Drugs & Medications for Anxiety – The Anxiety Guide

For those that struggle with anxiety, there is something inherently disturbing about the idea of taking medicine. The idea of taking a medicine that is going to affect how your brain thinks and works is a scary thought – it almost sounds like taking a medicine will make you someone else.

You shouldn’t be afraid of anxiety medication. Those that struggle with severe anxiety find that it can help you receive some much needed relief from your anxiety symptoms.

But you also shouldn’t depend on your anxiety medication. Anxiety medications only work when you take them, and someday, you want to be able to stop taking anxiety drugs without your anxiety coming back. Think of anxiety medications as more of a tool to help you control your anxiety while you treat it.

Anxiety Medications: Where Are We Now?

There are hundreds of anxiety medications available. Some are mild. Others are strong. Some may be for those with Panic Disorder. Others may be better for those with Generalized Anxiety Disorder or OCD. Some may interact with medications. Others are relatively safe for most medicines. Some are taken daily at the same time, and others are taken only when you need them.

That is a lot to consider. But first, let’s look at the benefits and weaknesses of anxiety drugs:

Potential Advantages

• Requires little effort.
• Can complement therapy.
• May speed up recovery in those with severe anxiety.
• Can be used when other therapy solutions have not worked.

Potential Disadvantages

• May cause side effects, including stomach issues and fatigue.
• May cause dependence and withdrawal issues.
• Body may develop a tolerance causing them to lose effectiveness.
• May make it harder to strengthen your nature coping habits (to cure anxiety)
• May alter personality (although not all have this side effect).

Some also may not work, because your own anxiety may have different causes or different needs. For example, some people respond well to anxiety medicines that affect serotonin levels, others respond better to medications that affect GABA levels. That means the first medicine you take may not work, even though an effective medicine is available.

With this in mind, medications shouldn’t be a first choice, but they also shouldn’t be a last resort. They should be something you consider along with all other treatment options. Be open minded, but don’t depend on the treatment either.

Types of Anxiety Drugs

Anxiety drugs generally fall into one of the following categories:

• Antidepressants (SSRIs, SNRIs, TCAs, MAOIs, Atypical Antidepressants)
• Benzodiazepines
• Beta Blockers
• Tranquilizers
• Anticonvulsant Medications
• Other
• Natural Medicines/Herbal Medicines

There is often going to be trial and error when determining the one that is best for you. Below is a breakdown of the types of medications available, along with information about their effects and usage patterns.

Type 1: Antidepressants

Contrary to popular belief, not all antidepressants were specifically designed to treat depression. Many were found to treat anxiety over the course of their antidepressant testing, and because many of those that suffer from anxiety also have depression (and vice-versa), these medications may benefit both.

There are many different types of antidepressants, which we will describe below:

Serotonin Selective Reuptake Inhibitors (SSRIs)

Examples:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox).

A brain chemical (neurotransmitter) known as serotonin has a powerful effect on mood. SSRIs work by preventing the brain from absorbing serotonin after your body has already used it. The effect of this is that serotonin starts to build up in your brain, causing more of it, which in turn helps improve your mood and decreases your anxiety.

Side effects of this type of medication differ, but may include nausea, vomiting, reduced sex drive, sexual dysfunction, insomnia, and digestive issues. Talk to your doctor about specific risks with each medication.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Examples:

• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)

Similar to SSRIs, SNRIs prevent the synapses in the brain from absorbing two different neurotransmitters – serotonin and norepinephrine. This differs from SSRIs, which only prevent the reuptake of serotonin.

Their success is similar to SSRIs, and so are their side effects. But some people with anxiety find that their bodies require norepinephrine to combat anxiety, while others do not. One of the few differences is that SNRIs may also increase anxiety as well as a side effect in some patients, which is why most psychiatrists recommend SSRIs first.

Tricyclic Antidepressants (TCAs)

Examples:

• Imipramine (Tofranil)
• Desipramine (Norpramin)
• Doxepin (Sinequan)
• Nortriptyline (Pamelor)
• Amitriptyline (Elavil)
• Clomipramine (Anafranil)

TCAs are also similar to SSRIs and SNRIs. Tricyclic Antidepressants increase serotonin and norepinephrine, like SNRIs, but also decrease another neurotransmitter known as acetylcholine, which in high levels was found to contribute to both anxiety and depression in studies in mice.

TCAs may be more powerful for severe anxiety and depression, but they also tend to have more side effects. They have fallen out of favor with psychiatrists and are less likely to be used unless anxiety has not responded to treatment.

Side effects include dry mouth, blurred vision, constipation, weight gain, sexual dysfunction, drowsiness, and low blood pressure. Overdose can be fatal.

Monoamine Oxidase Inhibitors (MAOIs)

Examples:

• Tranylcypromine (Parnate)
• Phenelzine (Nardil)
• Isocarboxacid (Marplan).

