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Anxiety Medication

What You Need to Know About Anti-Anxiety Drugs

Self-Help for Anxiety Relief

Worrying can be helpful when it spurs you to take action and solve a problem. But if you’re preoccupied with “what ifs” and worst-case scenarios, worry becomes a problem. Unrelenting doubts and fears can be paralyzing. They can sap your emotional energy, send your anxiety levels soaring, and interfere with your daily life. But chronic worrying is a mental habit that can be broken. You can train your brain to stay calm and look at life from a more positive perspective.

Understanding anxiety medication

This information is not intended to be a substitute for medical advice. If you are taking a medication for anxiety, do not change your dosage without consulting your physician!

Many different types of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs such as benzodiazepines, and newer options like antidepressants and beta-blockers.

These medications can be very effective, but they shouldn’t be thought of as a cure. Anxiety medication can provide temporary relief, but it doesn’t treat the underlying cause of the anxiety disorder. Once you stop taking the drug, the anxiety symptoms often return in full force.

It’s important to be aware of the risks of anxiety medication, too. Anxiety medication can cause a wide range of unpleasant and sometimes dangerous side effects. Many medications for anxiety are also habit forming and physically addictive, making it difficult to stop taking them once you’ve started.

The bottom line

If you have severe anxiety that’s interfering with your ability to function, medication may be right for you. However, many people use anti-anxiety medication when therapy, exercise, or self-help strategies would work just as well or better—minus the side effects and risks.

Therapy and self-help strategies can help you get to the bottom of your underlying issues and develop the tools to beat anxiety for good. So while drug treatment can be beneficial, it’s by no means the only answer. There are other effective treatment approaches that can be taken in addition to or instead of medications. It's up to you to evaluate your options and decide what's best for you.

Anti-anxiety drugs (tranquilizers / benzodiazepines)

Anti-anxiety drugs, also known as tranquilizers, are medications that relieve anxiety by slowing down the central nervous system. Their relaxing and calming effects have made them very popular: anti-anxiety drugs are the most widely prescribed type of medication for anxiety. They are also prescribed as sleeping pills and muscle relaxants.

Benzodiazepines are the most common class of anti-anxiety drugs. They include:

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

Benzodiazepines are fast acting—typically bringing relief within thirty minutes to an hour. Because they work quickly, benzodiazepines are very effective when taken during a panic attack or another overwhelming anxiety episode. But despite their potent anti-anxiety effects, they have their drawbacks.

Side effects of anti-anxiety drugs

Anti-anxiety drugs like benzodiazepines work by reducing brain activity. While this temporarily relieves anxiety, it can also lead to unwanted side effects.

The higher the dose, the more pronounced these side effects typically become. However, some people feel sleepy, foggy, and uncoordinated even on low doses of benzodiazepines, which can cause problems with work, school, or everyday activities such as driving. Some even feel a medication hangover the next day.

Because benzodiazepines are metabolized slowly, the medication can build up in the body when used over longer periods of time. The result is oversedation. People who are oversedated may look like they’re drunk.

Common side-effects of benzodiazepines or tranquilizers

  • Drowsiness, lack of energy
  • Clumsiness, slow reflexes
  • Slurred speech
  • Confusion and disorientation
  • Depression
  • Dizziness, lightheadedness
  • Impaired thinking and judgment
  • Memory loss, forgetfulness
  • Nausea, stomach upset
  • Blurred or double vision

Benzodiazepines are also associated with depression. Long-term benzodiazepine users are often depressed, and higher doses are believed to increase the risk of both depressive symptoms and suicidal thoughts and feelings. Furthermore, benzodiazepines can cause emotional blunting or numbness. The medication relieves the anxiety, but it also blocks feelings of pleasure or pain.

Paradoxical effects of anti-anxiety drugs

Despite their sedating properties, some people who take anti-anxiety medication experience paradoxical excitement. The most common paradoxical reactions are increased anxiety, irritability, and agitation. However, more severe effects can also occur, including:

  • Mania
  • Hostility and rage
  • Aggressive or impulsive behavior
  • Hallucinations

While rare, these adverse effects are dangerous. Paradoxical reactions to these anxiety medications are most common in children, the elderly, and people with developmental disabilities.

Other types of medications for anxiety

Because of the many safety concerns linked to anti-anxiety drugs, other medications for treating anxiety have gained in popularity. The alternatives to the anti-anxiety tranquilizers include antidepressants, buspirone, and beta blockers.

Antidepressant medications for anxiety

Many medications originally approved for the treatment of depression have been found to relieve symptoms of anxiety. These include certain selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and the newer atypical antidepressants.

Antidepressants are often preferred over the traditional anti-anxiety drugs because the risk for dependency and abuse is smaller. However, antidepressants take up to 4 to 6 weeks to begin relieving anxiety symptoms, so they can’t be taken “as needed.” For example, antidepressants wouldn’t help at all if you waited until you were having a panic attack to take them. Their use is limited to chronic anxiety problems that require ongoing treatment.

