Medications for Anxiety: A Complete Guide

    Kristin Hall, FNP
    Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/20/2020

    Feeling anxious? You’re not alone. Almost all adults experience anxiety from time to time, with some experiencing persistent, concerning anxiety as the result of an anxiety disorder. 

    Anxiety disorders are very common. In fact, according to the National Institute of Mental Health, an estimated 31.1 percent of all American adults will experience some form of anxiety disorder during their lives. 

    Due to the prevalence of anxiety disorders, a large range of medications are available to treat and manage anxiety. Although these medications don’t “cure” anxiety, they can improve many symptoms of anxiety disorders, helping you to feel better and enjoy a higher quality of life.

    Anxiety medications can range from over-the-counter products to prescription medications that you’ll need to discuss with your healthcare provider. Below, we’ve listed medications currently used to treat anxiety, along with information on each medication’s effects, side effects and more.

    Medications for Anxiety: An Overview

    Medications designed to treat anxiety are called anxiolytics, or anti-anxiety drugs. They’re some of the most widely used medications in the United States, with 8.3 percent of all American adults as of 2013 prescribed either a sedative, hypnotic or other type of anti-anxiety medication.

    Several different classes of medications are used to treat anxiety. Many anxiety disorders are treated using medications called benzodiazepines. Other drugs used to treat anxiety disorders include antidepressants, beta-blockers and azapirones like buspirone.

    Because no two people are the same, there’s no “one-size-fits-all” medication prescribed to treat anxiety. If you have an anxiety disorder, your healthcare provider may prescribe one or several drugs based on your symptoms, general health, lifestyle and other factors.

    Benzodiazepines

    Benzodiazepines are a class of medications used to treat anxiety disorders. Some medications in this class are also used as sleeping pills for the short-term treatment and management of insomnia.

    Benzodiazepines are some of the most widely prescribed medications in the United States, with tens of millions of users nationwide.

    Some widely used benzodiazepines include alprazolam (Xanax®), clonazepam (Klonopin®), diazepam (Valium®) and lorazepam (Ativan®).

    Benzodiazepines reduce anxiety, relax muscles and promote sedation. Most benzodiazepines are prescribed for short-term use. When used over the long term, benzodiazepines have a significant potential for increased tolerance, dependence and abuse. 

    One advantage of benzodiazepines is that they typically start working very quickly. People who use benzodiazepines to treat anxiety often begin to feel their anti-anxiety effects in less than an hour, making them an effective option for treating anxiety in the short term.

    How Benzodiazepines Work

    Benzodiazepines work in the body by increasing the effects of a neurotransmitter called gamma amino butyric acid, or GABA

    GABA is an inhibitory neurotransmitter — a type of chemical messenger that’s used by the brain and body to send messages between neurons. GABA’s job is to decrease activity in the neurons to which it binds. This can cause you to feel less anxious, stressed and fearful. 

    GABA is also thought to be responsible for regulating activity in the parts of your brain responsible for emotion and memory, thinking and certain essential biological functions.

    By increasing the effects of GABA, benzodiazepines essentially slow down certain activity in the brain to reduce feelings of anxiety and stress. 

    List of Benzodiazepines Used for Anxiety

    Benzodiazepines are very widely used, with tens of millions of prescriptions in the United States alone. Study data indicates that most benzodiazepine use is highest in older people. Common benzodiazepines include:

    • Alprazolam. Sold as Xanax, alprazolam is the most widely prescribed benzodiazepine medication in the United States, with tens of millions of prescriptions written for it annually. It’s prescribed to treat a diverse range of anxiety and panic disorders.

    • Chlordiazepoxide. Sold under the brand name Librium®, chlordiazepoxide is prescribed to treat anxiety and certain symptoms of alcohol/drug withdrawal.

    • Clorazepate. Sold under the brand names Tranxene® and Gen-Xene®, clorazepate is prescribed to treat a range of anxiety disorders.