MAOIs differs from SSRIs, SNRIs, and TCAs. MAOIs inhibit the production of monoamine oxidase, which is the enzyme responsible for breaking down serotonin, epinephrine, and dopamine. With less enzyme to break those neurotransmitters down, you end up having more in your system, which ultimately means an improved mood.

These have also fallen out of favor in recent years, because monoamine oxidase is needed to break down other chemicals, and that may cause more side effects, interact with more medications, and possibly lead to other concerns.

Possible side effects include initial worsening of anxiety, weight gain, sexual dysfunction, edema, light-headedness and assorted neurological symptoms. Using these drugs may imply dietary restrictions and bears risk of toxicity. Overdose can be fatal.

Atypical Antidepressants

Examples:

• Bupropion (Wellbutrin)
• Trazodone (Desyrel)
• Mirtazapine (Remeron)
• Vortioxetine (Trintellix)

Atypical antidepressants are drugs that do not fit into the typical antidepressant categories above. Each one may affect the body in different ways. Bupropion inhibits reuptake of dopamine, serotonin, and norepinephrine. Trazodone is a serotonin antagonist and reuptake inhibitor, which is similar to an SSRI but also blocks their uptake from other receptors.

Every atypical antidepressant tends to work in different ways. It’s not always clear if they help those with anxiety. Your psychiatrist may determine whether to use an atypical antidepressant depending on other symptoms. For example, those with severe insomnia and anxiety may be recommended Trazodone, which also doubles as a sleeping pill.

Side effects are based on the type of drug.

Type 2: Benzodiazepines

Examples:

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)

Perhaps the most commonly prescribed anxiety-only medications are benzodiazepines. There are dozens of these anxiety drugs available, but most work a similar way – by enhancing the effects of GABA, a neurotransmitter that relaxes the body.

Compared to anti-depressants, benzodiazepines have both advantages and disadvantages. The advantages are that they’re designed specifically for controlling the symptoms of anxiety. They generally provide a sedation effect, which ensures that your body responds more calmly to stressors.

They can also be adjusted fairly easily, and are generally well tolerated - although some minor gastrointestinal side effects are fairly common.

Disadvantages are that they cannot be taken daily. Benzos are generally used as a short term anxiety drug, because it’s possible to develop tolerance, which decreases how effective they are in the long term. They may be also addictive when used on a daily basis. Daily use may also increase their toxicity.

Side effects are largely mild, and are more common with long term use. Some of the possible side effects of benzodiazepines include:

• Sedation.
• Stomach Problems
• Withdrawal Issues
• Memory Loss and Concentration Issues
• Paradoxical Effects (More Anxiety, Irritation, or Anger)

Benzodiazepines are also not ideal for some types of anxiety, and they often interact with drugs and alcohol that can be dangerous. They can be misused as well, so those that have addiction problems may want to avoid these anxiety drugs.

Note: Given the way they contrast each other, antidepressants and benzodiazepines are often prescribed together.

Type 3: Beta Blockers

Examples:

• Atenolol (Tenormin)
• Propranolol (Inderal)

Beta blockers are most commonly used for heart attack patients. They block specific receptor sites inside the body responsible for initiating the fight or flight response. For heart attack patients, this ensures that nothing speeds up the heart more than it can handle.

But the fight or flight response is also responsible for anxiety, and so these anxiety drugs may also be used off label for certain types of anxiety disorders – most commonly social anxiety disorder and panic disorder. It is technically not approved by the FDA, but studies have shown it to be effective. Some surgeons use beta blockers to reduce anxiety during a major operation, for example.

Beta blockers are not meant to be taken every day. Side effects include nausea, dizziness, hair loss, insomnia/sleepiness, sexual dysfunction, and shortness of breath. In some, beta blockers may actually increase anxious thoughts, although symptoms may be more tolerable.

Type 4: Tranquilizers

Examples:

• Buspirone (Buspar)

The only mild tranquilizer used for anxiety at the moment is buspirone.

Buspar is a very mild tranquilizer that decreases dopamine and increases serotonin. This improves mood while slightly decreasing the amount of energy the body can release. Despite the term “tranquilizer,” Buspirone is considered very mild – so mild, that those with severe anxiety generally report no real benefits.

But for those with mild to moderate anxiety that want to start with a slow, gentle anxiolytic, buspirone may be a good choice, as the anxiety drug is not addictive, can be used every day, and comes with fairly mild side effects such as dizziness, blurred vision, and temporary restlessness. It is not meant for short term relief, as buspirone may take several weeks to work.

Type 5: Anticonvulsants

Examples:

• Pregabalin (Lyrica)
• Gabapentin (Neurontin)
• Valproate (Depakote)

If “anticonvulsant” sounds familiar, it is because these drugs are used to control seizures. But do not let that scare you. These drugs control seizures by preventing the brain from releasing large quantities of neurotransmitters at once, and altering GABA production. Both of which appear to improve anxiety levels.

