• Ativan
  
• BuSpar
  
• Centrax
  
• Librium
  
• Serax
  
• Tranxene
  
• Valium
  
• Xanax
  
• Catapres
  
• Habitrol
  
• Inversine
  
• Tenex
  
• Thyroid
  

Most of the drugs prescribed for anxiety are in the benzodiazepine family of tranquilizers. Some of these medications may also help to prevent seizures and ease depression. Doctors try to avoid prescribing these for long-term use. Tranquilizers slow down central nervous system activity, they often don't mix well with other medications, and they can be addictive. However, for patients with severe anxiety, benzodiazepine tranquilizers can be very effective. Some people can take these on an as-needed basis, avoiding medication dependency. They include the following medications:

Ativan

Generic name: lorazepam

Use: Antianxiety, panic disorder, PMS, irritable bowel syndrome. May also be used in acute mania to bring on sleep and stabilize the patient--some doctors prefer Ativan to antipsychotics, which are commonly used for this purpose.

Action, if known: Benzodiazepine--slows central nervous system activity.

Side effects: Sleepiness (this usually passes after a week), lethargy, confusion, headache, slurred speech, tremor. Addictive--withdrawal may be difficult.

Known interaction hazards: Alcohol, all tranquilizers (including over-the-counter sleep aids), narcotics, MAOIs, antihistamines (including over-the-counter allergy and cold remedies), antidepressants. Potentiated by cimetidine, SSRIs, Depakene, disulfiram, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranalol, rifampin, and oral contraceptives. Potentiates digoxin and phenytoin; decreases effect of L-Dopa.

Tips: If you smoke, take theophylline, or use antacids, Ativan may be less effective.

BuSpar

Generic name: buspirone

Use: Anxiety, decreasing emotional lability or mood swings, ADHD, PMS.

Action, if known: Non-benzodiazepine tranquilizer--enhances serotonin transmission, blocks dopamine receptors, increases metabolism of norepinephrine in the brain.

Side effects: Dizziness, nausea, headache, fatigue, jitteriness, tremor, sore muscles, heart palpitations, sweating, possible liver or kidney damage, tardive dyskensia-like movements or tics.

Known interaction hazards: Do not use with MAOIs. Potentiates Haldol and possibly other neuroleptics. Can cause liver inflammation when used with Desyrel. May have other side effects when used with antidepressants or similar drugs. Prolongs the effectiveness of SSRIs, and is sometimes prescribed for this specific purpose.

Tips: Side effects are a frequent problem with BuSpar, especially when taken in combination with other medications, including over-the-counter remedies. The BuSpar patch may be better tolerated and smoother-acting than the pill, especially for treatment of ADHD or mood swings. It has been tested with good results in children for treatment of ADHD without the same rebound effect as Ritalin, and for treating anxiety and irritability in children with neurological disorders. Many physicians like to prescribe BuSpar because it doesn't carry the addiction risk of the benzodiazepines.

Centrax

Generic name: prazepam

Use: Antianxiety, muscle spasm, seizures, panic disorder, irritable bowel syndrome.

Action, if known: Benzodiazepine, slows central nervous system activity.

Side effects: Sleepiness (this usually passes after a week), lethargy, confusion, headache, slurred speech, tremor. Addictive--withdrawal may be difficult.

Known interaction hazards: Alcohol, all tranquilizers (including over-the-counter sleep aids), narcotics, MAOIs, antidepressants, antihistamines (including over-the-counter allergy and cold remedies). Potentiated by cimetidine, disulfiram, SSRIs, Depakene, disulfiram, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranalol, rifampin, and oral contraceptives. Potentiates digoxin and phenytoin; decreases effect of L-Dopa.

Tips: Many people should not take Centrax, including people with severe depression, lung disease, liver or kidney disease, sleep apnea, alcoholism, or psychosis. Intended for short-term use. If you smoke, take theophylline, or use antacids, Centrax may be less effective.

Librium

Generic name: chlordiazepoxide

Use: Anxiety, panic attacks, irritable bowel syndrome.

Action, if known: Benzodiazepine, depresses central nervous system activity.

Side effects: Sedation (this should pass), depression, stupor, headache, tremor, dry mouth, sexual dysfunction. Addictive--withdrawal may be difficult.

