Most Common Stress Medications

The most common stress medications relieve the acute or chronic effects of the hormones that increase in response to stress, such as adrenaline, cortisol, serotonin, and others. These drugs help you cope with stress symptoms you perceive as excessive until your problem resolves.

Medications to Relieve the Effects of Stress

Stress medications relieve the distressing effects of excessive, acute, or persistent stress, such as:

• Symptoms of anxiety, including irritability, tremulousness, increased heart rate, anxious breathing, panic, and fear
• Symptoms of depression, including sleeplessness, poor appetite, and low mood and energy,

The following are the most common medications used to treat stress symptoms and are also used to treat post-traumatic stress syndrome (PSTD), which can develop after a traumatic stress experience.

Three SSRI Antidepressants

The selective serotonin reuptake inhibitor (SSRI) antidepressants that are approved for major depression, anxiety, and other psychological disorders are also frequently used off label to relieve the symptoms of stress. SSRIs increase the level of serotonin, according to the Mayo Clinic, by preventing the reuptake of serotonin back into cells after its release. The increase in serotonin in the brain elevates mood and energy. It also improves anxiety, sleep, appetite, and other stress dysfunctions.

The following SSRIs are among the most frequent doctors prescribe for stress:

• Fluoxetine: This was the first SSRI approved by the United States Food and Drug Administration (FDA) in December of 1987 and released on the U. S. market in 1988 as brand name Prozac™. It is also sold under the brand Serafem™. According to a PsychCentral 2013 analysis, in 2013 Prozac™ was the third most prescribed antidepressant among the top 25 psychiatric medications in the U. S. Fluoxetine is also on the World Health Organization's (WHO) list of essential medicines that are considered "efficacious, safe and cost-effective " for "priority public health conditions" in a health care system.
• Citalopram: First synthesized by a Danish company in 1972, according to a University of Bristol review, citalopram was released in Denmark in 1989 as Cipramil™, and in the United States in 1998 as brand name Celexa™. Citalopram became one of the most popular SSRI antidepressants after Prozac™ and by 2013, was the second most prescribed antidepressant in the U. S. based on the PsychCentral summary.
• Sertraline: This drug was approved by the FDA in December 1991 for release on the U. S.market as Zoloft™ to treat major depression, anxiety, and other disorders. By 2013, Zoloft became the most prescribed antidepressant in the U. S., according to the PsychCentral data.

Based on a 2000 review in the Journal of Clinical Psychiatry, SSRIs have similar efficacy but differ in their effective doses, metabolism, and how an individual responds to or tolerates each drug. Often, it requires switching from one SSRI to another to find the drug a person tolerates best. SSRIs have several side effects, but they are milder and better tolerated than the older non-selective antidepressants, according to another 2001 Journal of Clinical Psychiatry article.

The severity of side effects vary between each drug as summarized in a table in the 2001 Journal of Clinical Psychiatry review, some of which diminish within a few weeks of starting an SSRI. Side effects and risks include:

• Worsening of stress symptoms before they improve after starting on medication
• Headaches, blurred vision, dry mouth, allergic reactions
• Agitation or sedation
• Changes in appetite and weight, nausea or vomiting, diarrhea
• Fast or irregular heartbeat, high blood pressure
• Difficulty sleeping, low energy, sexual dysfunction
• Precipitation of a manic phase in people with manic depression (a bipolar disorder)

• Adverse interactions with many drugs including other SSRIs and antidepressants

• Rarely, easier bleeding and electrolyte imbalances

• The SSRI discontinuation syndrome: Stopping an SSRI abruptly can cause symptoms like dizziness, nausea, vomiting, lethargy, headache, and irritability, which usually resolve in three weeks, or on restarting the SSRI
• Serotonin syndrome: A more severe effect of increased serotonin, this causes restlessness, shivering, fever, sweating, stiff muscles, confusion, hallucinations, seizures, and risk of death, especially if two antidepressants are being used
• Risk of heart defect in newborn: In July 2006, the U. S. Food and Drug Administration (FDA) issued an alert about the risk of Persistent Pulmonary Hypertension of the Newborn (PPHN) in babies born to mothers who took SSRIs after 20 weeks of pregnancy. This was based on a study reported in February 2006 in the New England Journal of Medicine.

Important (black box) warning: Since 2004, all SSRIs drug labels are required by the FDA to carry a warning of the increased risk of thoughts of suicide in children, adolescents, and young adults.

