it's important to know that certain antidepressants interfere with how well a liver enzyme called CYP2D6 can convert tamoxifen into its active form. This could make tamoxifen less effective. Antidepressants that interfere with CYP2D6 are called CYP2D6 inhibitors.

For people taking tamoxifen, it is not clear whether CYP2D6 inhibitors increase the risk of dying from breast cancer. Research findings are mixed. Since there may be a risk, it’s important to talk with your doctor about antidepressant options if you're taking tamoxifen. Antidepressants that are strong CYPD26 inhibitors and interfere with tamoxifen include:

• Paroxetine
• Fluoxetine
• Bupropion

The good news is that there are many antidepressant options available that do not interfere with tamoxifen. You and your care team will talk about the best option for you.

For more information on these medicines, how they work, how they interact with anti-cancer medicines, and possible side effects, visit Medicines for depression.

Benzodiazepines

Benzodiazepines are medicines often prescribed to help with nausea caused by chemotherapy treatment. They may also be used if you have occasional anxiety or mild, ongoing anxiety. Benzodiazepines affect areas in the central nervous system that control anxiety and sleep.

The benzodiazepines include:

• Clonazepam (Klonopin)
• Alprazolam (Xanax)
• Diazepam (Valium)
• Lorazepam (Ativan)

Benzodiazepines start working right away. If you take them for a long time, though, your doctor might need to increase the dose for these medicines to have the same effect. These medicines can lead to dependence, so doctors usually prescribe them for short periods.

Side effects of benzodiazepines can include slowed or difficult breathing, drowsiness, headache, confusion, nausea, vomiting, diarrhea, fainting, and tremor. Generally, side effects improve over 1-2 weeks. But if you are taking a benzodiazepine and experience difficulty breathing, let your care team know right away.

It’s very important to avoid drinking alcohol and to avoid taking opioids when taking a benzodiazepine. Opioids include oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, fentanyl (Duragesic, Abstral), tramadol (ConZip, Ultram), and others.

If you are an older adult, these medicines can increase your risk of falling and affect your thinking. With all anti-anxiety medicines, you should talk to your doctor before stopping, but it’s especially important with benzodiazepines. Stopping suddenly can have a serious effect. Your doctor will help you taper off when you are ready.

Non-benzodiazepine anxiolytics

Buspirone (Buspar) is an anti-anxiety medicine in a class called non-benzodiazepine anxiolytics. Buspirone works on serotonin and dopamine receptors in the brain to help relieve symptoms of anxiety. Unlike benzodiazepines, these medicines take 5 to 10 days to start working. Common side effects include nausea, dizziness, headache, drowsiness, and changes in dreams. For some people, these side effects improve over time. For others, the nausea and dreams stay the same. If you are taking buspirone and having difficulty with nausea and dream changes, talk with your care team about safely adjusting or changing the medicine.

Anti-psychotic medicines

Anti-psychotic medicines may be used in low doses for very severe anxiety that causes restlessness or agitation. It’s rare to have these symptoms from anxiety associated with breast cancer. These medicines are:

• Aripiprazole (Abilify)

• Haloperidol (Haldol)

• Olanzapine (Zyprexa)

• Risperidone (Risperdal)

Things to remember

Like all drugs, anti-anxiety medicines have side effects. Side effects vary depending on the type of medicine and on the person taking it. When deciding whether to take medicine for anxiety, the risks of taking the medicine should be weighed against its benefits. You and your doctor will make this decision together.

Always let your oncologist know if you are thinking about starting medicines that aren’t part of your regular cancer treatment. If a different doctor has recommended medicine for anxiety, it's a good idea to suggest that they talk with your oncologist to make sure there are no interactions with your treatments for breast cancer.

Once you and your doctor have decided on the right medicine to try, keep your care team updated. Let them know about any side effects you experience. If one medicine doesn’t work for you, your doctor can suggest another option.

Always talk with your doctor before stopping any medicine for anxiety. Stopping quickly without lowering the dosage could be dangerous.

For more information on specific types and possible side effects of medicines for anxiety, visit the National Institute of Mental Health website.