Known interaction hazards: Avoid other central nervous system depressants, including alcohol, narcotics, tranquilizers (including over-the-counter sleep aids), MAOIs, antidepressants, and both prescription and over-the-counter antihistamines. Do not take with antacids. Potentiates digoxin and phenytoin; reduces potency of L-Dopa.

Tips: Many people should not take Librium, including people with severe depression, lung disease, liver or kidney disease, sleep apnea, alcoholism, or psychosis. Intended for short-term use. Smoking may reduce the effectiveness of Librium.

Serax

Generic name: oxazepam

Use: Anxiety, muscle spasm, seizures, panic disorder, irritable bowel syndrome.

Action, if known: Benzodiazepine, slows central nervous system activity.

Side effects: Sleepiness (this usually passes after a week), lethargy, confusion, headache, slurred speech, tremor. Addictive, withdrawal may be difficult.

Known interaction hazards: Alcohol, all tranquilizers (including over-the-counter sleep aids), narcotics, MAOIs, antidepressants, antihistamines (including over-the-counter allergy and cold remedies). Potentiated by cimetidine, disulfiram, SSRIs, Depakene, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranalol, rifampin, and oral contraceptives. Potentiates digoxin and phenytoin; decreases effect of L-Dopa.

Tips: Many people should not take Serax, including people with severe depression, lung disease, liver or kidney disease, sleep apnea, alcoholism, or psychosis. Intended for short-term use. If you smoke, take theophylline, or use antacids, Serax may be less effective.

Tranxene

Generic name: clorazepate

Use: Anxiety, panic disorder, irritable bowel syndrome.

Action, if known: Benzodiazepine--slows central nervous system activity.

Side effects: Drowsiness (this should pass), confusion, tremor, dizziness, depression. Addiction danger, withdrawal may be uncomfortable.

Known interaction hazards: Do not take with antacids. Alcohol and other central nervous system depressants, tranquilizers (including over-the-counter sleep aids), narcotics, barbiturates, MAOIs, antihistamines (including cold and allergy medications), and antidepressants all interact negatively with Tranxene. This drug potentiates digoxin and phenytoin. Potentiated by cometidine, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifamin, and Depakote/Depakene.

Tips: You should not take Tranxene if you have lung, liver, or kidney disease, psychosis, or depression. Intended for short-term use. Smoking may interfere with the action of Tranxene.

Valium

Generic name: diazepam

Use: Anxiety, muscle spasm, seizures, panic disorder, irritable bowel syndrome.

Action, if known: Benzodiazepine, slows central nervous system activity.

Side effects: Sleepiness (this usually passes after a week), lethargy, confusion, headache, slurred speech, tremor. Addictive, withdrawal may be difficult.

Known interaction hazards: Alcohol, all tranquilizers (including over-the-counter sleep aids), narcotics, MAOIs, antidepressants, antihistamines (including over-the-counter allergy and cold remedies). Potentiated by cimetidine, disulfiram, SSRIs, Depakote/Depakene, disulfiram, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranalol, rifampin, and oral contraceptives. Potentiates digoxin and phenytoin; decreases the effect of L-Dopa.

Tips: Many people should not take Valium, including people with severe depression, lung disease, liver or kidney disease, sleep apnea, alcoholism, or psychosis. Intended for short-term use. If you smoke, take theophylline, or use antacids, Valium may be less effective.

Xanax

Generic name: alprazolam

Use: Anti-anxiety, panic disorder, PMS, irritable bowel syndrome.

Action, if known: Benzodiazepine, slows central nervous system activity.

Side effects: Sleepiness (this usually passes after a week), lethargy, confusion, headache, slurred speech, tremor. Addictive, withdrawal may be difficult.

Known interaction hazards: Do not use with alcohol, tranquilizers of any kind (including over-the-counter sleep aids), MAOIs, antihistamines (including over-the-counter allergy and cold medicines), or antidepressants, unless under strict medical supervision.

Tips: Many people should not take Xanax, including people with severe depression, sleep apnea, liver or kidney disease, lung disease, alcoholism, or psychosis.

Other medications

Several other medications may be prescribed to your child to treat specific symptoms. One group of these, estrogen and related hormones used to treat menstrual irregularities, are discussed in more detail in Chapter 6, Other Interventions. Other drugs for bipolar-related symptoms that don't fit in the earlier categories follow:

Catapres

Generic name: clonidine

Use: High blood pressure, ADD/ADHD, tics/Tourette syndrome, extreme impulsivity, migraine, drug and alcohol withdrawal aid, ulcerative colitis, childhood growth delay.