The antidepressants most widely prescribed for anxiety are SSRIs such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. These work by regulating serotonin levels in the brain to elevate mood and have been used to treat panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD).

Common side effects include:

  • Nausea
  • Nervousness
  • Headaches
  • Sleepiness
  • Sexual dysfunction
  • Dizziness
  • Stomach upset
  • Weight gain

Although physical dependence is not as quick to develop with antidepressants, withdrawal can still be an issue. If discontinued too quickly, antidepressant withdrawal can trigger symptoms such as extreme depression and fatigue, irritability, anxiety, flu-like symptoms, and insomnia.

Antidepressant suicide risk

All antidepressants are required by the FDA to carry a warning about the risk of suicidal thoughts, hostility, and agitation. There is also the risk that antidepressants will cause an increase, rather than a decrease, in depression and anxiety.

Buspirone (BuSpar)

Buspirone, also known by the brand name BuSpar, is a newer anti-anxiety drug that acts as a mild tranquilizer. Buspirone relieves anxiety by increasing serotonin in the brain as the SSRIs do and decreasing dopamine. Compared to traditional anti-anxiety medications like Xanax, buspirone is slow acting. It takes about two weeks to start working on anxiety. However, it has several advantages over the older anti-anxiety drugs: it’s not as sedating, it doesn’t impair memory and coordination, it’s not very addictive, and the withdrawal effects are minimal.

Common side effects of buspirone include:

  • Nausea
  • Headaches
  • Dizziness
  • Drowsiness
  • Upset stomach
  • Constipation
  • Diarrhea
  • Dry mouth

Since the risk of dependence is low and it has no serious drug interactions, buspirone is a good option for older individuals and people with a history of substance abuse. However, its effectiveness is limited. It works for generalized anxiety disorder (GAD), but doesn’t seem to help the other types of anxiety disorders.

Beta blocker medications for anxiety

Beta blockers are a type of medication used to treat high blood pressure and heart problems. However, beta blockers are also prescribed off-label for anxiety. Beta blockers work by blocking the effects of norepinephrine, a stress hormone involved in the fight-or-flight response. This helps control the physical symptoms of anxiety such as rapid heart rate, a trembling voice, sweating, dizziness, and shaky hands.

Because beta blockers don’t affect the emotional symptoms of anxiety such as worry, they’re most helpful for phobias, particularly social phobia and performance anxiety. If you’re anticipating a specific anxiety-producing situation (such as giving a speech), taking a beta blocker in advance can help reduce your “nerves.”

Beta blockers include drugs such as propranolol (Inderal) and atenolol (Tenormin). Common side effects include:

  • Light-headedness
  • Sleepiness
  • Nausea
  • Unusually slow pulse

Anti-anxiety medication safety concerns and risk factors

Beyond the common side effects, medication for anxiety comes with additional risks. While the tranquilizing anti-anxiety drugs are relatively safe when taken only occasionally and in small doses, they can lead to severe problems when combined with other substances or taken over long periods of time. Furthermore, some people will have adverse reactions to any amount of anti-anxiety medication. They are not safe for everyone, even when used responsibly.

Drug interactions and overdose

Used alone, anti-anxiety medications such as Xanax or Valium rarely cause fatal overdose, even when taken in large doses. But when combined with other central nervous system depressants, the toxic effects of these anxiety medications increase.

Taking anti-anxiety medication with alcohol, prescription painkillers, or sleeping pills can be deadly. Dangerous drug interactions can also occur when anti-anxiety drugs are taken with antihistamines, which are found in many over-the-counter cold and allergy medicines. Antidepressants such as Prozac and Zoloft can also heighten their toxicity. Always talk to your doctor or pharmacist before combining medications.

Anti-anxiety drug risk factors

Anyone who takes anti-anxiety medication can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:

  • People over 65. Older adults are more sensitive to the sedating effects of anti-anxiety medication. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Anti-anxiety drug use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents.
  • Pregnant women. Expectant mothers should avoid anti-anxiety drugs. Since these anxiety medications cross the placenta, their use during pregnancy can lead to dependence in the baby. Following birth, the baby will then go through withdrawal, with symptoms such as muscle weakness, irritability, sleep and breathing problems, and trembling. These anxiety drugs are excreted in breast milk, so they should be avoided while breastfeeding, too.
  • People with a history of substance abuse. Anyone with a current or former problem with alcohol or drugs should avoid anti-anxiety drugs or use them only with extreme caution. The greatest benefit of benzodiazepines is that they work quickly, but this also makes them addictive. This can quickly lead to their abuse, often in dangerous combination with alcohol or other illicit drugs.

The connection between anxiety medication and accidents

Anti-anxiety medication causes drowsiness and poor coordination, which contributes to accidents at home, at work, and on the road. Studies show that taking anti-anxiety medication increases your risk of having a serious traffic accident.

Deciding if anxiety medication is right for you

If you’re trying to decide whether or not to treat your anxiety with medication, it’s important to weigh the pros and cons in conjunction with your doctor. It’s also important to learn about the common side effects of the anxiety medication you are considering. Side effects of anxiety medication range from mild nuisances such as dry mouth to more severe problems such as acute nausea or pronounced weight gain. For any anxiety medication, you will have to balance the side effects against the benefits.

