Do anxiety medications cause addiction?

Physical dependence refers to your body’s reliance on and tolerance of a medication, which can lead to withdrawal symptoms if you abruptly stop taking it. This may include continually needing a higher dosage to experience the same anxiety-relieving effects.

The term “addiction” can be more than just physical dependence. It may also involve emotional and psychological dependence and low impulse control.

Addiction also refers to a strong urge to continue using a medication, known as cravings, despite the negative effects it may have on your body, mind, and life in general. The clinical term is substance use disorder, a formal mental health diagnosis.

Anxiety medications typically fall into two categories:

• Controlled substances: These medications have a higher potential for dependence and addiction. They are highly regulated due to their potentially addictive properties. For example, benzodiazepines. 
• Non-controlled substances: These drugs have a statistically lower chance of dependence and addiction. For example, buspirone.

Because substance use disorder is a complex condition, any pharmaceutical has the potential to be misused and may lead to dependence or addiction. Following your doctor’s guidelines and monitoring your symptoms may reduce this chance.

Anxiety medications with a low chance of dependence

Substance use disorder is complex, and many factors may influence your chances of developing it.

If you have a family or personal history of dependence or substance use disorder or have concerns about becoming dependent on your medications, discuss the topic with your healthcare professional. They may provide the answers you need and recommend specific medications and instructions.

Anti-anxiety medications include a wide range of options, and some may be more suitable for specific types of anxiety.

The four types of anxiety disorders mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) include generalized anxiety, social anxiety, phobias, and panic disorder.

Your healthcare professional may determine which medication is most effective for your anxiety symptoms and type.

Some anxiety medications they may recommend because of the lower chance of addiction can include:

Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs are a group of antidepressant medications that may be used for anxiety symptoms. They work by increasing the levels of serotonin and norepinephrine in your brain, which may help improve mood and relieve anxiety symptoms. 

SNRIs have a low potential for dependence.

Common side effects of SNRIs may include:

• nausea
• dry mouth
• headaches
• insomnia

Non-addictive SNRIs that may treat some types of anxiety include venlafaxine (Effexor) and duloxetine (Cymbalta).

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are another group of antidepressants that help treat some types of anxiety disorders. They work by increasing serotonin levels in your brain. This is a brain chemical involved in mood regulation and the stress response.

When used as recommended, SSRIs may have a low chance of causing addiction during long-term anxiety treatment.  

Common side effects of SSRIs may include:

• nausea
• diarrhea
• dizziness
• lightheadedness

SSRIs may include paroxetine (Paxil), escitalopram (Lexapro), and sertraline (Zoloft).

Hydroxyzine

Hydroxyzine (Vistaril) belongs to the class of first-generation antihistamines. While doctors primarily prescribe hydroxyzine to manage allergic reactions, they may sometimes prescribe it off-label to treat some types of anxiety.

Hydroxyzine affects certain chemicals in the brain, including histamine receptors, which may reduce anxiety and increase relaxation. 

Common side effects may include:

• drowsiness
• dry mouth
• blurred vision
• dizziness

Buspirone

Buspirone (Buspar) is an anti-anxiety medication in the azapirones drug class. It affects certain chemicals in the brain, specifically targeting serotonin receptors, to help relieve anxiety symptoms. 

Buspirone does not cause sedation, which may reduce the chance of dependence. It is one of the most common options for long-term anxiety management. 

Common side effects may include:

• dizziness
• drowsiness
• headaches
• nausea

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Anxiety medications with a higher chance of dependence

Benzodiazepines, a particular class of drugs, have a higher chance of dependence and addiction when used as a long-term treatment for anxiety. Healthcare professionals may use benzodiazepines only as a short-term solution.

Benzodiazepines enhance the effects of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain that helps reduce anxiety symptoms and promote relaxation.

Common side effects may include: 

• drowsiness
• dizziness
• headaches
• lack of coordination or balance
• fatigue
• mental confusion
• difficulty concentrating

FDA-approved benzodiazepines for anxiety include:

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

Signs and effects of addiction to anxiety medications

Symptoms of anxiety medication dependence and addiction may include:

• Increased tolerance: You may find that over time, you need higher doses of the medication to achieve the same level of anxiety relief.
• Withdrawal symptoms: When you try to reduce or stop taking the medication, you may experience withdrawal symptoms such as rebound anxiety, irritability, insomnia, tremors, and headaches.
• Persistent thoughts about the medication: You might become preoccupied with getting and using the medication out of your schedule and feel anxious or uneasy when running low on your prescription refills.
• Doctor shopping or medication-seeking behavior: You may seek multiple doctors or pharmacies to obtain more medication or additional prescriptions than your primary healthcare professional recommended.

Treatment for medication dependence and substance use disorder

Depending on the type of medication, your overall health, and other factors, your healthcare professional may opt for one or another management option.

The treatment for substance use disorder involving anxiety medications may include:

• Medication tapering: A doctor may gradually reduce your anxiety medication dosage to help minimize withdrawal symptoms and safely discontinue its use. Tapering ensures a smooth transition as you gradually decrease your reliance on the medication. Discontinuing a medication cold turkey or on your own is not recommended.
• Alternative medications: Depending on your anxiety symptoms, a doctor may prescribe alternative anxiety medications such as buspirone (Buspar) that have a lower chance of dependence.
• Psychotherapy: Talk therapy, such as cognitive behavioral therapy (CBT), may help with anxiety and substance use disorder symptoms. Therapy may help you develop coping strategies and stress management techniques, and provide guidance throughout recovery.

Summary

Non-addictive anxiety medications may include buspirone, SNRIs, and SSRIs. Benzodiazepines, like Xanax and Valium, may have a higher chance of addiction when used as a long-term anxiety treatment.

Other anxiety medications may not lead to dependence and addiction when used as your healthcare professional recommends. Still, substance use disorder is a complex condition, and other factors may affect your likelihood of developing symptoms.  

Anxiety treatment also involves psychotherapy and may be the optimal management option for some people with a history of substance use disorder and drug dependence.

If you are concerned about the possible addictive properties of some anxiety medications, consider talking with a doctor. They can help you develop a comprehensive treatment plan, including alternative medications, therapy, and coping strategies to manage your anxiety effectively.

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