The Best Anxiety Medication: Pros, Cons, and How to Choose

From sweaty pre-date jitters to that drop-in-your-stomach feeling before a big work presentation, most people experience moments of anxiety. And while occasional anxiety is a normal part of life, some of us have anxiety disorders that can be much more debilitating. 

Luckily, there are treatments to help. So, what’s the best anxiety medication? 

Well, there isn’t a straightforward answer to that. Common anxiety medications include: 

• Antidepressants (SSRIs, SNRIs, TCAs, and MAOIs)

• Benzodiazepines 

• Beta blockers

• Buspirone 

But the best one for you will depend on you and your symptoms. 

Read on for the pros, cons, side effects, and whether these anxiety meds could help you.

There are many different types of anxiety and many different types of anxiety medications. 

Some medications work almost instantaneously, while others take a few weeks to fully kick in. Some have severe side effects, while others have much less.

You get the idea. 

Different anxiety disorder medications work differently — and they work differently on different people. Finding the right anti-anxiety medication for you is a process that can take some time and trial and error, and that’s totally normal.

Here’s what you need to know about common anxiety medications. 

Antidepressants

Despite the name, antidepressants aren’t just for depression. 

They work by targeting certain neurotransmitters in your brain that — at least partly — impact your mood. They’re often one of the first options a healthcare provider will suggest as treatment.

Some medications typically used to treat symptoms of depression have also been approved by the FDA (U.S. Food and Drug Administration) to treat symptoms of anxiety.

Namely, antidepressants used in the treatment of anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs)

• Selective norepinephrine reuptake inhibitors (SNRIs)

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

Our full antidepressant list reviews other medications to consider, as well as details on how they work.

Below, we’ll dig into what you can expect from these medications as treatments for anxiety symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs help to regulate your serotonin levels. Low levels of serotonin — which you may know as the “happy” hormone — have been linked to anxiety. 

SSRIs work to prevent serotonin reabsorption by your brain, so they can be effective in treating the symptoms of anxiety.  

In fact, they’re so effective that many healthcare professionals consider them a first-line treatment for anxiety disorder. 

The most commonly-prescribed SSRIs are: 

• Sertraline (Zoloft®)

• Escitalopram (Lexapro®)

• Paroxetine (Paxil®)

• Fluoxetine (Prozac®)

• Citalopram (Celexa®)

Pros: SSRIs are effective and can treat many types of anxiety disorders such as generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. 

Cons: You need to slowly build up how much SSRI medication you take over four to eight weeks, so it can take a while to feel the anti-anxiety benefits. 

Side effects: SSRIs generally have fewer side effects than other antidepressants, but potential side effects include a decreased sex drive, digestive issues, and insomnia. 

Best for: Most people. SSRIs are often a first-line treatment for anxiety.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs also work to regulate serotonin levels. However, they step up their game by also targeting a neurotransmitter called norepinephrine.

Norepinephrine helps regulate the sleep-wake cycle, stimulates the cardiovascular system, and is involved in the body’s fight-or-flight response. Low levels of norepinephrine are tied to symptoms like lethargy and poor concentration.

By targeting both serotonin and norepinephrine, SNRIs can be effective in treating the symptoms of anxiety and depression.

Additionally, norepinephrine can help your body maintain a healthy blood pressure and a healthy heart rate. And it creates usable energy for your body by increasing blood sugar and breaking down fat.

Two commonly prescribed SNRIs are: 

• Venlafaxine (Effexor®)

• Duloxetine (Cymbalta®)

Pros: SNRIs are considered another first-line treatment for anxiety and can treat several types of anxiety disorders. Some people who don’t get better on an SSRI respond to an SNRI.

Cons: For many people, they may not be more effective than SSRIs, despite acting on both serotonin and norepinephrine. 

Side effects: Side effects vary, but can include insomnia, nausea, dry mouth, and sexual dysfunction. SNRIs may have more side effects than SSRIs. 

Best for: If you find SSRIs don’t work for you, SNRIs might help instead.

Tricyclic Antidepressants (TCAs)

TCAs are a type of antidepressant developed in the 20th century. They’re among some of the first psychiatric prescription medications to be approved for use by the FDA.

