*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
The most common alternatives to Xanax are other benzodiazepines, SSRI antidepressants, and non-addictive anti-anxiety medications. Non-medication alternatives, such as cognitive behavioral therapy and lifestyle changes, can also be effective without the safety concerns of Xanax. Consult your healthcare provider about your options and how to safely stop taking Xanax if you need to switch medications.1
If you’re considering a Xanax alternative, an online psychiatry platform such as Talkiatry can connect you with a provider quickly. They can and will prescribe other benzodiazepines, which are controlled substances, and other anxiety medications that are not controlled substances. Brightside Health does not prescribe controlled substances, but may prescribe other alternatives, such as antidepressants. These platforms can provide an assessment and may offer you a prescription for a Xanax alternative if they determine a medication may help your symptoms.
Boxed Warning: Risks of Alprazolam (Xanax) include misuse, addiction, withdrawal and even death
Alprazolam, the active ingredient in Xanax, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA).
- Taking Xanax, a benzodiazepine, with other opioid medications increases your risk for serious side effects that include severe sedation, slower breathing, coma, and death. Xanax should not be taken with an opioid unless there are no other options.
- Taking Xanax can lead to misuse (abuse) and addiction of the medication, which can increase your risk of overdose and death.
- Using Xanax can lead to physical dependence and this risk increases the longer you take Xanax. If you suddenly stop taking Xanax, you can experience withdrawal. Withdrawal can be life threatening. Xanax should only be discontinued by gradual tapering of the dose.
Xanax is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
Key Takeaways
Xanax alternatives may be necessary for some to consider. Xanax is prescribed to treat anxiety disorders and other mental health conditions, but may not be right for everyone.
Several medications can be used as Xanax alternatives, including antidepressants and other anti-anxiety agents. Some may find natural and over-the-counter treatments helpful.
If you are considering an alternative to Xanax, a good place to start is with an evaluation from a medical provider. Talkiatry can and will provide evaluations and prescribe controlled substances such Xanax. Brightside Health and Talkiatry are two online psychiatry platforms that can offer antidepressants where they may be a good fit.
Reasons to Consider Xanax Alternatives
Some looking for anxiety treatments need to consider alternatives to Xanax. While it is a safe and effective medication for many who use it, Xanax may not be a good fit for everyone. Each person responds uniquely to benzodiazepines, and switching to a different medication can sometimes lead to better symptom relief.
Some individuals may experience uncomfortable side effects with Xanax, such as problems with coordination and low blood pressure. Some may be taking medications that interact with Xanax, leading to potential toxicity or reduced effectiveness. Those who have allergic reactions to ingredients in Xanax will need to avoid it, considering other medications or non-medication treatments instead.
Insurance coverage, costs, and personal preference are additional key factors to consider. Some patients may find the cost of Wegovy a burden. If you are considering Wegovy alternatives, communicate with your prescriber and pharmacist to identify the treatments that may be a good fit for you.
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What Medications Are Alternatives to Xanax?
Xanax is a commonly prescribed medication for treating symptoms of anxiety, but Xanax alternatives may be necessary for some needing treatment. Several types of medications are available to help manage anxiety symptoms. Every Xanax alternative medication carries risk and the potential for side effects.
Some of the most common Xanax alternatives include:
- Benzodiazepines: Ativan, Valium, Klonopin
- SSRIs: Zoloft, Lexapro, Paxil, Prozac, Celexa
- SNRIs: Effexor XR, Pristiq, Cymbalta
- Buspirone
- Beta blockers
Other Benzodiazepines
Several other benzodiazepines can be prescribed to alleviate anxiety symptoms. These medications work by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that calms nerve activity in the brain. This leads to a reduction in anxiety and a sense of relaxation. Common side effects of benzodiazepines include drowsiness, dizziness, confusion, headache, low energy, and stomach problems.
Benzodiazepines carry a risk of tolerance, dependence, and withdrawal symptoms if used for an extended period. All benzodiazepines carry the same black box warning from the FDA for this risk. They are generally recommended for short-term use or in acute situations due to these potential drawbacks.
