Which Medications Are Best for Anxiety Disorders?

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Various medications have been shown to provide relief for people with anxiety disorders.iStock

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.

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

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

According to the American Academy of Family Physicians, 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 make serotonin, a?neurotransmitter?that helps maintain mood, become more available to the brain.

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

“They’re supereffective in?treating anxiety?disorders,” 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.

Which Antidepressants Are Used for Anxiety?

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:

Examples of?SNRIs?include:

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:

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.

RELATED:?Meditation’s Soothing Effects

Which Benzodiazepines Are Used for Anxiety?

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:

Other side effects of?benzodiazepines?may include:

  • Drowsiness
  • Dizziness
  • Nausea
  • Blurred vision
  • Headache
  • Confusion
  • Tiredness or fatigue
  • Nightmares

What Other Medications Are Prescribed for Anxiety?

Buspirone?(brand name?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, 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,?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.

Editorial Sources and Fact-Checking

  • Locke A,?Kirst?N, Schultz C. Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults.?American Family Physician. May 2015.
  • Selective Serotonin Reuptake Inhibitors (SSRIs). Mayo Clinic. September 17, 2019.
  • Mental Health Medications. National Institute of Mental Health. October 2016.
  • Medication.?Anxiety and Depression Association of America.
  • SSRIs and Benzodiazepines for Generalized Anxiety Disorder (GAD). Anxiety and Depression Association of America. May 26, 2020.
  • Kennedy K, O’Riordan J. Prescribing Benzodiazepines in General Practice. British Journal of General Practice. 2019.
  • Benzodiazepine-Associated Risks. National Alliance on Mental Health. February 2019.
  • Buspirone (BuSpar). National Alliance on Mental Health. January 2019.
  • Anxiety Disorders. National Institute of Mental Health. July 2018.
  • Hydroxyzine (Vistaril, Atarax). National Alliance on Mental Health. January 2019.
  • Hydroxyzine. MedlinePlus. March 17, 2021.
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