They work by increasing levels of serotonin and norepinephrine in your brain.

Millions of people still use TCAs — prescribed either on-label or off-label. But they’ve largely been replaced with newer options like SSRIs and SNRIs because of these medications’ milder side effect profiles. 

While the side effect burden of TCAs make them a poor candidate as a first-line treatment for anxiety, research suggests they can be beneficial for certain kinds of anxiety disorders, particularly obsessive-compulsive disorder (OCD).

TCAs include: 

• Clomipramine (Anafranil®)

• Nortriptyline (Pamelor®)

• Amitriptyline (Elavil®) 

• Doxepin (Sinequan® and other brand names) 

For more details on how this drug works, including common side effects, check out our tricyclic antidepressants guide.

Pros: TCAs can treat GAD, social anxiety disorder, and OCD.

Cons: TCAs tend to have more side effects and drug interactions than other anxiety meds.

Side effects: Side effects can include drowsiness, dry mouth, reduced sex drive, weight gain, dizziness, and confusion.  

Best for: Those who find SSRIs and SNRIs aren’t working for them. 

Monoamine Oxidase Inhibitors (MAOIs)

First introduced in the 1950s, monoamine oxidase inhibitors belong to a group of medications that target an enzyme called monoamine oxidase. Monoamine oxidase plays a key role in breaking down neurotransmitters like serotonin, norepinephrine, and dopamine.

Since low levels of these neurotransmitters are at least partly connected to mental health conditions like anxiety, MAOIs are effective in treating symptoms.

Though their use has declined over the past few decades due to a rise in newer antidepressants, MAOIs are still prescribed in some cases. 

MAOIs include: 

• Phenelzine (Nardil®)

• Isocarboxazid (Marplan®)

• Tranylcypromine (Parnate®)

Pros: MAOIs may help anxiety disorders like social anxiety disorder and panic disorder. 

Cons: MAOIs are more likely to cause severe side effects than other anxiety medications, and they can have dangerous interactions with other drugs and even certain foods.

Side effects: Potential side effects include fatigue, insomnia, tremors, weight gain, sexual dysfunction, and dizziness. 

Best for: People who don’t respond to other anxiety medications. 

Benzodiazepines

Benzodiazepines are used to treat anxiety and panic disorders by providing fast-acting relief, like when you’re in the throes of a panic attack. 

They work by increasing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that creates feelings of calmness to counteract anxiety symptoms. 

You can develop a tolerance for benzodiazepines, meaning you’ll ultimately need a higher dose for the drug to remain effective. This is why healthcare providers tend to prescribe them for short periods. 

The most common benzodiazepines include: 

• Alprazolam (Xanax®) 

• Clonazepam (Klonopin®)

• Lorazepam (Ativan®) 

• Diazepam (Valium®)

Since these are controlled substances, they may not be available through an online prescription.

Pros: Benzodiazepines can act fast and they’re super effective in the short term. 

Cons: They come with a serious risk of dependence and you can develop a tolerance to them. Getting off of them after long-term use can be hellish for some people.

Side effects: Drowsiness, incoordination, falls, withdrawal symptoms, respiratory arrest in overdose (when your breathing stops).

Best for: Those who need short-term anxiety relief, stat.

Beta Blockers

If you find yourself in a highly stressful or high-stakes situation (i.e., your dog escapes from the yard or someone makes an illegal left turn directly in front of you), your body’s fight-or-flight response can help you spring into action. 

Beta blockers are a kind of medication that prevent the stress hormones activated by your fight-or-flight response from impacting your heart and other organs.  

Beta blockers are very popular for treating heart conditions like high blood pressure or irregular heart rate. They’ve also proven effective in treating anxiety disorders like social anxiety disorder or performance anxiety.

Beta blockers won’t affect your brain the way benzodiazepines (like Xanax®) or SSRIs (like Prozac®) do. Instead, they’ll block the physical effects of anxiety, such as sweating, tremor, and rapid heart rate. Sometimes, taking away the physical symptoms of anxiety can make a person feel calmer, indirectly decreasing the mental symptoms.

While not technically an anxiety disorder, a 2022 study suggests that those with post-traumatic stress disorder (PTSD) may benefit from using a beta blocker like propranolol.

