Your guide to anxiety medications

Key takeaways

• Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are often the first-line treatment for anxiety. They work by increasing neurotransmitter levels in your brain to help regulate mood and calm overactive nerve pathways.
• Benzodiazepines like alprazolam (Xanax) and lorazepam (Ativan) work within 30 to 60 minutes for fast relief during panic or anxiety attacks. However, they carry a high risk of dependence and are typically used short-term or as needed rather than for daily management.
• Finding the right anxiety medication depends on your main symptoms, other conditions like depression, how quickly you need relief, and your medical history. Medications are typically most effective when combined with talk therapy like cognitive behavioral therapy (CBT) and lifestyle changes.

Overview

Everyone feels some anxiety from time to time. But when it starts to affect your daily life or becomes severe, it may be time to speak with a doctor about treatment options.

In many cases, anxiety can be managed with stress reduction techniques or talk therapy options. However, sometimes, medications may be necessary. This Mental Health Month, let’s take a look at some of the most common anxiety medications.

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Antidepressants for anxiety

Despite their name, antidepressants are often a first-line treatment option for specific anxiety disorders, as well. These include selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Examples of antidepressants approved to treat anxiety include:

• SSRIs: Examples include escitalopram (Lexapro) and paroxetine (Paxil).
• SNRIs: Examples include duloxetine (Cymbalta) and venlafaxine (Effexor).

In some cases, doctors might use other antidepressants off-label for anxiety. These drugs aren’t approved specifically for anxiety, but they are likely to be safe and effective for this purpose. Examples of these include:

• Other SSRIs: Examples include fluoxetine (Prozac) and sertraline (Zoloft).
• Tricyclic antidepressants: Examples include clomipramine (Anafranil) and imipramine (Tofranil)
• Monoamine oxidase inhibitors: One example is phenelzine (Nardil).

Antidepressants for anxiety work by increasing the levels of neurotransmitters like serotonin in your brain, which can help to regulate your mood and calm overactive nerve pathways. This can reduce some physical symptoms of anxiety, including racing thoughts, a fast heartbeat, and sleeplessness.

Anxiety treatment with antidepressants can vary in length. Some courses may last 3 to 6 months, whilst others may last 1 to 2 years, or even longer if necessary. These medications are generally considered effective and well-tolerated in the long term.

Like any medication, antidepressants may cause some side effects, including:

• nausea
• sleep disturbances
• dry mouth
• weight changes
• sexual side effects

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Short-term and alternative anxiety medications

While long-term recovery often relies on daily maintenance medications, in some cases, you may need fast-acting relief for acute symptoms or specialized alternatives if you don’t respond to standard treatments.

Benzodiazepines

Benzodiazepines are fast-acting anxiety medications that work by calming down your central nervous system. They do this by increasing the effect of the GABA neurotransmitter in your brain. Common examples include:

• alprazolam (Xanax)
• lorazepam (Ativan)
• diazepam (Valium)

Benzodiazepines get to work very quickly — usually within 30 to 60 minutes. This makes them particularly effective for anxiety or panic attacks that are in progress and currently affecting your functioning.

While effective, they are rarely used for long-term treatment. Over time, the brain adjusts to the presence of the drug, leading to tolerance (requiring higher doses for the same effect) and a decrease in the medication’s efficacy for daily anxiety. There is also a high risk of dependence on these drugs.

Stopping them abruptly can also be dangerous. Symptoms range from rebound anxiety and insomnia to severe complications like seizures. Generally, doctors will slowly taper your dose to wean you off it.

Typically, benzodiazepines are used for as-needed symptom relief or short-term mood stabilization during a limited period of high stress.

Buspirone

Buspirone (BuSpar) is a type of medication called an anxiolytic. It works by altering serotonin and dopamine levels in the brain to reduce worry, fear, and nervousness. It’s different from benzodiazepines in that there is no risk of dependence or withdrawal symptoms, but it also takes several weeks to be fully effective.

It’s often prescribed alongside antidepressants for anxiety.

Anticonvulsants

Anticonvulsant medications are typically prescribed to manage seizure disorders, but they’re increasingly used off-label to manage anxiety. The anticonvulsants used for anxiety are pregabalin (Lyrica) and gabapentin (Neurontin). They’re typically used if you don’t respond well to other anxiety medications.

Anticonvulsants work for anxiety by calming overactive nerves in your brain. Like benzodiazepines, they can also be used for short-term relief from situational anxiety, and they’re considered a safer option.

Finding the right medication for you

No two brains are identical, which means the best medication is highly individual. Finding the right fit is often a process of careful observation and open communication with a healthcare professional. When weighing your options, several factors come into play:

• Main symptoms: Are you experiencing situational panic, constant mental worry, or anxiety that prevents you from sleeping? Antidepressants may be best for long-term use, whereas options like benzodiazepines are better for immediate relief.
• Other conditions: Many people with anxiety also experience depression. In these cases, an antidepressant is typically the preferred starting point.
• Speed of relief: If your symptoms are making it impossible to function today, a provider might use a fast-acting bridge medication while waiting for a long-term option to kick in.
• Medical history: Past experiences with medications or a history of substance use will heavily influence whether certain options, like benzodiazepines, are appropriate.

Medication costs may also be a factor in choosing a treatment option. You can speak with your doctor or pharmacist about strategies to save on your medications.

Optum Perks now also offers reduced pricing on over 60 branded medications, and consumers can now save an average of 22.5%, or $91, per prescription. The final price of your medications may be discounted at the pharmacy even further than the offers listed on our site.

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Medical perspective

What is the one thing you wish every patient knew before they started a new anxiety medication?

“I want every patient to know that these medications take time to work. In some cases, your doctor may have to increase the dose of the medication to get you to an effective therapeutic level.”

— Ifeanyi Olele, DO, MBA, MS, FAPA

Note: Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Combining medications with other treatments

While medication can often effectively manage the symptoms of anxiety, it is typically most successful when integrated into a broader treatment strategy.

Doctors will typically recommend a form of talk therapy alongside anxiety drugs, including cognitive behavioral therapy (CBT). They’ll also recommend some lifestyle factors, including:

• improving sleep hygiene
• increasing exercise
• practicing mindfulness techniques and deep breathing

Combining medications with these other strategies can help support your treatment in the long-term.

Summary

Anxiety is a common condition that can have a huge impact on your life. Medications are just one option to treat it.

Antidepressants are typically the first choice to treat anxiety, and these are typically used long-term. Other options include benzodiazepines or anticonvulsants. These may be combined with lifestyle strategies and talk therapies.

Download the free Optum Perks Discount Card to save up to 80% on many prescription medications. Plus, you can now get them delivered to your home in as little as 3 days. Search for your medication here.