Anxiolytics: uses, side effects, and risks

Anxiety includes emotions of fear, worry, and unease. Everyone experiences anxiety at one time or another. This occasional anxiety of stressful situations usually doesn’t require treatment. But if you have intense or persistent anxiety that interferes with your daily life, your healthcare provider might suggest treatment with an anxiolytic (anti-anxiety) medication. Read on to learn about anxiolytic medications, what conditions they’re used to treat, and their risks.   

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Anxiolytics are anti-anxiety drugs that work quickly to help ease the physical and mental symptoms of anxiety. Most anxiolytic medications affect neurotransmitters in your brain, such as serotonin, the “feel-good” hormone, and gamma-aminobutyric acid (GABA), an amino acid that affects brain signals.

Benzodiazepines

Benzodiazepines (BZDs) or “benzos” are the most frequently prescribed anxiolytics and also one of the most widely prescribed classes of drugs in the United States (Griffin, 2013). Besides their anxiolytic effects, BZDs are also used to treat seizures, muscle spasms, insomnia, and sedation during surgery (Bounds, 2020). They work by attaching to certain receptors in your brain, boosting the activity of the neurotransmitter GABA to produce a calming effect.

Some examples of benzodiazepines include:

• alprazolam (Xanax)

• chlordiazepoxide (Librax)

• clonazepam (KIonopin)

• clorazepate (Tranxene)

• diazepam (Valium)

• lorazepam (Ativan)

• oxazepam (Serax)

• temazepam (Restoril)

As we’ll explain more below, benzodiazepines come with several precautions. They carry a risk of psychological and physical dependence, especially when used for long periods of time. BZDs can potentially cause dangerous effects if combined with other drugs like opioid painkillers, alcohol, or sleep aids.

Buspirone 

Buspirone (Buspar) is another drug that’s classified as an anxiolytic (Bristol-Myers Squibb, 2010). It’s used to treat anxiety disorders and to ease short-term anxiety symptoms. It doesn’t usually cause sedation or drug dependence. While clinical studies demonstrate buspirone’s effectiveness for short-term anxiety, studies for generalized anxiety disorder showed buspirone isn’t more effective than a placebo (Bandelow, 2017). 

Other types of medications

Other medications are often prescribed to treat acute (short-term) anxiety, but they aren’t classified as anxiolytics. 

For example, hydroxyzine (Vistaril, Atarax) is an antihistamine. It’s used to treat itching in low dosages, but higher dosages can help ease anxiety and provide sedation (Pfizer, 2014).

Another example is pregabalin (Lyrica), which is an anticonvulsant medication FDA-approved to treat seizures. It's sometimes prescribed as an anti-anxiety treatment. Lyrica may be used to treat anxiety in people who have tried other treatment options, but either they weren’t effective or weren’t tolerated due to side effects (Bandelow, 2017). 

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are used to treat anxiety disorders, but they’re not anxiolytics. They take weeks of treatment to become fully effective, so they’re not useful for relieving sudden, severe anxiety. But, we’ll come back to this later to explain why antidepressants can be helpful for anxiety disorders.

Anxiolytics are used to treat sudden anxiety. Physical symptoms of a sudden anxiety or panic attack include sweating, heart palpitations, chest pain, trouble breathing, or dry mouth (Bandelow, 2017). People can take anxiolytic medications on an as-needed basis for these attacks, which can occur in people with anxiety disorders, such as:

• Panic disorder

• Agoraphobia

• Generalized anxiety disorder

• Social anxiety disorder

• Specific phobias

• Mixed anxiety and depressive disorder

Anxiolytics are used to prevent anxiety in the short term. For example, if you fear flying, your doctor might prescribe a single dose of a benzodiazepine to take before a flight. Anxiolytics are also given as sedatives before surgery or other medical procedure.

Anti-anxiety medications, especially benzodiazepines, come with risks. Common side effects include drowsiness, dizziness, lack of coordination, and slowed reaction time (Bandelow, 2017). Because of this, you should not drive after taking a benzodiazepine. 

While benzodiazepines can be effective anxiolytics, long-term use increases your risk of addiction, withdrawal, and brain function problems. They’re also linked to a higher risk of motor vehicle crashes and hip fractures (Johnson, 2013; Votaw, 2019). For this reason, experts suggest taking benzodiazepines for short-term use only. The American Academy of Family Physicians recommends that healthcare providers prescribe BZDs for no longer than one month (Johnson, 2013).  

If you take BZDs, be sure to avoid other substances that cause drowsiness, such as alcohol, sleeping pills, or pain medications. The combination can lead to serious harm, including central nervous system (CNS) impairment, slowed breathing, coma, or, in some cases, death (Bounds, 2020; Simone, 2020). 

Benzodiazepines are especially risky for adults aged 65 years and older. Because of age-related physical changes in metabolism, it generally takes longer for an older adult to break down and clear benzodiazepines from their system. This increases the side effects, such as confusion, dizziness, and raises the risk of injuries from falling (Griffin, 2013).

Since anxiolytics carry many risks and are usually only effective for short-term anxiety, antidepressants are typically recommended for the long-term treatment of anxiety disorders. The term itself is a bit misleading; antidepressants can treat people with mental health conditions other than depression.

The most common types of antidepressants used to treat anxiety disorders are SSRIs, such as Lexapro (escitalopram) or Prozac (fluoxetine), and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine). They don’t carry a risk of misuse or physical dependence. 

Antidepressants aren’t anxiolytics, so they won’t immediately help to urgently stop panic or anxiety attacks. However, long-term antidepressant treatment can help reduce the severity of your anxiety symptoms. They can take several weeks to reach their full effectiveness because they slowly build up the levels of certain “feel-good hormones” in your brain. Overall, long-term treatment with SSRIs or SNRIs can help to prevent panic or anxiety attacks.

It’s important not to take any anti-anxiety medications offered to you by a friend or relative. Instead, it’s best to discuss with your healthcare provider. They can help you decide whether short-term treatment with an anxiolytic drug is potentially safe and beneficial for you.

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Current version

July 12, 2021

Written by

Patricia Weiser, PharmD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.