Alone or used in combination with psychotherapy, medication management (sometimes called pharmacotherapy) is a frontline treatment for many symptoms of anxiety and anxiety disorders. As the most commonly occurring group of mental health conditions, anxiety disorders affect nearly 40 million American adults each year.1 Fortunately, medications for anxiety are generally safe and effective in battling anxious symptoms.
What Role Does Medication Play in Treating Anxiety?
Medications play an essential role in treating anxiety for many people, either as the only part of their treatment plan or when used jointly with psychotherapy. With medications and other care, anxiety disorders are very treatable, but sadly, only about 40% of those people with anxiety disorders seek professional treatment.1
According to Kirsten Thompson, M.D. Psychiatrist and Founder of Remedy Psychiatry, “Medication can be very helpful to those suffering from moderate to severe anxiety. When symptoms are impairing life and daily functioning, it can be hard to implement behavioral changes to feel better, such as eating well, exercising and going to therapy. In these cases, when behavioral changes are difficult to do, or simply not effective in reducing depression and anxiety, medication can often help. Outcomes vary, but studies show that medication can lead to remission of symptoms in about 35-65% of people.”
Anxiety disorders share common threads like excessive fear and worry. Some of the most common anxiety disorders include:1
- Generalized anxiety disorder
- Panic disorder
- Social anxiety disorder
- Specific phobias like the fear of spiders, bridges, or heights
In the past, mental health conditions like obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) were considered anxiety disorders. Although they no longer share this designation, they remain very similar to anxiety disorders.1
Medication does not cure or eliminate an anxiety disorder, but a helpful medication can reduce the unwanted symptoms that accompany the condition.2 When someone notes cognitive symptoms of increased feelings of fear, dread, and worry paired with the physical symptoms of being sweaty, tense, and shaky, starting a medication for anxiety could be very beneficial.
Before thinking about exploring treatment for anxiety, people must understand that some level of anxiety, including occasional stress, physical tension, and worry, is normal. In some cases, small doses of anxiety are actually helpful, so no one should establish the goal of eliminating all anxiety.
Each anxiety disorder and each person’s experience with their condition is unique, so the choice to start medication must be a unified decision between the individual and their prescriber. There are many different medications used for anxiety symptoms, which complicates treatment, but as long as the process is fully transparent and collaborative, there is a good chance of success.
Antidepressants
As the name suggests, antidepressants are a group of medications primarily used to manage depressive disorders, but antidepressants are often a firstline treatment for anxiety disorders also. Because antidepressants are so versatile, they can treat additional health concerns like pain, insomnia, and attention-deficit/hyperactivity disorder (ADHD) in adults, which is why antidepressants can be great options for people with multiple mental health concerns.3
Though there are different types of antidepressants, these medications generally work by increasing the available amounts of desirable chemicals in the brain. With higher levels of neurotransmitters like serotonin and norepinephrine, cells can better absorb these to promote feelings of relaxation and calm.4
One group of antidepressants, selective serotonin reuptake inhibitors (SSRIs), works by blocking neurons from reabsorbing serotonin before it can be appropriately used. Another group of antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), works by blocking the reabsorption of both serotonin and norepinephrine, which adds a dual mechanism to further improve symptom relief.
Antidepressants for anxiety are used whenever a prescriber believes adding more serotonin or serotonin and norepinephrine to the system could relieve symptoms. Examples of SSRI antidepressants include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
Examples of SNRI antidepressants include:
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- levomilnacipran (Fetzima)
- venlafaxine (Effexor)
These antidepressants work equally well overall, but some people will respond much better to one specific drug than another. At times, the first medication may not have the wanted effect, so the prescriber will try another option. Patience is always needed, as it may take up to six weeks to notice the wanted effects of an antidepressant.3
Side Effects of Antidepressants
Antidepressant medications are suitable options for many because they cause fewer side effects than other drug types—but the risk is still present. Just as some antidepressants work better for certain people, some will create more side effects.