SSRIs
Selective serotonin reuptake inhibitor (SSRI) medications treat anxiety as well as depression effectively. And because they often occur with other mental health conditions, SSRIs can be good alternatives to Xanax for anxiety. While all SSRIs affect serotonin levels in the brain, there are some differences with how they work and associated side effects. Common side effects for SSRIs include nausea, diarrhea, dry mouth, increased sweating, sleep changes, sexual dysfunction
SSRIs have many FDA-approved and non-FDA-approved (off-label) uses. Because depression and anxiety often occur with other mental health conditions, SSRIs are often considered as treatments. And because each person has a unique response to medication, some may find that one SSRI works better than others they try.
Here are some SSRIs prescribed as Xanax alternatives:
- Zoloft (sertraline): Some studies suggest that Zoloft may be associated with less drowsiness and fewer serious side effects than other SSRIs. Common side effects include nausea, loss of appetite, diarrhea, and anxiety.
- Lexapro (escitalopram): Lexapro may be better tolerated than Zoloft for some people. According to a comparative study, Lexapro is superior to Cymbalta in the short-term treatment of depression.2
- Paxil (paroxetine): Paxil’s side effect of drowsiness may be helpful for those having trouble with sleep. People are often prescribed Paxil for anxiety since it has been shown has been FDA-approved to treat three different anxiety disorders. Common side effects include sexual dysfunction, diarrhea, dry mouth, and sweating.
- Prozac (fluoxetine): Prozac is available in a form that stays in the body longer, making it suitable for individuals who struggle with remembering to take their medication every day. Common side effects from Prozac include sexual dysfunction, loss of appetite, dry mouth, and indigestion.
- Celexa (citalopram): Celexa is well-tolerated with a lower likelihood of weight gain and insomnia. Common side effects include nausea, dry mouth, drowsiness, and delayed ejaculation.
SNRIs
Serotonin norepinephrine reuptake inhibitors (SNRIs) are safe and effective treatments for anxiety disorders. They work by taking action on two different chemicals in the brain, serotonin and norepinephrine. Common side effects of SNRIs include anxiety, dry mouth, nausea, constipation, fatigue, sexual dysfunction.
SNRIs are a smaller drug class and are not used to treat the wide variety of disorders that SSRIs are. But because SNRIs and SSRIs are both effective at improving mood and anxiety, they are commonly used as alternatives for each other.
Here are some SNRIs prescribed as Xanax alternatives:
- Effexor XR (venlafaxine): Because of its extended-release formula, some Effexor side effects may not be as likely to occur when starting the medication than with other antidepressants. Common side effects of Effexor include nausea, dry mouth, sexual dysfunction, and sleepiness.
- Pristiq (desvenlafaxine): Pristiq’s active ingredient is closely related to that of Effexor. But because of the way it is formulated, the side effects of Pristiq, including insomnia, nausea, and fatigue, may not be as likely to occur.
- Cymbalta (duloxetine): Along with its antidepressant properties, Cymbalta is FDA-approved for managing chronic pain conditions like fibromyalgia and diabetic peripheral neuropathy. Common side effects include nausea, dry mouth, fatigue, and loss of appetite.
Online Psychiatry
Circle Medical – Anxiety and Depression Treatment. Meet with an online doctor today! All prescriptions are based on necessity determined by a medical professional. Diagnosis and prescription over video. Insurance accepted. No membership or hidden fees. Same day appointments. Visit Circle Medical
Plushcare There are many effective medications for anxiety and depression, including Zoloft and Lexapro, which a Plushcare doctor can prescribe. In as little as 15 minutes, you can speak with a board-certified doctor from PlushCare to receive anxiety or depression treatment. Plushcare DOES NOT prescribe controlled substances. Visit Plushcare
Other Anti-anxiety Medications
Other anti-anxiety medications can be prescribed as an alternative to Xanax for anxiety symptoms.
Buspirone
Buspirone is another medication used to treat symptoms of anxiety. Unlike benzodiazepines, another class of anti-anxiety medications, buspirone does not have sedative effects and is considered non-addictive.3 Common side effects include dizziness, nausea, headache, and lightheadedness.
Beta Blockers
Beta-blockers are a group of medications that help to reduce symptoms of high blood pressure. They are helpful for anxiety symptoms because they cause the heart to beat more slowly and create a decrease in blood pressure.4 With fewer physical symptoms of anxiety, a person could experience increased feelings of calm. Common side effects include dizziness, sleepiness, fatigue, diarrhea, and constipation.