    • Diazepam. Sold under the brand name Valium, diazepam is another widely prescribed benzodiazepine that’s used to treat anxiety disorders, panic attacks, seizures (in combination with other drugs) and drug and alcohol withdrawal symptoms.
    • Estazolam. Sold under the brand name Prosom®, estazolam is typically prescribed as a treatment for insomnia, including insomnia caused by anxiety.

    • Flurazepam. Flurazepam is a benzodiazepine derivative that’s primarily used as a short-term treatment for insomnia.

    • Oxazepam. Sold under the brand names Serax® and Zaxopam®, oxazepam is prescribed to treat anxiety and certain symptoms of alcohol withdrawal.

    Other benzodiazepines, such as temazepam and triazolam (sold under the brand name Halcion®) are used primarily as sleep aids and aren’t widely prescribed for anxiety. 

    Benzodiazepine Side Effects

    Benzodiazepines have a range of side effects, the most common of which are memory problems, drowsiness and fatigue. If you frequently need to drive long distances or operate machinery, doing this after using a benzodiazepine may be dangerous. 

    Taken in the evening, particularly when used to treat anxiety-related insomnia, it’s common for some benzodiazepines to cause a next-morning “hangover” effect. This is particularly a common side effect of long-acting benzodiazepine medications, such as diazepam.

    Most benzodiazepines are only recommended for use in the short term. Used for the long term, treatment with benzodiazepines can lead to dependence, addiction and abuse. 

    When used long term at high doses, benzodiazepines can cause withdrawal symptoms if they’re stopped suddenly. If you’re prescribed a benzodiazepine for anxiety, do not suddenly stop taking it. Instead, you should talk to your healthcare provider about gradually and safely reducing your dosage. 

    Overall, benzodiazepines can be very effective at treating anxiety and may be a good treatment if you have an anxiety or panic disorder. However, due to their abuse potential, it’s important to closely follow your healthcare provider’s instructions if you’re prescribed this type of anxiety medication. 

    Antidepressants

    Certain antidepressants are prescribed to treat anxiety. Although originally designed to treat depression, many modern antidepressants also target the neurotransmitters responsible for feelings of anxiety and stress, making them effective anxiety medications. 

    Unlike benzodiazepines, which can start working very quickly, antidepressants can often take several weeks to begin treating anxiety symptoms. Because of this, they’re typically used for long-term treatment and management of anxiety disorders. 

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    One of the most commonly prescribed antidepressants for anxiety are referred to as selective serotonin reuptake inhibitors, or SSRIs. 

    SSRIs work by blocking the reabsorption of serotonin and therefore increasing the levels of serotonin in your brain. Serotonin is a neurotransmitter that’s responsible for regulating a wide range of functions within the body, including your mood, ability to concentrate, memory, relaxation, appetite and ability to sleep.

    People with anxiety and depression are thought to  have low levels of serotonin. By increasing serotonin levels, SSRIs may help to improve the symptoms of anxiety.

    SSRIs first came onto the market in the 1980s. While they’re not considered addictive and have a significantly lower potential for abuse than benzodiazepines, SSRIs have a range of potential side effects that you should be aware of before using this type of medication to treat anxiety.

    List of SSRIs Used to Treat Anxiety

    Several SSRIs are prescribed in the United States to treat anxiety disorders. Common SSRIs used to treat anxiety include:

    • Sertraline. Sold under the brand name Zoloft®, sertraline is a widely used SSRI that’s primarily prescribed to treat depression. It’s also used to treat some anxiety disorders, including social anxiety disorder and panic disorder.

      Used by tens of millions of people in the United States alone, sertraline is one of the most widely prescribed antidepressants. You can learn more about how it works as an anxiety treatment, its side effects and more in our full guide to sertraline (Zoloft).

    • Escitalopram. Sold under the brand name Lexapro®, escitalopram is prescribed to treat several anxiety disorders, including generalized anxiety disorder, obsessive-compulsive disorder (OCD) and panic disorders.

      Like many other SSRIs, escitalopram is widely prescribed, with millions of people using it in the United States annually. We’ve explained how it works, its common side effects and more in our detailed guide to escitalopram (Lexapro).

