Last Updated Dec 2, 2021
There are several medications that can work to manage anxiety. While benzodiazepines are some of the most well-known anti-anxiety medications, the first treatments generally used are SSRIs and SNRIs, as they lack the abuse potential and more serious side effects associated with benzodiazepines.
Anxiety Medication Options
Many people try multiple anti-anxiety medications over their lifetime to find the best fit and adjust to changes in the way their body reacts to a given medication they had been taking previously. Here are some of the top anxiety medication options:
Benzodiazepines, often called benzos, are a class of depressant medication that slows the speed of messages traveling between the body and brain. In addition to helping to relieve stress and anxiety, they can also help people sleep and have uses in the treatment of alcohol withdrawal and epilepsy.
While benzodiazepines can serve a number of important medical purposes, they often aren’t the first option a doctor prescribes when an alternative option is available. This is because benzodiazepines have a high abuse and addiction potential.
Even legitimate use has the potential to cause physical dependence, meaning a person may experience withdrawal if they suddenly stop taking their medication. If a person has regularly been using benzodiazepines, they should only stop taking them under medical supervision. Doctors will generally recommend a tapered approach to withdrawal in order to lessen the severity of withdrawal symptoms.
It’s possible to overdose on benzodiazepines, which can potentially be life-threatening. The risk of an overdose increases dramatically when benzos are mixed with other drugs, especially other depressants, such as opioids.
Selective serotonin reuptake inhibitors (SSRIs) are an antidepressant that can help treat a number of mental health conditions, including generalized anxiety disorder (GAD), panic disorder, depression, and more.
SSRIs are frequently one of the first medications prescribed to a patient because they have low abuse potential and few side effects. This makes SSRIs, used in combination with talking therapy, one of the most popular anti-anxiety and antidepressant options.
This class of medication works by increasing the amount of serotonin in the brain, a neurotransmitter that is associated with improving mood, emotions, and sleep.
Normally, serotonin is reabsorbed by nerve cells. SSRIs block this reuptake process, which means serotonin spends more time in the brain and can spread its messages to more nearby cells. While serotonin isn’t the only factor in depression and anxiety, it can often play a significant role.
Serotonin norepinephrine reuptake inhibitors (SNRIs) are a class of medication similar to SSRIs, as they block the reuptake of both serotonin (as with SSRIs) and norepinephrine. While SNRIs were developed with the intention of essentially replacing SSRIs, further evidence has suggested that some people react better to SSRIs while others benefit more from SNRIs.
While they haven’t been able to completely replace SSRIs, SNRIs have represented a valuable addition to anxiety and depression treatments. With similarly low abuse potential to SSRIs and generally few side effects, SNRIs can help people gain control over their anxiety and/or depression with few downsides.
Many people being treated for these mental health issues will be prescribed SNRIs and then SSRIs, or vice versa, if the first medication they tried wasn’t having the desired effect.
Notable Alternatives & Supplemental Treatments
Beta blockers, such as the drug propranolol, are sometimes used to help reduce the physical signs of anxiety. They slow down a person’s heart rate and can reduce sweating and shaking caused by anxiety and panic.
Antihistamines are also sometimes used, such as the drug hydroxyzine. In addition to a variety of other uses, antihistamines can help to reduce feelings of fear and worry, nervousness, and irritability. They can also make sleeping and concentrating easier.
There aren’t many issues associated with long-term antihistamine use, although the medication shouldn’t be used in the first trimester of pregnancy or if one intends to breastfeed.
In total, there are over 30 antidepressant medications available, many of which can be used to help treat anxiety. Three other broad categories not yet discussed include the following:
- MAOIs (monoamine oxidase inhibitors)
- NASSAs (noradrenaline and specific serotonergic antidepressants)
Often the best way to understand the options relevant to your needs is to just talk to your doctor. Ask them why they’re making the recommendations they are. If you’re wondering if a different medication might fit your needs better, bring it up. Your doctor can likely talk with you about its benefits and drawbacks.
Generic & Brand-Name Medications
One thing people often understandably worry about when first prescribed a medication is whether there will be a notable difference between the generic version of a prescribed medication and the brand name version.
Part of this concern can come from the significant price difference, especially considering most insurance plans place generic medications in a better tier of coverage than their brand-name equivalents. The logical question is if there is a difference in quality between the cheap version of a medication and the more expensive branded medication.
