Venlafaxine belongs to a class of drugs called serotonin and norepinephrine reuptake inhibitor (SNRI). It is used off-label in multiple sclerosis to treat neuropathic pain (dysesthesias), anxiety and depression.
Selective serotonin reuptake inhibitors (SSRIs) are generally the first treatment option for people with MS who also experience depression or anxiety. These medications are also commonly prescribed in the general population. The side effects of these medications are usually mild and decrease over time.
Exercise and complementary therapies
Using your body helps to let off steam, releasing stress and anxiety. Exercise also helps with sleep and can give you more energy, both of which can help reduce your stress levels. Find ordinary everyday activities that are enjoyable to you.
Benzodiazepines (also known as tranquilizers) are the most widely prescribed type of medication for anxiety. Drugs such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) work quickly, typically bringing relief within 30 minutes to an hour.
Anxiety. Approximately half of people who have MS and depression also experience anxiety . But anxiety can also occur independently without depression. Anxiety disorders are three times more common in MS than in the general population.
Psychotic symptoms reported in MS patients include hallucinations and delusions (mostly paranoid), irritability/agitation, sleep disturbance, grandiosity, blunted affect, and rare symptoms like catatonia and transient catalepsy [45].
Fatigue is also among the most common symptoms, reported by at least 75% of MS patients at some point in the disease course. For many, fatigue is considered to be the single most debilitating symptom, surpassing pain and even physical disability.
The most prominent of anti-anxiety drugs for the purpose of immediate relief are those known as benzodiazepines; among them are alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan).
The anxiolytic effects of benzodiazepines begin soon after oral or parenteral application. In contrast to antidepressants, benzodiazepines do not lead to initially increased jitteriness and insomnia. In the United States, 55% to 94% of patients with anxiety disorders are treated with benzodiazepines.
Generalized anxiety and distress
MS can cause significant anxiety, distress, anger, and frustration from the moment of its very first symptoms. The uncertainty and unpredictability associated with MS is one of its most distressing aspects. In fact, anxiety is at least as common in MS as depression.
As well as your mental wellbeing, anxiety can also manifest with physical symptoms, which may be similar to some MS symptoms, such as: Increase in fatigue symptoms. Disrupted sleep and appetite.
Overall, the prevalence of anxiety among MS patients was 36% (95% CI = [0.30–0.42]) according to our results, which is in line with previous studies with the range of 22.1% (Boeschoten et al., 2017) to 55% (Hauer et al., 2021).
Diazepam is a muscle relaxant that can reduce stiffness and spasms. Because of side effects at higher doses, it may be more useful at night. Diazepam is no longer widely used to treat MS spasms and stiffness, but can help some people if other treatments have not worked.
Diazepam is a benzodiazepine that belongs to the group of medicines called central nervous system (CNS) depressants, which slow down the nervous system. Although diazepam is used for a variety of medical conditions, it is used in multiple sclerosis primarily for the relief of muscle spasms and spasticity.
Antidepressants are potential options to relieve nerve pain. In studies related to MS, duloxetine and venlafaxine have shown promising results.
Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan).
A second therapeutic candidate, LYT-310 (oral cannabidiol), is expected to enter the clinic in Q4 of 2023. A second therapeutic candidate, LYT-310 (oral cannabidiol), is expected to enter the clinic in Q4 of 2023.
Buspirone (BuSpar) works much more slowly than benzodiazepines and may not treat all types of anxiety disorder, but it causes fewer side effects and has a lower risk of dependency.
Panic disorder: This anxiety disorder is marked by intense and recurrent panic attacks that occur unexpectedly. During a panic attack, people who have this condition experience extreme anxiety that causes feelings of terror and physical symptoms of fear.
Panic disorder
Panic attacks are sudden periods of intense fear, discomfort, or sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder. During a panic attack, a person may experience: Pounding or racing heart.
If you have a panic disorder, you get intense, sudden panic attacks. These attacks often feature stronger, more intense feelings than other types of anxiety disorders. The feelings of terror may start suddenly and unexpectedly or they may come from a trigger, like facing a situation you dread.
Lesions in the brain may affect cognitive abilities. Some people with MS have trouble with memory, attention and concentration, multitasking and decision-making, says Dr. Scherz. The changes are usually mild at the beginning, but can be frustrating as time goes by.