    • Paroxetine. Sold under the brand name Paxil® (and others), paroxetine is prescribed to treat social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and several other anxiety-related conditions.

      Paroxetine is a common medication, with millions of prescriptions in the United States written for it every year. Our complete guide to paroxetine (Paxil) goes into more detail on how it works, both as an antidepressant and as a treatment for anxiety disorders.

    • Fluoxetine. Sold under the brand name Prozac®, fluoxetine is another SSRI. Although it isn’t approved specifically for treating anxiety, healthcare professionals may prescribe fluoxetine off-label for certain forms of anxiety.

      Tens of millions of people are prescribed fluoxetine every year in the United States,making it one of the most commonly used SSRIs. You can learn more about how fluoxetine works, its side effects and more in our complete guide to fluoxetine (Prozac).
    • Fluvoxamine. Sold under the brand name Luvox®, fluvoxamine is prescribed for several anxiety disorders and related disorders, including social anxiety disorder, panic disorder and obsessive-compulsive disorder.

    • Citalopram. Sold under the brand name Celexa®, citalopram is used to treat a range of anxiety disorders, including social anxiety disorder and panic disorder, and associated conditions such as body dysmorphic disorder.

    Other Antidepressants Used to Treat Anxiety Disorders

    In addition to SSRIs, several other types of antidepressants are commonly prescribed to treat depression. These include serotonin–norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). 

    SNRIs work similarly to SSRIs. In addition to increasing the amount of serotonin in your brain, they also block the reabsorption and therefore increase the level of norepinephrine — a neurotransmitter responsible for regulating alertness, attention, memory and other functions. SNRIs used to treat anxiety include:

    • Duloxetine. Sold under the brand name Cymbalta®, duloxetine is an SNRI that’s used to treat general anxiety disorder.

      Our guide to duloxetine (Cymbalta) provides more information on how duloxetine works as a treatment for depression, anxiety and other conditions.

    • Venlafaxine. Sold under the brand name Effexor®, venlafaxine is used to treat a range of anxiety disorders, from generalized anxiety disorder to social anxiety disorder and panic disorder. 

    Some monoamine oxidase inhibitors (MAOIs) may be effective as treatments for certain anxiety conditions, such as social anxiety disorder and panic disorder. MAOIs are older antidepressants that were first discovered in the 1950s by clinical researchers. 

    Like other antidepressants, MAOIs work by boosting the level of certain neurotransmitters, such as serotonin, norepinephrine and dopamine, in the brain. However, they’re more likely to cause side effects and interactions than newer antidepressants used to treat anxiety. 

    Most MAOIs are not approved by the FDA to treat anxiety. However, they may be prescribed by your healthcare provider for off-label use if other treatments aren’t effective. MAOIs sometimes  used to treat anxiety include phenelzine, selegiline and tranylcypromine. 

    If you’re prescribed a MAOI, your healthcare provider may require you to carefully monitor your use of other medications and consumption of certain foods to avoid interactions.

    Finally, some tricyclic antidepressants (TCAs) are used to treat anxiety disorders. Tricyclics are an older class of antidepressants first developed in the 1950s and, like other antidepressants, they work by increasing the levels of certain mood-related neurotransmitters in your brain.

    Tricyclic antidepressants that are used to treat anxiety disorders include clomipramine, doxepin and imipramine. 

    Like other older antidepressants, tricyclic antidepressants typically have a higher risk of causing side effects than newer SSRI and SNRI medications. Because of this, they’re often prescribed if other treatment options haven’t proven effective. 

    Beta-Blockers 

    Beta-blockers are a class of medications designed to reduce blood pressure. They’re commonly prescribed to manage heart conditions, such as angina, atrial fibrillation (irregular heartbeat) and heart failure, or to improve heart function in people who’ve recently had a heart attack. 

    Some beta-blocker medications are also effective at treating the physical symptoms of anxiety. Although they aren’t approved by the FDA as anxiety medications, your healthcare provider may prescribe a beta-blocker off-label if you’re often affected by anxiety in stressful situations. 