They are non addictive, may improve sleep, and have been shown to have a positive effect on anxiety disorders. They are similar to benzodiazepines but with less risk of addiction, and many psychiatrists are starting to recommend them in place of benzos.

However, they are not right for everyone and should not be used without a recommendation by your doctor, who will need to choose a safe dose. Side effects include dizziness, sleepiness, blurred vision, changes in sexual desire, constipation, and euphoria.

Type 6: Other - Not Otherwise Specified

Anxiety conditions may respond to treatments that do not fit into the above categories. For example, Prazosin, a drug that is meant for high blood pressure and nighttime urination, also seems to block adrenaline without many side effects, making it an intriguing choice for PTSD.

Several drugs over the past decade that have been prescribed for anxiety and anxiety disorders have no connection to anxiety or mental health at all, but studies have shown positive benefits for those with anxiety. Thus, it is possible that the drug prescribed to you may not be listed as an anxiety drugs.

Type 7: Natural Anxiety Drugs and Side Effect Free Anxiety Treatments

Many of those with anxiety look for so called “natural” anxiety drugs or natural herbal treatments. Examples include:

• Kava
• Passionflower
• Magnesium
• Ashwagandha
• L-Theanine

Given all the possible side effects of anxiety, it is easy to see why most people would want to try a side effect free treatment first. Some, like Kava, actually do have research supporting the idea that it may reduce anxiety when used in the right doses, and it may be something you will want to consider.

BUT WORD OF CAUTION: One of the things that herbal supplement marketing companies do not tell you is that many of the side effects of anxiety medications are because the medication is working.

For example, most of the gastrointestinal issues caused by SSRIs are because there are also serotonin receptors in the stomach. Creating more serotonin in the body can help boost mood, but it may also stimulate receptors in the stomach, causing you to feel nausea or stomach discomfort.

The reason that most herbal and natural medications cause no side effect is because many, in all likelihood, don’t do anything. It is currently impossible to increase serotonin in the brain without increasing serotonin elsewhere, and if you increase serotonin elsewhere, you may feel sick. Anxiety medication side effects are a result of them working, not because they are chemicals.

There are promising herbal supplements for anxiety, like kava, and promising nutritional supplements, like magnesium. But be careful about trusting supplements simply because they say they work and are side effect free. Most do nothing at all, or at best do very, very little.

Anxiety Drugs By Disorder

Every anxiety disorder responds differently to each medication. That means that your doctor may recommend a different medication depending on the type of anxiety. The following is a list of the most likely recommended medications for each condition, but always talk to your doctor and determine the one that is best for your symptoms.

Generalized Anxiety Disorder Medications

Most of the medications above may be recommended for GAD: All Benzodiazepines, all SSRIs, Buspirone, all SNRIs, and some anticonvulsants. Some of the most commonly prescribed generalized anxiety disorder medicines include:

• Escitalopram (Lexapro)
• Citalopram (Celexa)
• Pregabalin (Lyrica)
• Quetiapine (Seroquel)
• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Sertraline (Zoloft)

Panic Disorder Medications

Common panic attack and panic disorder medications include:

• Sertraline (Zoloft)
• Clonazepam (Klonopin)
• Alprazolam (Xanax)
• Paroxetine (Paxil)
• Buspirone (Buspar)
• Citalopram (Celexa)
• Lorazepam (Ativian)

Common social anxiety disorder medications include:

• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Venlafaxine (Effexor)
• Atomoxetine (Strattera)
• Gabapentin (Neurontin)
• Fluvoxamine (Luvox)

Obsessive Compulsive Disorder (OCD) Medications

Common obsessive compulsive disorder (OCD) medications include:

• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Clomipramine (Anafranil)
• Fluoxetine (Prozac)
• Escitalopram (Lexapro)

Post Traumatic Stress Disorder (PTSD) Medications:

Common post-traumatic stress disorder (PTSD) medications include:

• Prazosin (Minipress)
• Sertraline (Zoloft)
• Quetiapine (Seroquel)
• Asenapine (Saphris)
• Paroxetine (Paxil)
• Mirtazapine (Remeron)

The Benefits and Dangers of Anti-Anxiety Drugs

Anxiety is a complex disorder, and may respond to anxiety drugs in different ways. There is no perfect anti-anxiety drug, as many create side effects or cause dependency in a way that make them less than idea for regular use, and not everyone benefits from the same drug or dose. Trial and error is involved.

In addition, anxiety medications only work while you’re taking them. You still need to combine the drugs with therapy, lifestyle changes, self-help techniques, and more, even when you do not have anxiety. That way, someday, you can stop taking the medications and start living anxiety free.