Some of the most common antidepressant side effects include:3,4
- Nausea, vomiting, and diarrhea
- Weight gain
- Feeling tired and sleepy
- Sexual problems
- Insomnia
- Headache
Beyond the common side effects, antidepressants are sometimes linked to more serious consequences like:3
- Thoughts about death and dying
- Worsening depression
- Worsening anxiety
- Panic attacks
- Increased anger or violence
- High levels of energy and activity connected to mania
Antidepressants like SSRIs and SNRIs carry a black box warning, the most serious warning given by the FDA for increased risk of suicidal thoughts and actions. People under 25 are at an increased risk of suicidal thoughts and actions, especially in the first few weeks after starting or increasing an antidepressant. Prescribers, patients, and parents should be aware of the risks and communicate concerns.2
Benzodiazepines
Anti-anxiety medications specifically target the fear and worry of anxiety, and a class of medications called benzodiazepines are the most common form of anti-anxiety drugs.2 Benzodiazepines have many advantages, including their quick onset of action and efficacy, but they carry substantial risks as well.
Compared to antidepressants, benzodiazepines take effect very quickly. In some cases, people may feel the calming and relaxing benefits of these drugs just minutes after use.5
Rather than acting on serotonin or norepinephrine, benzodiazepines interact with another neurotransmitter called GABA, short for gamma-aminobutyric acid. GABA inhibits signaling in the brain and influences sleep, muscle relaxation, feeling calm, and slows brain activity.5
Examples of benzodiazepines include:4
- alprazolam (Xanax)
- clonazepam (Klonopin)
- diazepam (Valium)
- lorazepam (Ativan)
Detractors of benzodiazepines point to unwanted issues that may present if these drugs are used for longer periods of time than intended. In a process called tolerance, someone using benzodiazepines may need higher doses of the drug to maintain the same benefit over time. Over time, the brain may become physically dependent on these medicines to feel well and function normally. Physical dependence may lead to addiction, where a person becomes obsessively focused on getting and using the medication.3,5
Dependence occurs even when the person is using the medication as recommended. Because of this, stopping the medication abruptly can trigger a series of withdrawal symptoms ranging from mildly uncomfortable, like higher anxiety and poor sleep, to seriously life-threatening, like seizures.6
Side Effects of Benzodiazepines
Benzodiazepines, like many other medications, may initiate unwanted side effects, most notably drowsiness and dizziness. People using benzodiazepines could experience a range of side effects, such as:3
- Nausea
- Blurred vision
- Headache
- Confusion
- Fatigue and lack of energy
- Nightmares
Others may feel unsteady, experience poor coordination, and note problems thinking or remembering from benzodiazepine use. People prescribed these drugs should always keep their prescriber updated regarding side effects, their intensity, and their duration.
Buspirone
Buspirone (also known by the brand name BuSpar) is another type of anti-anxiety medication unrelated to benzodiazepines. This drug seems to produce its wanted effects by interacting with both serotonin and another neurotransmitter called dopamine. It may be considered when a person requires long-term anxiety treatment.7
Buspirone is similar to antidepressants because it can take several weeks before benefit begins, but because there is a lower risk of sedation, dependence, and withdrawal effects when compared to benzodiazepines, the drug is an appropriate option. Since it cannot manage acute anxiety linked to panic attacks, buspirone is a better fit for chronic symptoms associated with generalized anxiety disorder.7
Side Effects of Buspirone
The side effects of buspirone may emerge shortly after treatment starts. Some of the possible buspirone side effects include:3
- Dizziness and lightheadedness
- Headaches
- Nausea
- Increased nervousness and worry
- Feeling overly excitable
- Sleep problems
Side effects may alleviate or worsen over time, so people should always consult with their treatment team.
Beta-Blockers/Blood Pressure Medications
Beta-blockers, a group of medications that help to reduce symptoms of high blood pressure, can also help with anxiety symptoms. These medications work in the body by reducing the levels of epinephrine (adrenaline) in the body.
