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.
Before you begin a new medication for anxiety, it’s important that you have a thorough explanation from your prescriber about your dosage and any potential side effects you may experience. Knowing what to expect and adverse effects to watch for is critical before starting any new medication.
About Treatment & Medication for Anxiety
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 person and their prescriber. There are many different medications used for anxiety symptoms, which can complicate treatment, but as long as the process is fully transparent and collaborative, there is a good chance that you’ll find the best way to minimize your anxiety symptoms.
The Role of Medication for 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, like cognitive behavioral therapy. With medications and other care, anxiety disorders are very treatable, but sadly, only about 40% of those people with anxiety disorders seek professional treatment, perhaps because some people worry about what taking anxiety medication might feel like.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 – although you shouldn’t necessarily expect immediate results.
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.”
Antidepressants for Anxiety
Antidepressants are a group of medications primarily used to manage depressive disorders, but antidepressants are often a firstline treatment for anxiety disorders also. 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 them to promote feelings of relaxation and calm.4
Antidepressants for anxiety are used whenever a prescriber believes adding more serotonin or (serotonin and norepinephrine) to the system could relieve symptoms.
SSRIs
Selective serotonin reuptake inhibitors (SSRIs) work by blocking neurons from reabsorbing serotonin before it can be appropriately used.
Examples of SSRI antidepressants include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
SNRIs
Serotonin-norepinephrine reuptake inhibitors (SNRIs), work by blocking the reabsorption of both serotonin and norepinephrine, which adds a dual mechanism to further improve symptom relief.
Examples of SNRI antidepressants include:
- desvenlafaxine (Pristiq)
- duloxetine (Cymbalta)
- levomilnacipran (Fetzima)
- venlafaxine (Effexor)
SSRIs vs. SNRIs
Both SNRIs and SSRIs 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
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)
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. Talk with your prescribing doctor prior to starting medication to better understand how different antidepressants might affect you.
Some of the most common antidepressant side effects include:3,4
- Nausea, vomiting, and diarrhea
- Weight gain or weight loss
- 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 & Suicide Risk
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
Benzodiazepines are the most common form of anti-anxiety drugs.2 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, but they have substantial risks as well.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)
Benzodiazepine Side Effects
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
- Weight gain
- 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.
Benzodiazepine Dependence & Safety Concerns
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
Drug Interactions & Overdose
Benzodiazepines work by slowing the central nervous system (CNS) and, in turn, reducing breathing and cognitive function.10,11 When combined with other substances or medications that also slow the CNS, it can potentially cause an overdose. It can be dangerous to combine benzodiazepines with sedatives (such as certain medications for sleep), alcohol, and medications combined with opioids such as codeine as they can put you at risk for an overdose. Overdosing can be fatal if no treatment occurs, and can look like confusion, significant sleepiness, balance problems, weakness, lowered heart rate, difficulty breathing, and even passing out.10,11
The Centre for Addiction and Mental Health (CAMH) reports no major interactions with caffeine, although if too much is ingested (like more than 4 cups of coffee), it may keep the medication from reducing anxiety levels.
Benzodiazepine Risk Factors in Certain Populations
While benzodiazepines have medical benefits, they may not work for everyone and can be a significant risk to some groups of people. These groups of people generally include people who are pregnant or breastfeeding, people with addiction backgrounds, people who are under 18, and older adults.
If benzodiazepines are used close to a pregnant person’s delivery date, the baby may experience drowsiness and withdrawal issues, and small amounts of benzodiazepines can transfer to the baby during breastfeeding.10 Benzodiazepines are highly addictive and often closely monitored when prescribed.12 In addition, when combined with other street or non-prescription drugs, people are at risk for increased mental health symptoms, difficulty sleeping, and even overdose, if mixed with sedatives or opioids.10,11
It is not suggested for people under 18 to be prescribed benzodiazepines, unless it is for short-term medical issues. Older people are more sensitive to side effects of benzodiazepines, most likely because they have a slower metabolism so the benzodiazepine stays in the body longer. These side effects can include confusion and decreased muscle coordination, which poses significant risk to their physical health.10
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 someone starts to feel better, but because there is a lower risk of sedation, dependence, and withdrawal effects when compared to benzodiazepines, the drug can be 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 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
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 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 Anxiety Medications
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.
MAOIs
Monoamine oxidase inhibitors (MAOIs) are options when other medications 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)
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
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)
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
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
Medication Isn’t the Only Option for Treating Anxiety
While medication can be beneficial, it may not be right for everyone, and even if you do take medication for anxiety, it’s best to supplement with other treatment options and lifestyle changes as well. Other ways to treat and manage anxiety symptoms have been found to be effective for different people, including therapy, exercise, and natural remedies.
Therapy
Therapists often work with people on identifying their symptoms, potential connections and triggers, ways to process these feelings, and ways to cope with and manage anxiety symptoms. Anxiety therapy can be useful in learning skills that can be applied in the future, even after therapy is over, and to help identify needed skills and resources.
Exercise
Researchers have noted that general physical activity may decrease anxiety and stress-related symptoms.13 This can look like simply shaking your limbs, going on walks or runs (especially in nature!), yoga, and, according to research, high and moderate-intensity interval training (HIIT/MIIT).13 Starting out small can be helpful to see what works best for you.
Meditate
Meditation has become a popular coping skill that may decrease anxiety symptoms. Meditation creates an opportunity to clear your mind, to consider and challenge your perspective, and to calm yourself down.13 Meditation can also help you to identify physical indicators of anxiety. You can try meditation apps and videos that help with guided meditation to help you focus.
Natural Remedies
More natural resources have become available over time and are suggested to be helpful in treating anxiety. This can include using oils from nature (e.g. lavender, grapefruit, sage, etc.) that give off scents that can help people to feel calm, lower blood pressure, and even increase quality sleep. Natural resources can also include herbal supplements, like lavender and chamomile tea, CBD oil, and even epsom salt baths or floats. It is important to note which natural remedies are approved by the FDA to treat symptoms of anxiety and to always speak with your doctor before starting a natural supplement.
Avoiding Caffeine & Other Stimulants
Caffeine and other stimulants can influence and increase anxiety, especially the feeling of being shaky or jittery. It is suggested to reduce or limit caffeine use, alcohol use, and other stimulants, like certain drugs or nicotine.13
Deciding If Anxiety Medication Is Right for You
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
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.”
Questions to Ask Yourself & a Mental Health Professional Before Beginning a New Anxiety Medication
It can be hard to decide if medication is right for you, especially if this is the first time you have considered taking it or reached out to a mental health professional. It may feel overwhelming since the idea of medication may be stigmatized for many people. There is no shame in reaching out to a medical provider to ask questions and it is suggested to find out what you can before you make that decision for yourself.
Questions you may want to ask yourself and a mental health professional include:
- Am I comfortable with taking something every day or as needed?
- Can I safely take medications with my work schedule and expectations?
- What side effects will I experience as a result of this medication?
- What side effects am I comfortable dealing with to see if this medication works for me?
- What kind of routine or process is helpful with this medication? (i.e. taking the medication with or without food)
- Is this medication the best fit for my symptoms?
- Do I use substances that may impact this medication from being helpful for me?
- If I feel the medication is not working or is harming me, how do I let you (the mental health professional) know this?
Questions to Ask Your Doctor
Anxiety medications are typically safe and effective, but an inappropriate medication or medication dose can result in serious and potentially life-threatening consequences. Additionally, women who are pregnant or breastfeeding should discuss which anxiety medications are safe to take in pregnancy with their OB/GYN or prescribing physician.
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 everyone 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.
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.”
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.
