What treatment options are available for anxiety and restlessness?
After an ALS diagnosis and as the disease progresses, anxiety and inner restlessness may occur. In severe cases, treatment with appropriate medications is possible and advisable. Benzodiazepines are the preferred treatment for the immediate management of severe anxiety symptoms and restlessness (including panic attacks). Within this class of medications, lorazepam and diazepam are the most commonly used. These medications are classified as “sedatives” (calming agents) or “anxiolytics” (anti-anxiety medications). In addition to their calming and anxiety-relieving effects, benzodiazepines can also cause other effects such as fatigue and drowsiness. These side effects are usually undesirable, but can also be beneficial in certain situations (e.g., in cases of sleep disorders). With frequent use, the effectiveness of these medications diminishes—a tolerance develops. Balancing the benefits against the side effects and assessing the potential for tolerance requires specialist expertise and experience with this class of medication.
The decision to treat with benzodiazepines is made through a dialogue between the doctor and the patient. In cases of frequent anxiety and restlessness, treatment with mood stabilizers (antidepressants) may be considered to prevent or alleviate the onset of anxiety. Modern antidepressants (e.g., citalopram, escitalopram, and paroxetine) are suitable for this prophylactic therapy. The advantages of these antidepressants include their prophylactic nature (they reduce the onset of anxiety), their favorable side-effect profile (generally no fatigue or drowsiness), and the absence of a tolerance effect (the medications can be administered for years without a decline in pharmacological efficacy).
In certain situations, patients become strongly fixated on their illness or individual symptoms—a “vicious cycle of thoughts” develops that, in some cases, they cannot break on their own. In such cases, the use of neuroleptic medications—which are otherwise used to treat psychiatric disorders—can be helpful. Promethazine, chlorpromazine, and olanzapine are neuroleptics that may be used in certain situations. If anxiety and restlessness occur in conjunction with other severe ALS symptoms—such as labored breathing or pain—treatment with morphine-containing medications can be helpful. In addition to their pain-relieving effects, opioids can also promote relaxation and alleviate anxiety.
These medications are subject to the Narcotics Act and require a physician’s experience in treating patients with opioids. Overall, there are a variety of options for treating symptoms of anxiety and inner restlessness on an individual basis and depending on the situation.