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Jun 03, 2021
7 min read

Your guide to anxiety medications

There are many evidence-backed medications for people with anxiety. All of these drugs work in slightly different ways. Some drugs work better than others for certain types of anxiety, but not everyone responds well to these drugs. Anxiety medications do have side effects and about 1 in 3 people who have anxiety do not find relief from medications alone.

felix gussone

Reviewed by Felix Gussone, MD

Written by Health Guide Team

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 is one of the most commonly diagnosed mental health conditions. By some estimates, roughly 32% of Americans will develop an anxiety disorder at some point in their lifetimes (Garakani, 2020; NIMH, 2007).

There are many different ways to treat an anxiety disorder. These include psychotherapy and many relaxation techniques. Anxiety medications can also help, whether taken alone or used alongside another type of anxiety treatment (Chand, 2021). 

In this guide, you’ll find a list of common anti-anxiety medications. Keep in mind that not all of these drugs are appropriate for all forms of anxiety or for all people. Every brain is unique. A drug that helps one person with anxiety may not work the same way for you.  

Also, you may notice that many of these anti-anxiety drugs are also used to treat depression. This is because some of the same brain systems and neurochemicals that play a role in anxiety also seem to be involved in depression (Garakani, 2020).  

Types of anti-anxiety medications

There are a few different types of medications used to treat anxiety. Here are the most common.

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin is a neurotransmitter (basically, a brain chemical) that seems to promote positive mood and emotions.

SSRIs block the brain’s nerve cells from absorbing serotonin, which is a process known as “reuptake.” By blocking this reuptake, it’s thought that the brain’s levels of serotonin get a boost. And there’s a lot of evidence that this helps relieve anxiety symptoms (NHS, 2018).

Some of the most common SSRIs are (Chand, 2021):

SSRIs are popular in part because they don’t mess with the activity of other brain chemicals. Like all drugs, they do have side effects. But these tend to be minor compared to many other anti-anxiety medications (Chu, 2021).

Some side-effects of SSRIs include (Chu, 2021):

  • Sexual dysfunction
  • Sleep problems
  • Weight changes
  • Dizziness
  • Dry mouth
  • Headache
  • Upset stomach

SSRIs don’t start to work immediately. It usually takes at least two weeks before you’ll feel any benefits and it might take up to six weeks until you feel the full effects of the drug (Taylor, 2006). However, some of the side effects can come on right away (Bandelow, 2017).

SSRIs are prescribed for all forms of anxiety and are considered a “first-line” treatment (Chand, 2021). How long you’re taking the drugs can vary.  A healthcare provider might recommend you take SSRIs for up to a year or two if they work well for you (Garakani, 2020; Bystritsky, 2021). 

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Norepinephrine, like serotonin, is another brain chemical that seems to play a role in mood and anxiety. SNRIs block the reuptake of both serotonin and norepinephrine. And there’s evidence that these work well for some people with anxiety (Sheffler, 2021).

Some of the most common SNRIs are venlafaxine (Effexor XR; see Important Safety Information) and duloxetine (Cymbalta; see Important Safety Information) (Chand, 2021).

Side effects of these and other SNRI drugs include (Bandelow, 2017):

  • Jitteriness
  • Nausea
  • Restlessness
  • Headaches
  • Fatigue
  • Weight gain or loss
  • Sweating
  • Sexual dysfunction
  • Diarrhea

Like SSRIs, SNRIs don’t start to work immediately. While side-effects may show up right away, anxiety benefits tend to take at least a couple of weeks (Bandelow, 2017). Some research has shown that SNRIs work well for treatment lasting six months and longer (Rickels, 2010).

SNRIs are also considered first-line treatment—specifically for generalized anxiety disorders (Chand, 2021). But some of the side effects such as nausea and dry mouth may be more pronounced than those associated with SSRIs (Santarsieri, 2015).

Benzodiazepines

Benzodiazepines, or “benzos,” have been a mainstay of anxiety treatment for decades. Along with SSRIs and SNRIs, they remain one of the most commonly prescribed classes of anti-anxiety drugs (Garakani, 2020).

Benzos can help reduce anxiety—often very quickly. They start to work in as little as 30 minutes, and they tend to reduce muscle tension and other symptoms of anxiety. For this reason, they’re popular as a short-term anxiety treatment or for people who are in the midst of a panic attack or other severe bout of anxiety (Chand, 2021).

Some common benzodiazepines include:

While benzodiazepines are popular and often effective, there’s some evidence that they’re more likely than other anti-anxiety drugs to lead to addiction or abuse. This is one of the reasons why benzos are not considered the go-to medication for anxiety anymore. Today, healthcare providers prefer to prescribe benzos in combination with other anti-anxiety drugs, like SSRIs (Garakani, 2020).

Other side-effects of benzos include (Vashchinkina, 2014):

  • Memory problems
  • Dizziness
  • Clumsiness or falls
  • Confusion
  • Sleepiness

Tricyclic antidepressants (TCAs)

Like SNRIs, tricyclic antidepressants help increase the brain’s circulating levels of serotonin and norepinephrine. But they do this in slightly different ways than SNRIs (Garakani, 2020).

While there’s evidence that TCAs can help treat anxiety, these drugs have been around since the 1950s (Gillman, 2007). They tend to cause harsher side-effects than SSRIs, SNRIs Is and other, newer anti-anxiety medications. For that reason, medical providers don’t often prescribe them anymore (Garakani, 2020).

TCAs are not FDA approved for the treatment of most anxiety disorders, although there are some special cases when they may still be helpful—for example, when SSRIs or other drugs don’t work well (Garakani, 2020).