How to Get a Prescription for Xanax Alternative Medications
To get prescribed Xanax online or in person, you will first need an evaluation to determine whether it is a good fit for treating your anxiety symptoms. The process of getting diagnosed and potentially prescribed Xanax online or in person may vary for people of different ages.
The first step is to book an appointment with an online provider that can and will prescribe controlled substances, such as Talkiatry. These are the primary online providers that prescribe benzodiazepines like Xanax.
Due to special regulations for controlled substances, it can be difficult to find a provider to prescribe controlled substances like Xanax online. We have thoroughly reviewed these platforms, and in using the services ourselves, we have found them each to be a good place to get started with an evaluation.
A good place to start for an in-person evaluation is with your primary care provider. This may be a physician, nurse practitioner, or physician assistant. If they determine it is needed, they can refer you or your child to a specialist, such as a psychiatrist. They can further evaluate whether to include Xanax as a part of the treatment plan for you or your child.
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Non-medication Alternatives for Xanax
Some with anxiety may consider non-medication alternatives to Xanax. Over-the-counter treatments, lifestyle changes, and psychotherapy are non-medication alternatives for treating anxiety. These options vary in effectiveness and research support.
Discuss these alternatives with your primary provider to understand which may be most helpful to you. Before taking an over-the-counter treatment or supplement, consult with your primary provider as they can interact with other substances and medications.
Over-the-counter Xanax Alternatives
Currently, there are no over-the-counter Xanax alternatives available FDA-approved to treat anxiety. Many over-the-counter and natural products claim to help with the treatment of anxiety. However, quality studies are limited and have yet to show whether such supplements improve anxiety symptoms. However, some individuals may find them helpful.
- Passion flower: Some small clinical trials suggest that passion flower might help with anxiety. It’s generally considered safe, but it can cause drowsiness, dizziness, and confusion.
- Valerian: Some studies indicate that valerian can reduce anxiety and stress. It’s generally considered safe at recommended doses, but long-term safety trials are lacking. Side effects may include headaches, dizziness, and drowsiness.
- Chamomile – Many people drink chamomile before bedtime, and research shows it contains some benefits that can promote sleepiness and increase sleep quality.5 However, it can increase the risk of bleeding when used with blood-thinning drugs and may cause allergic reactions in some individuals.6
- L-theanine: L-theanine is a natural amino acid found in both black and green teas. While it’s not essential for survival, L-theanine is associated with affecting certain parts of brain function, with research showing it may promote a state of relaxation without causing drowsiness.7
- Lavender (lavandula angustifolia): Lavender is a flowering plant that can be used in the form of teas and oils for aromatherapy/ massages/baths for a relaxation effect. Research findings suggest that a lavender oil preparation Silexan in capsule form has some efficacy for its calming effects and alleviating anxiety.8
- Kava: Studies have shown some support for using kava as a treatment for anxiety. However, there have also been reports of serious liver damage associated with its use. The FDA has issued warnings about dietary supplements containing kava.9
- Cannabidiol (CBD): There is a lot of information on CBD for anxiety and how it can slow down thinking and racing thoughts, helping a person stay in the present moment. It can reduce stress in the body and reduce the production of cortisol. CBD can help by regulating mood and minimizing the agitation associated with anxiety or mood swings.
Lifestyle Changes
Making positive lifestyle changes can help people improve their mental wellbeing. Healthy activities and routines can enhance the effects of therapy and/or medication. And for some with mild symptoms, lifestyle changes alone may be enough to improve quality of life.
Important lifestyle changes for managing anxiety include:
- Getting enough sleep: Adequate sleep is crucial for mental health. Poor sleep can exacerbate anxiety symptoms, while quality sleep promotes emotional resilience and better coping mechanisms.
- Exercising: Regular exercise benefits mental health by releasing “feel-good” hormones that improve mood and reduce stress. It also provides an outlet for tension and promotes relaxation, helping to alleviate anxiety.
- Balanced diet: A diet rich in whole foods, including fruits, vegetables, lean proteins, and healthy fats, supports brain health and mood regulation. Avoiding excessive caffeine and sugar can also help stabilize mood.