Two SNRI Antidepressants

The serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants treat symptoms of stress by increasing serotonin and norepinephrine. According to CNS Spectrums, they increase these neurotransmitters by preventing the uptake of both serotonin and norepinephrine. The two common SNRIs doctors recommend are:

• Venlafaxine: According to Perspectives in Psychiatric Care, venlafaxine, as brand Effexor™ (immediate release), was the first SNRI approved by the U. S. FDA in 1993. Effexor ER™ (extended release) was released in 1997. Both are approved to treat major depression and anxiety disorders, but Effexor ER™ has fewer side effects, such as nausea and dizziness. Effexor ER™ was the seventh most prescribed antidepressant in 2013 based on the PsychCentral prescription data. A review of SNRIs in Innovations in Clinical Neurosciences notes that venlafaxine inhibits serotonin reuptake before norepinephrine, which explains the sequence of side effects seen.

• Duloxetine: As the brand Cymbalta™, duloxetine was approved in the U. S. in 2004, according to the Perspectives in Psychiatric Care article. Duloxetine is approved for major depression and anxiety disorders, as well as several nonpsychiatric pain disorders, based on the Innovations in Clinical Neurosciences review. Like venlafaxine, duloxetine inhibits serotonin reuptake before that of norepinephrine. It is listed as the fifth most prescribed antidepressant.

In addition to sharing the side effects of the SSRIs, other side effects of venlaxafine and duoloxtine include:

• Increased heart rate
• High blood pressure (more frequent with venlafaxine than duloxetine)
• Risk of liver toxicity with duloxetine
• Irregular menstrual cycles
• Urinary frequency

Two Benzodiazepine Anti-Anxiety Medicines

Benzodiazepines depress the central nervous system by decreasing excitatory signals between brain nerve cells through their effect on the inhibitory hormone gama amino-butyric acid (GABA). By this mechanism, they decrease stress symptoms and are used to treat anxiety, panic, insomnia, and muscle tension, according to the journal of American Association of Family Physicians (AAFP). They take effect quickly and can be taken intermittently when symptoms recur. Two common benzodiazepines used for stress are:

• Alprazolam: As brand name Xanax™, alprazolam is listed on the PsychCentral list as number one of the top 25 psychiatric medicines prescribed in the U. S. in 2013.
• Diazepam: The brand Valium™ is the second most prescribed anti-anxiety medicine and the 11th psychiatric medicine in the U. S. in 2013. It is also on the WHO list of essential medicines.

Side effects of benzodiazepines according to the AAFP article include:

• Drowsiness, sedation, confusion, and double vision
• Lack of coordination and impaired driving skills
• Poor memory, amnesia, and depressed mood
• Risk of drug dependence and withdrawal symptoms when off the drug, and a risk of addiction
• They cross the placenta and are secreted in breast milk, which may lead to dependence in a newborn and infant

A Sleep Medicine

Zolpidem, according to the National Library of Medicine, is a sedative-hypnotic that helps relieve insomnia, a common response to stress. It induces sleep through its inhibitory effects on the central nervous system and was developed as a milder alternative to benzodiazepines. Zolpidem is available as Ambien™, which induces sleep in about 15 minutes and is short acting, and Ambien CR™, which has a slower onset of action and gives a longer lasting sleep.

Side effects and risks include:

• Drowsiness, fatigue, lightheadedness, dizziness, unusual dreams, rebound insomnia
• Nausea, change in appetite, constipation, or diarrhea
• Change in balance and coordination, difficulty walking, muscle cramps
• Decreased awareness and amnesia
• Withdrawal symptoms if a user stops taking the drug abruptly
• Allergic reaction

Zolpidem should be taken only for a short time because it can be addicting. The Food and Drug Administration recommends taking the lowest dose possible, especially for women, because of the possibility of drowsiness the next morning, which may impair driving and other critical activities.

A Beta Adrenergic Receptor Blocker

Propranolol, according to WebMD, is a beta-blocker used to treat high blood pressure and rapid or irregular heart beat. It does this by binding to beta adrenergic receptors in muscles in the heart and blood vessels, thus blocking the effects of adrenaline and noradrenaline.

Propranolol is best for treating symptoms of acute or short term stress. By causing the heart and blood vessels to relax, it relieves symptoms of anxiety, such as a racing heart, chest pain, and anxious breathing. It is available as brands Inderal™ and Inderal LA and XL It was the first beta-blocker in the United States and is on the WHO list of essential medicines.

Side effects of beta blockers include:

• Dizziness, lightheadedness, fatigue
• Slow heart rate, heart failure
• Cough, difficulty breathing
• Nausea, diarrhea, or constipation

Alternative Herbal Medicines

People who prefer to take alternative medicines may be interested in the potential benefits of Chinese traditional herbal remedies for stress. These herbs include valerian root, dong quai, bupleurum, and rhemania. Note that Chinese herbal medicines have little research to back up their use to treat stress symptoms. There is also a lack of data about their safety.

Stress Management

Consider the need for stress medications only if your stress symptoms are severe or persistent, or other psychological or physical problems develop. These medications should be considered as a short-term measure while you work on non-medical ways to manage stress and seek psychotherapy, if needed, to help you cope with and decrease your stress.