Side effects of these drugs include (Garakani, 2020):

  • Weight gain
  • Dry mouth
  • Sleepiness
  • Urinary problems
  • Irregular heartbeat

Beta-blockers

These drugs reduce tension, a racing heart, and the other physical symptoms of anxiety. Two common types are propranolol and atenolol (Chand, 2021).

Beta-blockers aren’t FDA-approved for the treatment of anxiety. But medical providers still prescribe beta-blockers in some cases. They’re especially common for people who have specific fears (phobias), such as a fear of public speaking or a fear of spending time in social situations (Chand, 2021).

These drugs work by binding to beta receptors that normally bind to epinephrine and other chemicals associated with increased nervous system activity. By blocking the action of these chemicals, the heart slows, muscles relax, and the nervous system mellows out (Farzam, 2021).

On the other hand, beta-blockers can cause side effects. These include (Farzam, 2021):

  • Low blood pressure
  • Fatigue or sleepiness
  • Dizziness
  • Nausea
  • Constipation
  • Sexual dysfunction

Along with anxiety, beta-blockers can help treat a range of medical conditions. This list includes heart disease, tremors, glaucoma, hyperthyroidism, and many others. If a person has one or several of these conditions, as well as anxiety, their medical provider may be more likely to prescribe a beta-blocker (Farzam, 2021).

Other types of anti-anxiety medications

There are a few other drugs that healthcare providers occasionally prescribe for the treatment of anxiety. These include:

  • Buspirone (Buspar; see Important Safety Information), a mild tranquilizer sometimes used to treat generalized anxiety disorder. The effects are similar to those of benzodiazepines, but without the risk of dependence (Chand, 2021).
  • Antipsychotics, which are not FDA-approved for anxiety but are sometimes helpful for people with generalized anxiety disorder (Garakani, 2020).
  • Antihistamines, which may be safer than other drugs for kids, and can also help with insomnia (Garakani, 2020).

There are others. But the ones above are far and away the most common.

Do anxiety medications work?

For some people, yes. All of the types of medication mentioned above are backed by solid research. That said, not everyone with anxiety will respond to medication. In fact, about 1 in 3 people with anxiety don’t find durable relief in the form of a pill (Garakani, 2020).

For these people—and for many others with anxiety—the best treatment may involve other forms of therapy, including psychotherapy (Chand, 2021).

What exactly is anxiety?

Technically, it’s a mood state fueled by worry and fear. This worry or fear tends to be “future-oriented,” meaning it’s about something that may or may not happen—as opposed to something that is happening in the present.

But anxiety isn’t just a mood. It’s a complicated experience that also involves thoughts, feelings, and behaviors (Chand, 2021).

The common symptoms of anxiety can be broken down into three categories.

Cognitive symptoms

The first category involves cognitive symptoms. These include (Chand, 2021):

  • Worry
  • Fear of losing control
  • Fear of injury or death
  • Fear of “going crazy”
  • Fear of negative judgment from others
  • Poor concentration
  • A sense of unreality or detachment

Physical symptoms

The second category involves the body. These symptoms include (Chand 2021):

  • Racing heart
  • Shortness of breath
  • Sweating or sweaty palms
  • Muscle tension
  • Rapid breathing
  • Hot flashes
  • Nausea
  • Upset stomach
  • Weakness or unsteadiness

Behavioral symptoms

The final category includes behavioral symptoms. Some of these are (Chand, 2021):

  • Avoiding certain things or situations
  • Urge to escape or flee
  • Moving away from sources of fear or worry and toward safer situations
  • Seeking reassurance

The different types of anxiety

There are many different anxiety medications in part because there are many kinds of anxiety. All of them involve some form of fear or worry.

General anxiety disorder, for example, involves persistent, hard-to-control worry about any number of different concerns—school, work, family, etc. Meanwhile, social anxiety disorder involves a fear of being around other people who may cause you to feel judged, embarrassed, or otherwise uncomfortable (Chand, 2021).

If you feel like you may benefit from anxiety medication, your healthcare provider can help you figure out whether a drug can help—and which one is best 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. Bystritsky, A. (2021). Pharmacotherapy for generalized anxiety disorder in adults. In: UpToDate. Retrieved from https://www.uptodate.com/contents/pharmacotherapy-for-generalized-anxiety-disorder-in-adults#H303453001
  3. Chand, S. P., & Marwaha, R. (2021). Anxiety. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470361/
  4. Chu, A., & Wadhwa, R. (2021). Selective serotonin reuptake inhibitors. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/
  5. Farzam, K., & Jan, A. (2021). Beta Blockers. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532906/
  6. Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in Psychiatry, 11, 595584. doi: 10.3389/fpsyt.2020.595584. Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyt.2020.595584/full
  7. Gillman P. K. (2007). Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. British Journal of Pharmacology, 151(6), 737–748. doi: 10.1038/sj.bjp.0707253. Retrieved from https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1038/sj.bjp.0707253
  8. National Health Services (NHS). (2018) Overview: Selective serotonin reuptake inhibitors (SSRIs). National Health Service (UK). Retrieved from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/
  9. National Institute of Mental Health (NIMH). (n.d.). Any anxiety disorder. Retrieved June 1, 2021 from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
  10. Rickels, K., Etemad, B., Khalid-Khan, S., Lohoff, F. W., Rynn, M. A., & Gallop, R. J. (2010). Time to relapse after 6 and 12 months’ treatment of generalized anxiety disorder with venlafaxine extended release. Archives of General Psychiatry, 67(12), doi: 10.1001/archgenpsychiatry.2010.170. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/21135327/
  11. Santarsieri, D., & Schwartz, T. L. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs in Context, 4, 212290. doi: 10.7573/dic.212290. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630974/
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