- Social connections: Maintaining strong social connections and spending time with loved ones provides emotional support and reduces feelings of isolation, which can contribute to anxiety.
- Limiting caffeine and alcohol: Both caffeine and alcohol can trigger or worsen anxiety symptoms. Limiting or avoiding these substances can lead to a calmer nervous system.
- Time management: Effective time management can reduce stress and prevent feeling overwhelmed. Prioritizing tasks and setting realistic goals can promote a sense of control.
- Journaling: Writing down thoughts and feelings can help process emotions and reduce anxiety. It provides an outlet for self-expression and self-reflection.
How to Get Therapy Online & In Person
Therapy is a research-backed treatment approach for anxiety, depression, and many other mental health conditions. While therapy and medication are often used together, it can be an alternative to Xanax or other psychiatric medications.
Start by finding a therapist with the experience and training to treat your condition. For in-person treatment, your primary care provider or insurance company can provide a referral, or you may get one from family or friends. To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
Cognitive behavioral therapy (CBT) for anxiety that focuses on identifying and changing negative thought patterns and behaviors. It provides coping strategies and tools to manage anxiety effectively.
Questions to Ask Your Provider
When considering a Xanax alternative medication, consult your doctor and pharmacist to better understand what treatment may be the best fit for you. Prepare for your appointment by creating a list of questions addressing issues such as side effects, effectiveness, other medications you take, and more.
Questions to ask your provider about Xanax alternatives include:
- What are signs that I should consider an alternative to XAnax?
- How long does it typically take for a benzodiazepine to start working for anxiety, and how long will the effects last?
- What are the risks of dependency and addiction associated with long-term Xanax use?
- What are the potential withdrawal symptoms I might experience when stopping Xanax or another benzodiazepine, and how can they be managed?
- Is there a certain medication or specific benzodiazepine that is best for treating the type of anxiety I experience?
- Are there any risk factors that make me more susceptible to developing dependence on benzodiazepines?
- Is it safe to take Xanax with my other medications?
- Am I at risk for Xanax side effects if I am already taking other medications?
- Could my symptoms get better without medication?
- How long should I try a Xanax before deciding it is not for me?
- Can I take natural remedies alongside Xanax?
- What lifestyle changes can I make to help manage my anxiety?
Prescriber’s Tips
Your prescriber will share important information about your Xanax prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Xanax.
- Take your medication as prescribed, do not change your dose or stop taking it unless your prescriber tells you to. Keeping a consistent dosing schedule reduces the chance of unwanted side effects and withdrawal symptoms.
- Take your medication at the same time each day. Doing so can help you remember to take it, making it as effective as possible. Your healthcare provider can help determine the optimal timing based on your sleep patterns and initial medication response.
- Tell your prescriber right away if you or your child have any worsening mental health symptoms. Benzodiazepines may worsen depression, and antidepressants have a boxed warning for increased risk of suicidal thoughts and behaviors in children under age 18 and young adults.
- Some antidepressants and anti-anxiety medications can cause drowsiness and may affect your decision making. Talk to your doctor about how taking one of these medications may affect your ability to drive, operate heavy machinery, or do other dangerous activities safely.
- Benzodiazepines have sedative effects and can interact dangerously with other medications that depress the central nervous system (CNS). This includes alcohol, opioids, and certain antidepressants. Combining these substances can significantly increase the risk of drowsiness, impaired coordination, and even respiratory depression, which can be dangerous or life-threatening.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications.
Frequently Asked Questions
Does the Generic Version of Xanax Work the Same as the Brand Name?
Alprazolam is a generic version of brand name Xanax with the same uses and risks as Xanax.
Why Might I Need to Consider a Xanax Alternative?
Xanax alternatives may be needed for people who have taken Xanax but did not respond well enough, had an allergic reaction, or had intolerable side effects. Xanax can also interact with other substances and medications.
What Xanax Alternatives Have the Least Sexual Side Effects?
Wellbutrin and Remeron are among the antidepressants least likely to cause sexual side effects. Also, buspirone reportedly has fewer sexual side effects than antidepressants.