The good news is that, practically speaking, generic medications are identical in every way that matters. Assuming all regulations are being followed, a generic drug manufacturer must ensure its drug contains the same active ingredient as the brand name alternative. This must be the same in the following ways:
- The same dosage or concentration
- The same form
- Administered in the same way
Generic medications can be different in a few ways not usually relevant to a person’s needs, including these:
- Inactive ingredients
- Preservatives used
Unless you have unusual allergies or your doctor can outline a specific reason you need a brand-name medication over the generic alternative, there usually isn’t a major reason to select the brand name of a medication if the generic is cheaper (which it almost always will be).
Avoid Exclusively Medication-Based Treatments
While medications can play a critical role in helping a person overcome some of their worst anxiety symptoms, they aren’t going to cure a person’s anxiety issues and don’t usually produce the best possible results if used without any additional treatments.
For most people, some combination of talk therapy, commonly cognitive behavioral therapy (CBT), should be combined with regularly taking medication. Therapy can help a person work to identify and better control the sources of their anxiety and channel that anxiety in healthier ways.
Whereas medication can generally help treat the symptoms of anxiety problems, therapy may help a person partially or fully address the source of those issues more directly. The short-term goal is often to manage acute anxiety symptoms with medication as needed, but the long-term goal is to do work in therapy that lessens the frequency and severity of anxiety symptoms over time.
Much of that work in therapy will relate to identifying anxiety triggers and developing coping mechanisms to better manage those triggers and the resulting anxiety. Various techniques include deep breathing, meditation, progressive muscle relaxation, and other relaxation techniques.
Factors to Consider With Anxiety Medications
There are a few factors to talk about with your doctor when you are trying to determine the best anti-anxiety medication for your needs.
You and your doctor will discuss your current health before you’re prescribed any medication, including if you have any history of health problems in your family. Health conditions can sometimes impact which medications are best for your needs. Heart problems specifically can make some medications not a good fit if alternatives are available.
Other Drugs You’re Taking
Closely related to your current health are the current drugs you’re taking. Medications can often interact, sometimes in unpredictable ways, and this may bar you from some anti-anxiety options. If some anti-anxiety options are better than the alternatives, you may be required to switch how you’re medicated for other conditions in order to avoid negative interactions.
Recreational drugs can also impact your ability to take certain medications. For example, several medications shouldn’t be taken with alcohol.
If you can’t stop taking a drug that may interfere with a treatment, talk to your doctor about those issues. They’re not there to judge you or report you if you’re using drugs illegally. It is their job to make sure you get the safest, most effective treatment possible, and it’s important they fully understand what you’re putting into your body.
Planned Life Changes
Significant life changes, especially pregnancy or sometimes major surgeries, may temporarily change which anti-anxiety medications are best suited to your needs. Pregnancy and breastfeeding are two big factors many treatments, including anti-anxiety treatments, should be planned around, as some medications can affect a fetus in the womb as well as potentially be unintentionally delivered to a nursing baby through milk.
A Comprehensive Treatment Plan
While medications may be a vital part of your treatment plan, they shouldn’t be the only component. Work with your care team to develop a comprehensive treatment plan for your anxiety that includes medications, therapy, and lifestyle changes that support a healthy, balanced life.
With a complete approach, you’re more likely to effectively manage your anxiety in the long term.
Benzodiazepines. (August 2022). Alcohol and Drug Foundation.
Overview – Selective Serotonin Reuptake Inhibitors (SSRIs). (December 2021). UK NHS.
Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison. (March 2014). Innovations in Clinical Neuroscience.
Antidepressants. (May 2022). Scotland NHS.
Propranolol. (November 2021). UK NHS.
Hydroxyzine (Vistaril, Atarax). (September 2021). National Alliance on Mental Illness.
Antidepressants. (September 2012). Royal College of Psychiatrists.
What’s the Difference Between Brand-Name and Generic Prescription Drugs? (December 2004). Scientific American.
Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. (July 2021). Evidence-Based Complementary and Alternative Medicine.
Treatment of Anxiety in Patients with Coronary Heart Disease: Rationale and Design of the UNWIND Randomized Clinical Trial. (March 2016). American Heart Journal.
Pharmacological Treatment of Anxiety Disorders: Current Treatments and Future Directions. (December 2012). Journal of Anxiety Disorders.
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