- Obsessive Compulsive Behavior
Anxiety Symptoms: General anxiety is a constant feeling of fear and worry. There can also be panic attacks with intense anxiety which occurs intermittently. There can also be social anxiety, or discomfort with social interactions. Anxiety occurs both before and after motor symptom development. Anxiety often occurs with depression and shares many of the same symptoms. Both interfere with concentration, appetite and sleep. Anxiety can be a manifestation of pain or discomfort. Irritability, agitation and restlessness are common symptoms that accompany anxiety.
Anxiety Treatments: Antidepressants of several types and benzodiazepine medications are most often used to treat anxiety. More severe symptoms may require the addition of a mood stabilizer medication or antipsychotic medication.
Antidepressants: Though these drugs are called antidepressants, they all have drug benefit for the treatment of anxiety. The drugs of first choice for anxiety are often 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 any SSRI drug can be used. Buspirone (BuSpar®) and mirtazapine (Remeron®) are atypical antidepressants that can be very useful 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. Clonazepam is often chosen by the experts.
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 with a doctor's supervision.
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 or so 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. This drug is not recommended for long-term use.
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®.