Action, if known: Stimulates alpha-adrenergic receptors in brain to widen blood vessels, stimulates similar receptors throughout the body.

Side effects: Dry mouth, dizziness, constipation, sedation, unusually vivid or disturbing dreams, weight gain.

Known interaction hazards: Could interact with other medications for blood pressure.

Tips: Do not use if you have heart trouble, disease of the blood vessels in the brain, or chronic kidney failure. The time-release clonidine patch is far less sedating than the pills. You can become tolerant of clonidine, requiring a higher dose. You should have regular eye exams, as clonidine can affect the retina.

Habitrol

Generic name: nicotine

Also known as: Nicoderm, Nicotrol, ProStep.

Use: Aid to stopping smoking; may be prescribed to potentiate neuroleptics or atypical neuroleptics without increasing the actual dose.

Action, if known: Affects many central nervous system functions--not all actions known. May reduce tics and anxiety in some people.

Side effects: Diarrhea, insomnia, nervousness. Addiction possible.

Known interaction hazards: Caffeine interferes with absorption.

Tips: People with insulin-dependent diabetes, heart problems, liver or kidney disease, high blood pressure, or pheochromocytoma should be carefully monitored when using nicotine in any form (including cigarettes).

Inversine

Generic name: mecamylamine HCI

Use: High blood pressure, rage/aggression, aid to stopping smoking.

Action, if known: This older drug, now rarely used for hypertension, blocks nicotine receptors in the brain and relaxes blood vessels.

Side effects: Dizziness, blurred vision, nausea, dry mouth, constipation.

Known interaction hazards: Interacts with sulfa drugs and antibiotics. Potentiated by antacids, bicarbonate of soda, acetazolamide, potassium or sodium citrate, citric acid. Decreases the effects of ambenonium, neostigmine, and pyridostigmine.

Tips: The use of Inversine for rage and aggression is still experimental, although early research looks promising. Those with bladder, kidney, prostate, or bowel problems will require regular monitoring while taking Inversine. May make glaucoma and heart problems worse.

Tenex

Generic name: guanfacine

Use: High blood pressure, migraines, extreme nausea, heroin withdrawal aid, ADHD/ADD, tic disorders/ Tourette syndrome.

Action, if known: Stimulates central nervous system to widen blood vessels, and has other as yet unknown effects.

Side effects: Sleepiness, changes in blood pressure or heart rate, nausea.

Known interaction hazards: Alcohol and other central nervous system depressants. May be counteracted by stimulants such as Ritalin and many over-the-counter drugs; by estrogen and oral contraceptives; and by indomethacin, ibuprofen, and non-steroidal anti-inflammatory drugs.

Tips: If you take another medication that lowers blood pressure, your doctor will need to adjust your Tenex dose accordingly to prevent problems. Most people take Tenex at bedtime due to its sedating effect.

Thyroid hormone replacements

Generic name: levothyroxine, liothyronine, T3, T4.

Also known as: Euthroid, Armour, S-P-T, Thyroid Strong, Thyrar, Cytomel, and many more.

Use: Treatment of thyroid disorders, mood disorders that do not respond to conventional treatment, or as an adjunct to antidepressants.

Action, if known: Potentiates effects on noradrenergic receptor sensitivity, increases the efficiency of noradrenergic neurotransmission, corrects thyroid abnormalities by replacing deficient natural hormones.

Side effects: May negatively affect your body's natural production of thyroid hormone, as do other forms of hormone replacement therapy. Overdose symptoms include headache, irritability, nervousness, sweating, and irregular heartbeat--call your doctor if these continue over a period of time. Can cause hair loss in children at the beginning of therapy, although this usually reverses.

Known interaction hazards: Potentiates antidepressants (and is sometimes used for this specific effect). Do not use with maprotiline. May be potentiated by aspirin and other salicytates. Dosage needed will be affected by the use of other hormones, including estrogen and insulin. Reduces the effectiveness of some beta blockers, may potentiate theophylline drugs.

Tips: Thyroid status must be monitored via regular blood tests. A few people have an allergic skin reaction to thyroid hormone, and should not take it. T3 is usually more effective than T4.