Written by Dr. Inez Van Roy on
August 19, 2021
Reading Time: 7 minutes

Medically Reviewed by our Medical Affairs Team

Written by Dr. Inez Van Roy on:

Medications to Treat Anxiety Disorders

Are you looking for ways to manage your anxiety? Perhaps you’re searching for the best medication for anxiety? We’ll answer that and more in this post. So, keep on reading. 

Anxiety disorders are the most common mental health disorders. 31.1% of adults in the U.S experience any anxiety disorder at some time in their lives. Also, 19.1% of adults in the U.S had an anxiety disorder in the past year, and it happened more in women than in men. 

There are many types of anxiety disorders. They include:

  • phobias
  • panic disorder (PD)
  • separation anxiety disorder
  • social anxiety disorder (SAD)
  • generalized anxiety disorder (GAD)
  • obsessive-compulsive disorder (OCD)
  • post-traumatic stress disorder (PTSD)

Treatment of anxiety usually consists of psychotherapy and medication. Medications can be very helpful for a person to function in their daily life. But, they don’t cure anxiety and they come with some significant side effects.

Also, it can be very hard to get off of anxiety medications. Stopping them abruptly can lead to withdrawal symptoms. Withdrawal symptoms are the symptoms that occur when somebody suddenly stops using a substance they are addicted to.

Withdrawal symptoms include irritability, increased anxiety, insomnia, depression, and a pounding heart. The right anxiety medication will depend on your diagnosis and symptoms. It’s important to speak with your doctor about which drug is best for you.

Keep reading to learn more about the different medications that can be used to treat anxiety!

4 Classes of Medications for Anxiety

According to the Anxiety and Depression Association of America (ADAA), there are 4 major classes of drugs for anxiety disorders:

1.Selective Serotonin Reuptake Inhibitors (SSRIs)

Many drugs that were originally used for the treatment of depression are also prescribed for anxiety. SSRIs are a class of antidepressants, but they are currently the first-line treatment for many types of anxiety disorders. 

SSRIs work by increasing levels of serotonin, a chemical that plays a vital role in mood regulation. SSRIs are usually started at a low dose and then increased gradually.

They take 2 to 6 weeks to begin relieving anxiety symptoms. This is why they cannot be taken “as needed”. SSRIs are only used for chronic anxiety issues that need continuous treatment.

They do not form a physical dependence as quickly as other anxiety medications like benzodiazepines. However, withdrawal can still be an issue. Thus, SSRIs dosage should always be reduced gradually. 

SSRIs are usually prescribed for PD, SAD, GAD, OCD, and PTSD.

Examples of SSRIs used for anxiety include:

What are the side effects of SSRIs?

  • fatigue
  • nausea
  • agitation
  • diarrhea
  • dizziness
  • drowsiness
  • weight gain
  • headaches
  • dry mouth
  • nervousness
  • muscle weakness
  • increased sweating
  • sexual dysfunction

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are another class of antidepressants also used for anxiety. 

SNRIs work by increasing levels of serotonin and norepinephrine in the brain. Like serotonin, norepinephrine is also a chemical that plays a vital role in mood regulation. SNRIs are as effective as SSRIs in treating anxiety and are also considered a first-line treatment.

But, in OCD, SSRIs are the preferred first-line treatment. As with SSRIs, SNRIs take many weeks to have an effect. SNRIs may also be an effective alternative for people who’ve had unsuccessful treatment with SSRIs. 

Examples of SNRIs used for anxiety are:

What are the side effects of SNRIs?

  • fatigue
  • nausea
  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • headaches
  • weight gain
  • loss of appetite
  • sleep problems
  • increased sweating
  • sexual dysfunction
  • an upset stomach

3. Benzodiazepines

Scientists believe that anxiety disorders are caused by excessive activity of nerves. Nerves in your brain and spinal cord release chemicals that communicate with each other.

One of these chemicals is gamma-aminobutyric acid (GABA), and its role is to suppress the activity of nerves. Benzodiazepines are a class of drugs that work by enhancing the effects of GABA, leading to a slower activity of nerves in the brain and spinal cord. 