Do I Need to Consider a Xanax Alternative if I’m Pregnant or Breastfeeding?
It’s possible. The impact of antidepressants, benzodiazepines, and anti-anxiety medications are unclear on pregnancy and breastfeeding. Patients and prescribers need to weigh the risks and benefits of these medications for each situation.
What Xanax Alternatives Are Available for Panic Attacks?
Xanax alternatives commonly prescribed for panic attacks include: Paxil and Prozac, (SSRIs); Effexor XR (SNRI); and Klonopin (benzodiazepine).
What If I Switch to a Xanax Alternative & It Still Doesn’t Work for Me?
Some people try more than one medication before they find one that works for them. Consult your prescriber about which medications may work for you and how to safely make a change, if needed.
What Can I Expect If I Need to Stop Taking Xanax, & How Can I Minimize Withdrawal Effects?
It is not uncommon for prescribers to recommend tapering for several weeks. Frequent check-ins with your doctor may be recommended.
How Long Should I Take Xanax Before I Consider an Alternative?
It may depend on the reason for considering a Xanax alternative. Seek immediate medical care if you experience symptoms of a medication interaction, serious side effect, or an allergic reaction. When evaluating side effects and symptom improvement, it may take a few weeks to observe changes and make a determination.
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Xanax (alprazolam) tablets. (January 18, 2023). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Wade, Gembert, and Florea (2007). A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder. Curr Med Res Opin. 23(7), 1605-14. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17559755/
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Tyler K. Wilson; Jayson Tripp (2023). Buspirone. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531477/
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Shahrokhi, M., & Gupta, V. (2023). Propranolol. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557801/
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Chamomile: A herbal medicine of the past with a bright future (2010, November). National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/.
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Schwartz, J. A., Romeiser, J. L., Kimura, R., Senzel, L., Galanakis, D., Halper, D., Mena, S., & Bennett-Guerrero, E. (2023). Effect of chamomile intake on blood coagulation tests in healthy volunteers: a randomized, placebo-controlled, crossover trial. Perioperative medicine (London, England), 12(1), 51. Retrieved from https://doi.org/10.1186/s13741-023-00339-7
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Nobre, A. C., Rao, A., & Owen, G. N. (2008). L-theanine, a natural constituent in tea, and its effect on mental state. Asia Pacific journal of clinical nutrition, 17 Suppl 1, 167–168. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18296328/.
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Malcolm, B. J., & Tallian, K. (2017). Essential oil of lavender in anxiety disorders: Read for prime time? Mental Health Clinician, 7(4), 147–155. Retrieved from https://doi.org/10.9740/mhc.2017.07.147
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US Food & Drug Administration/Center for Food Safety & Applied Nutrition. (2020). Review of the published literature pertaining to the safety of Kava for
use in conventional foods. Retrieved from https://www.fda.gov/media/169556/download
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary Changes: Retitled and revised the following “When to Seek Professional Help” to “How to Get Therapy Online & In Person”. Revised and retitled “Lifestyle Changes That Help Manage Anxiety” to “Lifestyle Changes”. Revised and retitled “Non-medication Alternatives to Xanas” and “Over-the-Counter Xanax Alternatives”. Revised and retitled “The Best Alternatives to Xanax” to “What Medications Are Alternatives to Xanax?”. Revised and expanded “Benzodiazepines”, “Antidepressants”, and “Are There Affordable Alternatives to Xanax?”. Added new sections; “Key Takeaways”, “How to Get a Prescription for Xanax Alternatives”. Retitled “Questions to Ask Your Health Team” to “Questions to Ask Your Provider”. Retitled and expanded “In My Experience” section to “Prescriber’s Tips”. Removed “What Is Xanax?”, “What Are the Common Side Effects of Xanax Alternatives?”, “For Further Reading”. Added FAQs.
Author: Elyar Gasanli, PharmD
Medical Reviewer: Dena Westphalen, Pharm.D
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Plushcare There are many effective medications for anxiety and depression, including Zoloft and Lexapro, which a Plushcare doctor can prescribe. In as little as 15 minutes, you can speak with a board-certified doctor from PlushCare to receive anxiety or depression treatment. Plushcare DOES NOT prescribe controlled substances. Visit Plushcare
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