Anxiety is one of the most common concerns during perimenopause. And there are many treatment options available from relaxation techniques to medication. As a quick review, one of the most common causes of mid-life anxiety in women is the lack of estrogen we experience during perimenopause. Estrogen receptors in the brain regulate the production of serotonin and other neurotransmitters that make us feel good.
So sometimes the only effective treatment for women in perimenopause is with hormone replacement or medications that make serotonin more available in the brain! There are numerous approaches to treatment for anxiety but feeling guilty for how you choose to treat your symptoms should never be an issue. We are all on our own journey. Medication is a well known and well studied treatment option alone and in conjunction with alternative therapies. Providing you this information is a way to empower you and give you some tools to discuss options with your personal healthcare provider. Knowledge is power friends!
Not all healthcare providers are comfortable prescribing some of the medications we will cover so you may need to have a visit with a psychiatrist if it is warranted based on your symptoms and medical history. I specialize in mental health so I am very comfortable discussing and prescribing these medications. Some of the listed medications are NOT typically prescribed in a primary care or OBGYN setting at all. Cost is also a factor to determine which medication is used initially.
Due to the positive benefit/risk balance of SSRIs and SNRIs, these are usually recommended as first-line drugs for treating situational anxiety, depression and generalized anxiety disorder.
What do you need to know about SSRIs and SNRIs?
👉🏻Increases the amount of available serotonin and norepinephrine in the brain that regulates our mood, social behavior, appetite, digestion, sleep, memory and sexual desire and function. THIS is why these neurotransmitters are so important!
👉🏻Can take 2-4 weeks before effective and feeling relief of symptoms.
👉🏻Side effects are most prevalent the first two weeks and then most often go away.
👉🏻Initial “jitteriness” or an increase in anxiety can occur during the first two weeks. I will usually start with the lowest dose and taper up as needed to decrease this effect.
👉🏻Withdrawal symptoms can occur if you just stop taking the medication abruptly and it is best to taper down with the direction of your healthcare provider. It depends on the medication and dose how long this may take.
These medications can help immensely with acute and chronic symptoms of anxiety. They have to be taken consistently every day to be effective. These are very commonly used medications during perimenopause, especially in women with anxiety that are not candidates for hormone replacement therapy or that choose not to go that route.
Benzodiazepines are typically used in practice for significant anxiety when symptoms are affecting daily life and/or quality of life. They can be most commonly prescribed when anxiety is significant or due to acute psychological and physical symptoms related to extreme grief or trauma. They are also used to treat other conditions like seizures, panic disorders, or extreme agitation in the areas of neurology and psychiatry. But for the purpose of anxiety symptoms, best practice is that we no longer prescribe this class of drugs for long term or daily for the treatment of mild to moderate anxiety symptoms or generalized anxiety disorder.
They will be more commonly prescribed short term for the initial treatment of acute anxiety or generalized anxiety disorder in the time prior to an SSRI or SNRI becoming effective. I will typically prescribe benzodiazepines temporarily as a “bridge” to treat their current symptoms during this waiting period. They can also be commonly used for medical procedures, dental procedures and occasional times of acute anxiety like flying. However, this practice will depend on the severity of the anxiety symptoms, the patient preference and can vary based on the prescribing practices of the provider. Prescribing guidelines have changed over the past few years as we have learned that these medications have a high potential for dependency, abuse and can be very difficult to discontinue. They are prescribed with caution and many providers have opted not to prescribe them at all and have reserved them for use under the care of a psychiatrist.
What do you need to know?
👉🏻Benzodiazepines are controlled Schedule IV medications and require a DEA license to prescribe.
👉🏻The most difficult physical dependencies and withdrawal to drugs I have seen in my 20 year career have been to benzodiazepines, not opioids.
👉🏻If your healthcare provider is hesitant to provide these medications for you it is for your own safety and effective treatment of symptoms.
👉🏻These medications have NOT been shown in the research to be superior or more effective in treating acute anxiety symptoms than other medications I have covered in this article..
👉🏻Street names for Xanax include Z-Bars, Xanbars, Footballs, Planks, White Girls, Upjohn, Benzos, and School Bus to name a few.
👉🏻This class of medications are Central Nervous System (CNS) Depressants; alcohol and opioids are also CNS Depressants and therefore two of these substances together can cause severe respiratory depression and even death.
Hydroxyzine (Vistaril or Atarax) has been a recently more commonly used anti-anxiety medication. This is because it can be used for acute anxiety and has similar fast-acting properties like the benzodiazepines that provides fast relief from acute anxiety symptoms. But in contrast, it does not cause dependency, withdrawal symptoms or increasing tolerance. It is an antihistamine, similar to Benadryl, that is used for allergic reactions. But it works great for anxiety! It works better than any of the other antihistamines for this indication because of its specific interactions with a subset of serotonin receptors.
What do you need to know?
👉🏻This medication can be very sedating. However, this effect decreases over time.
👉🏻Side effects include dizziness, drowsiness, fatigue, dry mouth.
👉🏻This medication should not be taken with alcohol as it will increase the sedating effect.
Buspirone is a serotonin receptor agonist which means it increases serotonin activity at the receptors in the brain similar to the SSRI’s but a slightly different mechanism. Buspirone can be used as a stand-alone or as an add-on to other medications such as SSRIs for treatment of anxiety and depression. It has a large range of doses from 5mg-30mg and is taken 2-3 times per day.
What do you need to know?
👉🏻This medication can be sedating but not as much as some of the other medications used for anxiety. Use with caution while operating machinery or driving a car.
👉🏻Side effects include restlessness or dizziness, nervousness, drowsiness, dry mouth, or muscle stiffness.
👉🏻This medication should not be used in some people with liver disease.
Again, I have provided this information to you so that you are well informed of the medications on the market and can advocate for yourself when it comes to your treatment plan. I hope this has been helpful to so many of you that have had questions about how to treat your anxiety. While some women choose more natural ways of treating their symptoms, many women find that it is not enough and their anxiety can greatly affect their quality of life.
The purpose of taking the time to highlight some of the more commonly used medications available for anxiety treatment is to help you understand the options but also to share that there are multiple treatment options available.
It is important for everyone to remember that even if they don’t have significant anxiety or they are able to treat their symptoms without medication that it NOT ok to offer an unsolicited opinion on how others choose to manage their mental health.
PSA: I do NOT receive kickbacks, payments or otherwise from “big Pharma”. I prescribe medications for the wellbeing of my patients and to provide ALL treatment options available for their symptoms and conditions.
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.
Meet the Author
Perry Babe Carmen, MSN, FNP-C, WHNP-BC, a Family and Women's Health Nurse Practitioner, nationally recognized by both the AANP (American Association of Nurse Practitioners) and the NCC (National Certification Corporation). Her specialties include family centered care, perimenopause/menopause, high risk obstetrics, cardiovascular health, disease prevention and mental health.
She is passionate about helping women cut through the marketing noise in the wellness industry, clarify misinformation, and drop honest advice you can trust in a community of solidarity amongst like minded women. With over 10 years of experience as a Nurse Practitioner and over 20 years in women's healthcare, she is on a mission to help women like you improve their health and wellness through preventative care and clinical insights. She is passionate about educating women on the information and the confidence needed to advocate for their own health and wellness in and outside of a doctor's office.
She lives with her husband and three boys in the Minneapolis area and works as a Nurse Practitioner in a private OBGYN practice. She is the author of the blog Wits & Wellness and leads a community of women discussing health issues in an online forum.