Benzodiazepines generate a quick sedative effect, typically bringing relief within 1 hour. They are sometimes prescribed with antidepressants, as the latter takes time to start showing an effect. Benzodiazepines are usually used for the short-term management of anxiety.

This is because long-term use can require higher doses to be able to relax, which may lead to problems related to tolerance and dependence. Benzodiazepines are also used as an add-on treatment, in treatment-resistant anxiety disorders. 

Stopping benzodiazepines suddenly can also be risky, and withdrawal symptoms can occur. Factors that increase the risk of withdrawal symptoms are high doses and long-term benzodiazepine use. Withdrawal symptoms may be reduced by decreasing the dose over time.

Benzodiazepines also have a long list of side effects. It’s important to follow your doctor’s instructions before starting or discontinuing them. 

They are usually prescribed for SAD, GAD, and PD.

Examples of benzodiazepines used for anxiety include:

What are the side effects of Benzodiazepines?

  • drowsiness
  • dizziness
  • nausea
  • blurred vision
  • slurred speech
  • headaches
  • confusion
  • fatigue
  • nightmares
  • difficulty concentrating
  • memory problems
  • stomach upset

4. Tricyclic antidepressant (TCAs)

TCAs are an older class of antidepressant drugs. 

They work the same way as SSRIs and SNRIs do. Today, TCAs are usually only prescribed when other antidepressants fail. This is because newer drugs are usually more effective and have fewer side effects. 

TCAs are as effective as SSRIs at treating most anxiety disorders, except for OCD and SAD.

Examples of TCAs used for anxiety include:

What are the side effects of TCAs?

  • dizziness
  • drowsiness
  • lack of energy
  • dry mouth
  • nausea
  • vomiting
  • constipation
  • blurred vision
  • weight gain
  • decreased blood pressure

TCA side effects can usually be controlled by changing the dose or switching to another TCA.

Other anxiety medications

1.Monoamine oxidase inhibitors (MAOIs)

MAOIs were the first type of antidepressant developed and became widely used in the 1950s. 

MAOIs work by increasing the number of chemicals that regulate mood. An enzyme called monoamine oxidase is involved in removing some chemicals from the brain.

These chemicals are norepinephrine, serotonin, and dopamine. MAOIs prevent this from happening, making these chemicals more available in the brain. Like TCAs, MAOIs are older drugs that cause more side effects than newer drugs.

They are only prescribed when other antidepressants fail. This is because newer drugs are usually more effective and have fewer side effects. Talk to your doctor before you stop taking an MAOI. Abruptly stopping treatment with MAOIs has been associated with withdrawal symptoms.  

MAOIs are usually prescribed for PD, SAD, and social phobia.

Examples of MAOIs used for anxiety include:

  • phenelzine (Nardil)
  • moclobemide (Amira)

What are the side effects of MAOIs?

  • dry mouth
  • nausea
  • diarrhea
  • constipation
  • drowsiness
  • headache
  • insomnia or other sleep disturbance
  • agitation
  • skin reactions
  • dizziness
  • low blood pressure
  • involuntary muscle jerks or muscle aches
  • reduced sexual desire or decreased sexual ability
  • weight gain
  • difficulty urinating
  • tingling sensation of the skin

What drugs and foods do MAOIs interact with?

Taking an MAOI with certain foods or medications can cause life-threatening side effects. These include increased blood pressure and a condition called serotonin syndrome. 

Serotonin Syndrome:

Serotonin syndrome occurs when serotonin builds up in your body. Symptoms include confusion, fever, irregular or rapid heartbeat, dilated pupils, and occasional unconsciousness. Serotonin syndrome can occur when a person on MAOIs takes other drugs or supplements that increase the levels of serotonin. They include:

To avoid serotonin syndrome, people taking MAOIs should wait 2 weeks from the end of their treatment with an MAOI before beginning a new drug. 

Cheese effect:

Certain tyramine-containing foods can react with MAOIs and cause an increase in blood pressure. This is the “cheese effect”. Foods containing considerable amounts of tyramine include meats that are potentially aged. Smoked, marinated, and fermented foods, such as cheeses and alcoholic beverages, are also rich in tyramine.