Beta-blockers are helpful for anxiety symptoms because they cause the heart to beat more slowly and create a decrease in blood pressure. With fewer physical symptoms of anxiety, a person could experience increased feelings of calm.7
Examples of beta-blockers include:7
- acebutolol (Sectral)
- atenolol (Tenormin)
- bisoprolol (Zebeta)
- metoprolol (Lopressor, Toprol XL)
- nadolol (Corgard)
- nebivolol (Bystolic)
- propranolol (Inderal, InnoPran XL)
Clonidine (Catapres) is another medication designed for hypertension that is used with anxiety as well. Although this medication is not a beta-blocker, it has a similar effect on adrenaline in the body.7
Side Effects of Beta-Blockers
The side effects of beta-blockers match many unwanted effects of other medications with some troubling additions. Some of the possible beta-blocker side effects include:7
- Cold hands or feet
- Feeling tired and fatigued
- Gaining weight
- Lower mood and feeling depressed
- Experiencing shortness of breath
- Trouble sleeping
Other Medications for Anxiety Disorders
Several other groups of medications, like antihistamines, MAOIs, tricyclic antidepressants, and atypical antidepressants, may also be used for anxiety disorders. Since these are not usually first line treatments, prescribers may use them only when other medications fail to deliver anxiety relief.
Antihistamines
Physicians typically prescribe antihistamines to manage allergy symptoms. These medications can help anxiety by calming the brain in the short term.
Hydroxyzine (Atarax and Vistaril) works to reduce anxiety quickly but can lead to drowsiness and decreased alertness. Meclizine (Antivert) is commonly used for motion sickness, but the drug can reduce unwanted symptoms of a panic attack.9
MAOIs
Monoamine oxidase inhibitors (MAOIs) are available options for anxiety treatment when other treatments for social phobia and panic disorder are unsuccessful. Some serious side effects like hypotension, weight gain, and sexual side effects are possible, so people should use these medications cautiously.8
Examples of MAOIs include:8
- phenelzine (Nardil)
- selegiline (Emsam)
- tranylcypromine (Parnate)
- isocarboxazid (Marplan)
Antidepressants like MAOIs carry a black box warning, the most serious warning given by the FDA for increased risk of suicidal thoughts and actions. People under 25 are at an increased risk of suicidal thoughts and actions, especially in the first few weeks after starting or increasing an antidepressant. Prescribers, patients, and parents should be aware of the risks and communicate concerns.2
Tricyclic Antidepressants
As an older group of medications used for depression, tricyclic antidepressants may be used as anxiety treatments because of their sedating effects. Many tricyclics create effects by interacting with serotonin and norepinephrine. Caution must be practiced with these medications due a risk of accidental overdose.8
Some examples of tricyclics include:8
- imipramine (Tofranil)
- amitriptyline (Elavil)
- clomipramine (Anafranil)
- nortriptyline (Pamelor)
Antidepressants like tricyclic antidepressants carry a black box warning, the most serious warning given by the FDA for increased risk of suicidal thoughts and actions. People under 25 are at an increased risk of suicidal thoughts and actions, especially in the first few weeks after starting or increasing an antidepressant. Prescribers, patients, and parents should be aware of the risks and communicate concerns.2
Atypical Antidepressants
Atypical antidepressants are not explicitly approved for anxiety treatment, but several medications from this class may be helpful. These drugs usually create change by interacting with norepinephrine and serotonin in the brain.8
Examples of atypical antidepressants include:8
- trazodone (Desyrel)
- mirtazapine (Remeron)
Antidepressants like atypical antidepressants carry a black box warning, the most serious warning given by the FDA for increased risk of suicidal thoughts and actions. People under 25 are at an increased risk of suicidal thoughts and actions, especially in the first few weeks after starting or increasing an antidepressant. Prescribers, patients, and parents should be aware of the risks and communicate concerns.2
Finding the Right Anti-Anxiety Medication
Finding the right anti-anxiety medication is sometimes challenging because different medications will create different effects in the people who use them. One medication that works exceptionally well for a friend or family member may not have the same positive effect on another person.
With the unpredictable nature of medications for anxiety, the process of starting a medication involves some trial and error. People may have to experiment with several unhelpful medications or endure medications with strong side effects before finding the best option for their symptoms.2
Working with a knowledgeable and experienced prescriber can help streamline the process and identify a great medication more quickly. Like with other medical professionals, an individual should inform the prescriber about any excessive caffeine use, over-the-counter medications, herbal substances, or other drug use, as these situations can negate the benefits of the medication.2
Thompson states, “To start, a thorough history and evaluation of a patient’s symptoms and medical health by a psychiatric specialist is the best way to insure that a patient is on the best possible medication for them. If they’ve tried medications in the past, an understanding of which medications have worked, which haven’t, and any prior side effects, is also very important to decide a treatment plan. As it can be hard to remember, having this medication history list in advance of an appointment can be very helpful for the provider to come up with a treatment plan so as to avoid medications that have already been tried in the past. Additionally, regular follow-up appointments to assess for side effects and symptom remission is important to ensure that the medication prescribed is an appropriate fit and dosage.”
