Anxiety Symptoms: General anxiety is a constant feeling of fear and worry.  Intense and persistent anxiety occurs frequently in Huntington's, interfering greatly with daily life.  This symptom occurs both before and after motor symptom development.  Anxiety most often occurs with depression and shares many of the same symptoms. Both interfere with concentration, appetite and sleep.  Irritability, agitation and restlessness are also common symptoms that accompany anxiety.

Anxiety Treatments: Antidepressants and benzodiazepine medications (like Valium®) are most often used to treat anxiety. More severe symptoms may require the addition of a mood stabilizer medication or antipsychotic medication.

Antidepressants: The drugs of first choice for anxiety are SSRI or NSRI antidepressants. Several of these drugs are specifically FDA approved for use in anxiety. This list includes SSRI drugs -- fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), escitalopram (Lexapro®)--and NSRI drugs venlafaxine (Effexor®), and duloxetine (Cymbalta®).  In practice all SSRI drugs can be used. Buspirone (BuSpar®) and mirtazapine (Remeron) are atypical antidepressants that can be usefuls additions for the treatment of anxiety.  Mirtazapine is often helpful for insomnia as well.  See Antidepressant Fact Page for more information on these drugs.

Benzodiazepines: This type of drug decreases anxiety, but does not help with depression. In fact, drugs from this class may intensify depression and apathy if used chronically. All of these drugs have similar effect, but differ in length of action.  See Benzodiazepine Fact Page for more information on these drugs.

Though it is probably best to use this type of drug briefly or just when symptoms require immediate treatment, some with HD will need long-term treatment to control anxiety.

All of these drugs can cause sleepiness and interfere with concentration. If any of these drugs are used long-term, they should never be discontinued abruptly.  Always gradually taper the dose over several weeks.

Commonly Used Benzodiazepine Anxiety Medications

Clonazepam (Klonopin®): This drug works slowly, but has long lasting effect.  It is usually given twice a day for anxiety.  This drug is less helpful for insomnia.  Dosages should start at 0.25 mg twice daily, increasing by 0.25 every 3 days until best benefit.  Dosage maximum is 4 mg in 24 hours. This drug is considered the least likely benzodiazapine to cause addiction.

Alprazolam (Xanax®): This drug works rapidly, but its effect is shorter, requiring dosing several times a day.  This drug is less effective if depression is present with anxiety.  Dosages should start at 0.5 in divided doses, increasing to 4 mg over 24 hours taken in intervals of 3 or 4 times per day.

Diazepam (Valium®): This drug can have a very long duration of action and often results in day time sleepiness.  Usual dosages are 2 to 10 mg per day.

Lorazepam (Ativan®): This drug is rapidly absorbed and is often used for insomnia.  It gives less daytime sleepiness than Valium