High blood pressure can also be associated with medications: 

  • over-the-counter decongestants and cough drugs that contain ephedrine, pseudoephedrine, and phenylpropanolamine.
  • L-dopa
  • methylphenidate
  • dextroamphetamine
  • reserpine
  • guanethidine
  • tetrabenazine

Be sure to tell your health care professional about all the medications you’re taking before you start taking an MAOI. This includes prescription and OTC medications, vitamins, herbal products, and recreational drugs. It also includes supplements like nutritional shakes, protein powders.

2. Beta-Blockers

Beta-blockers are a class of drugs used to treat high blood pressure and heart problems. 

They work by blocking the effects of norepinephrine. Norepinephrine is a chemical that plays an important role in regulating fear-related responses.

In response to stress, norepinephrine is involved in the fight-or-flight response. This response is characterized by elevated heart rate, increased sweating, and shaky hands. These are all physical symptoms of anxiety.

Beta-blockers are also prescribed off-label to help relieve anxiety, mainly in SAD. Taking a beta-blocker before an anxiety-producing event can help reduce your level of nervousness. Examples of anxiety-producing events are giving a speech or attending a party.

Examples of Beta-Blockers used for anxiety include:

  • propranolol (Inderal)
  • atenolol (Tenormin)

What are the side effects of Beta Blockers?

  • fatigue
  • dizziness
  • drowsiness
  • dry mouth
  • nausea
  • Headache
  • Constipation
  • Diarrhea
  • trouble sleeping
  • shortness of breath

3. Buspirone (BuSpar)

Buspirone, also known as BuSpar, is a newer anti-anxiety drug that acts as a mild tranquilizer. Buspirone is used to treat both short-term anxiety and chronic (long-lasting) anxiety disorders. The drug can take up to several weeks to become fully effective. 

Buspirone works by increasing serotonin and decreasing dopamine in the brain. Buspirone takes about two weeks to begin relieving anxiety symptoms. It takes more time to work than benzodiazepines, which are fast-acting. But, it’s less sedating, doesn’t impair memory and coordination, and the withdrawal symptoms are minimal.

The risk of dependence with Buspirone is low, has no serious side effects, and has no serious interactions. Thus, it is ideally suited for older people and those with a history of substance abuse. Buspirone is usually prescribed for generalized anxiety disorder. Its effectiveness regarding any other anxiety disorder is limited.

What are the side effects of Buspirone?

  • dizziness
  • drowsiness
  • headaches
  • nausea
  • weight gain
  • upset stomach
  • constipation
  • nervousness
  • diarrhea
  • dry mouth

4. Pregabalin (Lyrica)

Pregabalin is an antiepileptic medication.

It isn’t known exactly how pregabalin works. It appears the drug may work by calming the damaged or overactive nerves that cause pain or seizures in your body.

Pregabalin can be used alone or in combination with another drug. It is frequently used as an alternative treatment for patients who don’t tolerate or respond to SSRIs or SNRIs.

Pregabalin has sedating properties. Sleep disorders associated with anxiety may improve earlier with pregabalin than with SSRIs or SNRIs. 

Pregabalin is usually prescribed for GAD and SAD.

What are the side effects of Pregabalin?

  • dizziness
  • somnolence
  • dry mouth
  • edema
  • blurred vision
  • weight gain
  • constipation
  • euphoric mood
  • balance disorder
  • increased appetite
  • difficulty concentrating

Takeaway on medication for anxiety disorders

Anxiety disorders are the most common mental health disorders. 

If you experience symptoms of an anxiety disorder, you should see your doctor, who can help you find the best course of treatment. Proper treatment will likely include therapy, medications, or a combination of both. 

There are many factors that a doctor will evaluate before prescribing an anxiety medication. It includes the severity of your symptoms, your health problems, other medications you take, and what has worked for you in the past. Also, how a person reacts to different antidepressants greatly varies.

Thus, one antidepressant may work better for you than another. This is either because of the side effects that the treatment brings or the way it improves your symptoms. 

It may take many weeks before you get the full benefits of an antidepressant and for initial side effects to ease up. Your doctor may need to change your dose or the antidepressants, but with patience, you and your doctor can find a medication that works well for you. 

Never start or stop taking a prescription medication without consulting with your doctor first. Stopping your medication abruptly can cause withdrawal symptoms.

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