    Beta-blockers work by blocking the effects of epinephrine, or adrenaline, a hormone responsible for controlling your fight-or-flight response. By blocking the effects of epinephrine, beta-blockers slow your heartbeat and improve blood flow throughout your body. 

    Beta-blockers may be particularly helpful for treating the symptoms of performance anxiety — a form of anxiety that’s related to speaking, acting or performing in front of others. 

    Like benzodiazepines, beta-blockers start working quite quickly to treat the physical symptoms of anxiety. For example, propranolol, a widely-used beta blocker, usually starts to work 30 to 60 minutes after it’s taken. 

    One thing to note about beta-blockers is that they only treat the physical effects of anxiety, not the underlying psychological cause. As such, they’re usually only prescribed for short-term anxiety that’s event based, such as anxiety related to public speaking or other stressful situations.  

    Beta blockers used to treat anxiety include:

    • Propranolol. Propranolol is a common, widely-prescribed beta-blocker that’s often used off-label to treat performance anxiety. If you often experience the physical symptoms of anxiety while speaking, interviewing, or auditioning, this medication may help.

      Propranolol has been available in the United States for more than 40 years. We’ve explained how it works, its side effects and more in our detailed guide to propranolol.

    • Atenolol. Atenolol is a slightly longer-acting beta-blocker than propranolol. Although it’s not officially approved to treat anxiety, it’s occasionally used off-label to treat the physical symptoms associated with performance anxiety.

    Like other prescription medications, beta-blockers may cause side effects. Common side effects of beta-blockers include fatigue, dizziness, drowsiness, cold hands and feet and a slow heart rate. Beta-blockers can also interfere with certain other medications, including cardiovascular health drugs. 

    To avoid these side effects and interactions, you’ll need to discuss your general health and use of any other medications with your healthcare provider before using any beta-blocker to treat anxiety. 

    Other Medications and Treatments for Anxiety

    Most cases of anxiety are treated using medications such as benzodiazepines, antidepressants or beta-blockers. However, several other classes of medication can also be used to treat anxiety disorders. These include: 

    • Antihistamines. Some antihistamines have a calming effect on mood, making them an effective option for some cases of mild to moderate anxiety. These drugs can also help to promote sleep — a common difficulty for people with anxiety disorders. 

      Hydroxyzine, sold under the brand name Vistaril®, is an antihistamine that’s sometimes used as a short-term treatment for anxiety.

    • Anticonvulsants. Anticonvulsant medications, such as gabapentin and pregabalin, may help to treat symptoms of certain anxiety disorders, such as generalized anxiety disorder and social anxiety disorder.
    • Buspirone. Buspirone is an azapirone medication that’s used to treat certain anxiety disorders. Like SSRIs, buspirone may take several weeks to begin effectively treating the symptoms of anxiety.

    In addition to the use of medication, psychotherapy and lifestyle changes can often help to treat anxiety. People with anxiety disorders often benefit from the following lifestyle changes:

    • Consume less caffeine. Although evidence is mixed overall, some studies have found that large amounts of caffeine contribute to feelings of anxiety. While there’s no need to totally give up caffeine, consider scaling back slightly if you’re a regular coffee drinker.

    • Exercise regularly. Research shows that regular aerobic exercise, such as running, biking or simply walking outside, can reduce feelings of anxiety and improve symptoms in people with anxiety disorders.

    • Try meditating. Meditation has a range of benefits, including potentially reducing some anxiety symptoms. In a 2013 study, researchers found that mindfulness meditation may have a beneficial effect for people with generalized anxiety disorder. 

    In Conclusion

    A wide range of different medications, from antidepressants to benzodiazepines, beta-blockers and more, are used to treat anxiety. 

    Of these medications, there’s no “one-size-fits-all” drug that’s best for everyone. Depending on your symptoms, your overall health and your previous experience with anxiety treatments, your healthcare provider may recommend one or several of the treatment options listed above. 

    If you’re prescribed any medication to treat anxiety, closely follow the instructions provided by your healthcare provider. If you feel that you’d be better suited to another medication, or want to adjust the dosage of your current medication, talk to your healthcare provider before making any changes.

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    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.