Beta blockers include: 

• Propranolol (Inderal®)

• Atenolol (Tenormin®) 

• Metoprolol (Lopressor®)

Pros: Beta blockers get to work in less than an hour. You can take them before anxiety-provoking events, like public speaking, performances, or flights. 

Cons: They treat the physical symptoms of anxiety, not the mental symptoms.

Side effects: Some side effects include nausea, dizziness, slow heartbeat, weight gain, and depression.  

Best for: Those with performance anxiety, situational anxiety, or PTSD. 

Buspirone

If antidepressants and benzodiazepines aren’t the right fit for you, buspirone (BuSpar®) can be a potential alternative. 

Buspirone was originally developed as an antipsychotic, but it was ineffective for psychosis and was instead found to have effective anti-anxiety features.

BuSpar is similar to Xanax in that both provide anxiety relief — but a major difference is their side effects and how low it takes for them to start working. 

For instance, in a study on people who use Xanax, 77 percent reported side effects of drowsiness, whereas one of the most common adverse side effects of BuSpar is dizziness. Another key difference is that those who use Xanax are at risk of developing dependence and abuse, whereas buspirone is non-habit-forming.

This is also a great time for us to say: If you think you might have a substance abuse problem of any kind, reach out to a professional for help. 

Pros: Buspirone can be effective for long-term anxiety treatment. 

Cons: It may take two to four weeks to start working.

Side effects: Potential side effects include dizziness, drowsiness, blurred vision, nausea, and diarrhea. 

Best for: Those with GAD who want to avoid the sexual side effects of SSRIs or don’t respond to SSRIs. 

There are many anxiety disorder treatments out there, so what’s the best anxiety medication? Unfortunately, we don’t have a straightforward answer for you. 

The best medication for anxiety will depend on your genetic profile, symptoms, diagnosis, and other factors like your lifestyle and any health conditions.

Luckily, you don’t have to make the decision alone. A healthcare provider can walk you through the pros and cons of different anti-anxiety meds and recommend the best one for you. 

If you want to explore getting anxiety medication, you’ll first need to make an appointment with a healthcare provider to get a prescription. A healthcare provider is the only person who can prescribe medication, but it’s not as complicated as it sounds.

In fact, there are several ways you can do this. You can talk to:

• Your primary care provider (PCP). They can be an excellent place to start since you have an existing relationship with them and they already know your medical history. 

• A psychiatry professional. You can get a referral to see one from your healthcare provider or find one on your own.

• An online psychiatric provider. If the thought of bringing your issues to the attention of your primary healthcare provider makes you uneasy, you can also connect with a psychiatric provider online through our telehealth primary care platform. If you have a qualifying diagnosis, they can help you get anxiety medication online from the comfort of your couch.

There’s a good chance a provider might suggest additional forms of treatment like: 

• Psychotherapy

• Group therapy (there are even anonymous support groups if you’d prefer to be more private)

• Follow-up appointments to evaluate how your medication is working

And if you’re stumped on what to say during your initial appointment, our guide on how to ask your doctor for anxiety medication can give you some thought-starters. 

Thinking about getting anxiety medication is a big step toward recovery in your mental health journey. As you navigate this new terrain, know that there are other steps you can take to help reduce the symptoms of your anxiety.

These include:

• Talking to a healthcare provider. In addition to making sure you get the best anxiety medication for your unique needs — be it for the short term or the long haul — they may also guide you to different treatment options or types of therapy like cognitive behavioral therapy (CBT). Another option is online therapy, which you can do from the comfort of your bed.

• Moving your body. According to the National Institute of Mental Health (NIMH), just 30 minutes of walking a day can offer a significant mental health boost. So, load up your playlist with your favorite songs or grab a friend, and walk for any amount of time that feels right.

• Practicing mindfulness. Practicing mindfulness is finding a mental state where you’re focused on the present moment, allowing feelings and thoughts to pass through without judgment. Studies show that mindfulness meditation is a powerful exercise that can reduce negative thoughts, decrease anxiety, and produce an overall more peaceful state of mind. Even a few minutes a day can make a significant impact in the long run. 

And of course, if you start to feel overwhelmed, our mental health services are always available.