Medication for the Treatment of Adult Separation Anxiety Disorder
It is important to note that most cases of ASAD are co-morbid with other disorders, and treatments are usually tailored to the prevailing conditions, as there is no current standard of medicinal treatment. Depression and anxiety are the main presenting disorders that have established pharmacological research supporting their efficacy in reducing their associated symptoms.
Selective serotonin reuptake inhibitors (SSRIs), commonly known as anti-depressants, are a class of medications that aim to improve overall mood by increasing the amount of serotonin (a neurotransmitter involved with emotional regulation) in the brain. Specifically, the SSRI is a molecule that blocks the reuptake of serotonin at the gaps between brain neurons.
Normally, after a neuron fires and releases serotonin, it clears the amount of serotonin at the gap so that it doesn’t continue to have an effect on other neurons. By blocking this clean-up action, the total amount of effective serotonin is increased, contributing to increased mood regulation; people with major depressive order, which is often co-morbid with ASAD, are purported to have a lower baseline level of serotonin. SSRIs have also been used to treat anxiety disorders due to the increased mood regulation.
SSRIs typically take up to 3-4 weeks to have full efficacy, as they are thought to re-wire the brain’s normal firing patterns over that period of time. Individuals respond variably to different medications, so although the basic function of each SSRI is the same, they may differ slightly in their detailed mechanistic action.
Common SSRIs include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), and Luvox (fluvoxamine).
Benzodiazepines, commonly known as benzos, are a class of medications that aim to decrease overall anxiety by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. GABA is an inhibitory molecule that normally works in the brain to decrease overall neuron firing, or brain activity. By enhancing GABA’s effect, benzodiazepines induce anxiolytic (anxiety-relieving) and sedative (sleep-inducing) effects on a person. So, for sufferers of ASAD, benzodiazepines may be taken whenever their anxious feelings are at their strongest (e.g. when they know they must be away from their person or object of affection), or may be taken daily to prevent persistent anxiety.
Most benzodiazepines work relatively quickly, with their peak blood concentration achieved at 1–2 hours. However, despite their efficacy in treating anxiety, they are meant for short-term use, as tolerance builds up with continuous use, which means the anxiety-relieving effects are less pronounced over time. Withdrawal has been noted to increase anxiety.
Common benzodiazepines include Klonopin (clonazepam), Xanax (alprazolam), and Valium (diazepam).
ASAD has not been extensively studied, so there is no currently accepted standard of pharmacological treatment. Most current treatment, however, involves cognitive-behavioral therapy (CBT) in conjunction with medication (SSRIs, benzodiazepines, or other medications). Not all medications for the treatment of adult separation anxiety disorder are listed here. But the main ones that are used to treat depression and anxiety, which are highly correlated with ASAD, respectively, are described above. It is recommended for someone with ASAD to consult a doctor or therapist to figure out the best course of treatment.
Adult Separation Anxiety Often Overlooked Diagnosis - Arehart-Treichel 41 (13): 30 - Psychiatr News
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