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Last updated: Jul 12, 2021
5 min read

Anxiolytics: uses, side effects, and risks

Anxiolytic literally means “to break anxiety.” Anxiolytics are anti-anxiety medications. The most commonly prescribed anxiolytic drugs are benzodiazepines, such as Xanax (alprazolam). Benzodiazepines are effective for quickly relieving short-term anxiety, but their long-term use carries many risks, especially when combined with alcohol, painkillers, and sleep aids.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

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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What is an anxiolytic?

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:

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; see Important Safety Information) 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; see Important Safety Information) 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.

What conditions do anxiolytics treat?

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:

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.

Risks of anxiolytics

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).

Alternatives to anxiolytics

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; see Important Safety Information) or Prozac (fluoxetine; see Important Safety Information), and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine; see Important Safety Information). 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.

References

  1. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. doi: 10.31887/DCNS.2017.19.2/bbandelow. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
  2. Bounds, C. G., Nelson, V. L. (2020). Benzodiazepines. [Updated Nov 22, 2020]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470159/
  3. Bristol-Myers Squibb. (2010). BuSpar – buspirone hydrochloride. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018731s051lbl.pdf
  4. Griffin, C. E., 3rd, Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effects. The Ochsner Journal, 13(2), 214–223. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/
  5. Johnson, B., & Streltzer, J. (2013). Risks associated with long-term benzodiazepine use. American family physician, 88(4), 224–226. Retrieved from https://www.aafp.org/afp/2013/0815/p224.html
  6. Pfizer. (2014). Vistaril (hydroxyzine pamoate) capsule and oral suspension. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/011459s048%2C011795s025lbl.pdf
  7. Simone, C. G. & Bobrin, B. D. (2020). Anxiolytics and sedative-hypnotics toxicity. [Updated Sep 3, 2020]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562309/
  8. Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug and Alcohol Dependence, 200, 95–114. doi: 10.1016/j.drugalcdep.2019.02.033. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639084/