What meds treat anxiety?

Many different medications can be used to treat anxiety. Each type of anxiety medication works in a different way, and they often target different symptoms or types of anxiety. Many times, people take multiple anti-anxiety medications together.

There are three main aspects of anxiety that can be treated by medications:

  • Long-term anxiety or “chronic anxiety” is when you feel anxious most days for a significant part of the day. You may feel anxious for no particular reason, or you may have many things that trigger your anxiety each day. To treat chronic anxiety with medication, you usually need to take the same medication every day for several weeks before you feel the full effect.
  • Short-term anxiety or “acute anxiety” is when you experience brief episodes of intense anxiety. These episodes might last a few hours or a few days. The most extreme form of acute anxiety is a panic attack, where you might hyperventilate or feel like your heart is going to explode. Less extreme episodes are usually called anxiety attacks.
  • Insomnia is when you have trouble falling asleep or staying asleep. Many people have trouble falling asleep because they can’t stop worrying at night. But not getting enough sleep can also make you more anxious during the day!

It’s common to experience more than one of these together. For example, you may feel moderately anxious every day, but every once in a while you have an anxiety attack that makes you even more anxious than usual. On a day when you are particularly anxious, you’ll probably also have a harder time falling asleep. Here are a few things to keep in mind when you’re thinking about taking medication for anxiety:

  • Anything that helps with long-term anxiety is likely to also make your anxiety attacks less intense and less frequent. [1]
  • Medications that only help with short-term anxiety tend to cause problems if you take them too often.
  • Treating your anxiety is likely to help you sleep better—and improving your sleep is also likely to help with anxiety!

Antidepressants

Anxiety is not the same thing as depression, but they do often go together. Antidepressants are often effective in treating anxiety as well. They are most commonly used to treat generalized anxiety disorder (GAD) [2] obsessive-compulsive disorder (OCD) [3].

Antidepressants are taken daily for long-term anxiety. You usually need to take them every day for several weeks before you feel the full effect.

There are many types of antidepressants. Most of them work by boosting serotonin, a substance in your brain that affects your mood. [1] If one antidepressant doesn’t help you, a different kind might.

Common side effects of antidepressants include:

  • Changes in your sleep, appetite, weight, or sex drive
  • Feeling nauseous or dizzy
  • Headaches

Some of the antidepressants most commonly used to treat anxiety include:

Generic nameBrand name(s)Type of antidepressant
CitalopramCelexaSSRI
FluoxetineProzacSSRI
SertralineZoloftSSRI
VilazodoneViibrydSSRI
DuloxetineCymbaltaSNRI
VenlafaxineEffexorSNRI
ImipramineTofranilTCA
Bupropion*Wellbutrin*Atypical

*A few antidepressants, like bupropion/Wellbutrin, are stimulating and can sometimes increase your anxiety. [4] Many doctors are hesitant to prescribe bupropion to a patient who experiences anxiety. On the other hand, if you have both anxiety and depression, anything that helps with depression will likely also help with anxiety!

For more information, check out our full article on antidepressants.

Buspirone

Busprione (brand name Buspar) is similar to antidepressants in a few ways: it is taken daily for long-term anxiety, and it works by affecting your serotonin levels. It has relatively few side effects compared to many other anxiety medications. [5]

Benzodiazepines

Benzodiazepines (“benzos”) are fast-acting anti-anxiety medications. They take effect quickly—usually within 30 minutes to an hour. They also leave your system quickly—the strongest effects wear off within a few hours. [6]

Benzodiazepines are generally prescribed to treat short-term anxiety, panic attacks, or insomnia (trouble sleeping). They are also used to treat seizures.

Although benzodiazepines are generally considered safe and effective in the short term, they can become habit-forming in the long term. If you take them too often, after a while you will need more and more to get the same effect [6]. Some people use them as a party drug, and they can become addictive. The way they work in the brain is similar to alcohol—for both better and worse. (One of the reasons alcohol is commonly used in social settings is because it reduces people’s social anxiety—but it can lead to addiction.)

Generic nameBrand name(s)
AlprazolamXanax
ClonazepamKlonopin
DiazepamValium
LorazepamAtivan

For more information, check out our full article on benzodiazepines.

Atypical Antipsychotics

These medications are called “antipsychotics” because they were originally used to treat conditions like schizophrenia and bipolar disorder. More recently, they are being used to treat other conditions, including insomnia (trouble sleeping) and anxiety [7]. The medications used for anxiety are called “atypical” or 2nd-generation antipsychotics.

Like all medications, atypical antipsychotics can have side effects. However, antipsychotics are unique in that they can sometimes cause a movement disorder called tardive dyskinesia, which can become permanent. Be sure to speak with your doctor about warning signs to look out for if you try these medications.

Generic nameBrand name(s)
AripiprazoleAbilify
QuetiapineSeroquel
RisperidoneRisperdal

For more information, check out our full article on atypical antipsychotics.

Other off-label medications

An off-label medication is something that is typically used to treat one condition, but is sometimes also used to treat something else. For example, anxiety is an off-label use for atypical antipsychotics. Other types of medications that are used off-label to treat anxiety include [8]:

  1. Anticonvulsants, typically used to treat seizures, nerve pain, or fibromyalgia. These are taken daily for long-term anxiety.
  2. Antihistamines, typically used to treat allergies. These can be taken every day for long-term anxiety, or they can be taken as-needed for short-term anxiety.
  3. Beta-blockers, typically used to treat high blood pressure or other heart problems. These are taken as needed for short-term anxiety.

Antihistamines and beta-blockers do not have the same risks as benzodiazepines. Of course, like all medications, there is still the possibility of side effects.

Generic nameBrand name(s)Type of antidepressant
GabapentinNeurontinAnticonvulsant
PregabalinLyricaAnticonvulsant
HydroxyzineVistarilAntihistamine
BetaxalolBetopticBeta-blocker

References:

  1. Graeff et al. (2010). The Dual Role of Serotonin in Defense and the Mode of Action of Antidepressants on Generalized Anxiety and Panic Disorders. Central Nervous System Agents in Medicinal Chemistry 10(3), pp. 207-217. Retrieved from https://www.ingentaconnect.com/content/ben/cnsamc/2010/00000010/00000003/art00002
  2. Strawn et al. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy Volume 19(10), pp. 1057-1070. Retrieved from https://doi.org/10.1080/14656566.2018.1491966
  3. (2010). Drug treatment of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience 12(2) pp. 187–197. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181958/
  4. Patel et al. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic Advances in Psychopharmacology 6(2), pp. 99-144. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837968/
  5. Wilson & Tripp. (2021). Buspirone. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531477/
  6. (2016). Benzodiazepine use, misuse, and abuse: A review. The Mental Health Clinician 6(3), pp. 120-126. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007645/
  7. Hershenberg et al. (2014). Role of Atypical Antipsychotics in the Treatment of Generalized Anxiety Disorder. CNS Drugs 28, pp. 519-533. Retrieved from https://link.springer.com/article/10.1007/s40263-014-0162-6
  8. Huh et al. (2011). Treatment of Generalized Anxiety Disorder: A Comprehensive Review of the Literature for Psychopharmacologic Alternatives to Newer Antidepressants and Benzodiazepines. The Primary Care Companion for CNS Disorders 13(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184575/