Prescribers including psychiatrists, nurse practitioners, and primary care doctors, are widely available to meet medication needs and answer the questions a person may have. Comfort and trust are paramount here, so if a person does not feel positively about their prescriber, it could be a sign to seek out another opinion. Because mental health issues are so subjective, another professional could offer a much different perspective on one person’s symptoms and care.
Is It Alright to Stop My Dose When I Start Feeling Better?
According to Thompson, “It’s very common for patients to slowly start feeling better once the medication is working, which usually takes 3-6 weeks. Many patients make the mistake of then stopping medication, when they’re actually feeling better because the medication is working! It’s always better to have a conversation with the provider before changing or stopping the dose. This is so that an adequate assessment of benefits and side effects, along with a safe plan for tapering off the medication, can be determined.”
Questions to Ask Your Doctor Before Beginning a New Anxiety Medication
Beginning a new anxiety medication takes a full collaboration between the prescriber and individual in treatment. Since there is not a one-size-fits-all for anxiety medication, the treatment must be tailored to the exacting needs of the client. These medications are typically safe and effective, but an inappropriate medication or medication dose can result in serious and potentially life-threatening consequences.
Before beginning a new medication for anxiety, consider asking your doctor or psychiatrist the following questions:2
- Will this medication take away all anxiety and cure my condition?
- What type of medication for anxiety is best for me and my goals?
- What are the potential repercussions of this medication?
- Will I have to take this medication forever or can I stop whenever I start feeling better?
- Can I contact you or someone on your staff if medication side effects begin?
- How do I end the use of this medication if the side effects become too problematic?
- Do I need to use this medication everyday or only as needed? If the medication is “as needed,” how do I know when to take it?
- Will taking this medication mean that I do not need therapy or counseling in the future?
Some people may feel confused or intimidated by the prospect of starting a new medication for anxiety, but every individual has the right to be actively involved in their treatment plan. If a prescriber seems disinterested or dismissive, it could be a sign that another prescriber would be a better fit.
Tips for Taking Your Anxiety Medication Consistently
For medications to be at their peak efficacy, they need to be taken as prescribed. Not only will medications be less effective if they are not taken consistently, they could trigger dangerous symptoms to emerge.
Thompson suggests, “It’s always important to take medication as prescribed, namely, not skipping days as this can reduce the effective dose. And while many medications are relatively safe with alcohol in moderation, using any substances while on antianxiety medications can make it difficult to distinguish between the medication and substance with regard to benefits and side effects.”
If you have trouble remembering to take your medication, considering trying these tips:
- Write down the medication schedule during your appointment: It may sound obvious, but too often, people do not keep track of their prescriptions in tangible ways. Without writing down the medication plan, a person has to constantly spend energy to reflect and recall the schedule discussed with the doctor.
- Take advantage of technology: Phone alarms and timers paired with smart assistants’ tips and reminders can make remembering medication a breeze. Setting one or many of these options to take medication will take the guesswork out of the process.
- Create a routine: Pairing medication with a behavior that you do every day can build a good habit. Take your medication before you brush your teeth, after your shower, during lunch, or after you get the kids on the bus to link these behaviors together.
- Get an assistant: Ask a friend, coworker, or family member to help with your memory. It may seem uncomfortable to ask this of others, but remember, it won’t take long for the pattern to become part of the routine.
- Check your symptoms: People that may be taking medications “as needed” have a unique task of remembering to take their pills before symptoms escalate too far. These people should consider making a list of their symptoms to refer to throughout the day. If symptoms begin worsening, it could be time to reach for the prescription bottle.
Additional Resources for Anxiety Treatments
Anxiety is a complex condition that affects millions every day, but luckily excellent organizations are putting forth resources to understand and treat anxiety while informing the public about the group of disorders. With these efforts, anxiety treatments will continue to improve over time.
Some key organizations leading the way include:
