Which Medications Are Best for Anxiety Disorders?

Each anxiety disorder has different symptoms, but Ken Duckworth, MD, the chief medical officer for the National Alliance on Mental Illness (NAMI) and an assistant professor of psychiatry at Harvard Medical School in Boston, says many people with these disorders can benefit from this three-pronged approach: psychotherapy, exercise, and medication.

Each person may need a different combination of these three elements, and in different sequences. “There’s no magic in the treatment of anxiety,” says Dr. Duckworth.

“Some people will get better with psychotherapy alone, while some people might need medication to help them concentrate better on the therapy. Anxiety and depression can decrease motivation to exercise, but medication may give you the energy to do it.” Also, says Duckworth, a patient may need more than one medication.

There are several types of medications used to treat anxiety disorders.

Antidepressants
Benzodiazepines
Buspirone
Hydroxyzine
Beta blockers

Within each of these categories, there are subgroups of drugs that work differently and have their own benefits, risks, and possible side effects.

Antidepressants are often used as the first line of treatment.

In particular, SSRIs, or selective serotonin reuptake inhibitors, are the kind of antidepressant that is most often prescribed. They impact a neurotransmitter that has been linked to mood.

These medications often take four to six weeks, or longer, to be fully effective.

“They’re supereffective in treating anxiety disorders [for certain people],” says Beth Salcedo, MD, the medical director of the Ross Center for Anxiety & Related Disorders and a past board president of the Anxiety and Depression Association of America. It’s not known exactly how SSRIs work on serotonin to alleviate anxiety, says Dr. Salcedo, but what is known is that they’re not addictive like benzodiazepines are (though they can cause uncomfortable symptoms if people stop too abruptly).

It’s important to follow your doctor’s instructions when taking any prescription drug. Talk to your doctor if you’re concerned about the side effects of a medication or if the drug you’re taking doesn’t seem to be alleviating your symptoms.

The two classes of antidepressants most commonly used to treat anxiety disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Examples of SSRIs include:

fluoxetine (Prozac or Sarafem)
citalopram (Celexa)
sertraline (Zoloft)
paroxetine (Paxil, Paxeva, or Brisdelle)
escitalopram (Lexapro)

Examples of SNRIs include:

venlafaxine (Effexor)
duloxetine (Cymbalta)

Common side effects of both SSRIs and SNRIs may include:

Nausea
Nervousness or restlessness
Dizziness
Reduced sexual desire
Drowsiness
Insomnia
Weight gain or loss
Headache
Dry mouth
Vomiting
Diarrhea

Other antidepressants that may be prescribed for anxiety include:

bupropion (Wellbutrin, Zyban, Aplenzin, Budeprion, or Buproban)

Some people respond better to some antidepressants rather than others. You may need to try a few different medications before you find one that works for you.

Benzodiazepines help relieve anxiety by enhancing the activity of a neurotransmitter in the brain and generating a sedative effect. They work quickly, and can relieve anxiety for several hours.
They are usually prescribed for those with generalized anxiety disorder, panic disorder, and social anxiety disorder.

Because they work so quickly, and because people taking them can build up a tolerance that leaves them needing higher doses to feel better, doctors will prescribe them for very short periods of time — usually no more than a month.

Unfortunately, people can become addicted to benzodiazepines, even in a short period of time. If you stop taking them suddenly, withdrawal symptoms may occur, so it’s important to follow your doctor’s instructions for tapering off your medication.

They can also be used with antidepressants initially while antidepressants take time to work.

“They’re a powerful tool,” says Duckworth, “but you have to be really smart about their use.”

Commonly prescribed benzodiazepines include:

alprazolam (Xanax or Niravam)
clonazepam (Klonopin)
lorazepam (Ativan)
diazepam (Valium)

Other side effects of benzodiazepines may include:

Drowsiness
Dizziness
Nausea
Blurred vision
Headache
Confusion
Tiredness or fatigue
Nightmares

Buspirone (BuSpar) is typically used to treat generalized anxiety disorder. It is often prescribed with an antidepressant.

Side effects of buspirone may include:

Dizziness
Headaches
Nausea
Nervousness
Light-headedness
Trouble sleeping

Some people with phobias or panic disorder may be prescribed a heart medication known as a beta blocker. These drugs are primarily prescribed for uneven heartbeat and high blood pressure, but they have been found to be helpful for treating the feelings that come with high-pressure situations.

“Beta blockers can be very helpful but in a limited way,” says Dr. Salcedo. “They are most commonly used for performance anxiety. They are really good for the physical symptoms such as heart racing, sweating, and shakiness, but they work less well for the anxious thoughts that might be causing the symptoms.”

Beta blockers are prescribed to be used on an as-needed basis; they’re not taken long-term.

Hydroxyzine (Atarax and Vistaril) is another medication prescribed for anxiety.
It’s an antihistamine that’s used to treat allergic reactions, but it also works to decrease activity in the brain.
These medications act quickly, like benzodiazepines, but unlike benzodiazepines, they don’t cause addiction.

Additional reporting by Carlene Bauer.

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