Questions to ask yourself and a mental health professional

  • Is medication the best option for my anxiety problem?
  • Am I willing to put up with unpleasant side effects in return for anxiety relief?
  • What non-drug treatments for anxiety might help?
  • Do I have the time and am I willing to pursue non-drug treatments such as cognitive-behavioral therapy?
  • What self-help strategies might help me get my anxiety under control?
  • If I decide to take anxiety medication, should I pursue other therapy as well?

Questions to ask your doctor

  • How will the medication help my anxiety?
  • What are the drug’s common side effects?
  • Are there any food and drinks I will need to avoid?
  • How will this drug interact with my other prescriptions?
  • How long will I have to take the anxiety medication?
  • Will withdrawing from the medication be difficult?
  • Will my anxiety return when I stop taking the medication?

Medication alone is not enough

Remember, anxiety medications aren’t a cure. Medication may treat some symptoms of anxiety, but can’t change the underlying issues and situations in your life that are making you anxious. Anxiety medication won’t solve your problems if you’re anxious because of mounting bills, a tendency to jump to “worst-case scenarios”, or an unhealthy relationship. That’s where therapy and other lifestyle changes come in.

There are many treatment alternatives to medication, including cognitive-behavioral therapy, which is widely accepted to be more effective for anxiety than drugs. To overcome anxiety for good, you may also need to make major changes in your life. Lifestyle changes that can make a difference in anxiety levels include regular exercise, adequate sleep, and a healthy diet. Other effective treatments for anxiety include talk therapy, meditation, biofeedback, hypnosis, and acupuncture.

The advantage of non-drug treatments for anxiety is that they produce lasting changes and long-term relief. If your anxiety is so severe that it interferes with therapy, medication may be useful in the short-term to get your symptoms under control. Once your anxiety is at a manageable level, other forms of behavior and talk therapy can be successfully pursued.

Guidelines for taking anxiety medication

If you decide to take medication for your anxiety disorder, it is important to learn all you can about your prescription and to take it as directed. The more you know about your anxiety medication, the better equipped you’ll be to identify and deal with side effects, avoid dangerous drug interactions, and minimize other medication risks.

Some suggestions if you decide to take anxiety medication:

  • Be patient. It takes time for most anxiety medications to reach their full therapeutic effect. While you may want immediate relief, it’s important to have realistic expectations. You will need to work closely with your doctor to find the right dosage and evaluate the anxiety drug’s effectiveness.
  • Avoid alcohol. Alcohol and anxiety medications don’t mix. The combination can even be lethal. But even in less toxic doses, alcohol and anxiety medication can cause poor coordination and impaired thinking, increasing the risk of motor vehicle accidents and other injuries.
  • Monitor your medication response. Keep a close eye on your reaction to the anxiety medication, including any physical and emotional changes you’re experiencing. Everyone reacts differently to medications, so it’s impossible to predict what side effects you will have or how well your anxiety drug will work. If you’re taking benzodiazepines (Valium, Xanax, etc.), don’t drive or operate heavy machinery until you know how the drug affects you.
  • Talk to your doctor. Be open and honest about side effects your anxiety drug is causing. Don’t be afraid to discuss problems or concerns. And while you should never stop your anxiety medication without talking to your doctor first, ultimately the decision is up to you. If you’re unhappy with how the pills make you feel, ask your doctor to help you taper off.
  • Continue therapy. Medication can control the symptoms of anxiety, but it doesn’t treat the underlying problem. Therefore, it’s crucial to pursue therapy or some other form of anxiety treatment. Therapy can help you get to the root of your anxiety problem and develop better coping skills.

If you're taking a benzodiazepine

  • Make regular appointments with a psychiatrist who specializes in the treatment of anxiety disorders and who is up on the latest research on benzodiazepines and other anxiety medications and therapies.
  • DO NOT discontinue your medication without talking to your psychiatrist first. If you’ve been taking benzodiazepines for over a month, you should gradually reduce your dose under your doctor’s supervision.
  • Finding the right dosage is a trial and error process, but you should be concerned if it keeps increasing. If you need higher and higher doses to achieve the same effect, this is a sign of a developing drug dependency.

Anti-anxiety drug dependence and withdrawal

Anti-anxiety medications including popular benzodiazepines such as Xanax, Klonopin, Valium, and Ativan are meant for short-term use. However, many people take anti-anxiety drugs for long periods of time. This is risky because, when taken regularly, benzodiazepines quickly lead to physical dependence. Drug tolerance is also common, with increasingly larger doses needed to get the same anxiety relief as before. According to the American Academy of Family Physicians, benzodiazepines lose their therapeutic anti-anxiety effect after 4 to 6 months of regular use.

Most people become addicted to their anti-anxiety drug within a couple of months, but problems may arise sooner. For some, drug dependency develops after a few short weeks. Once you’re physically dependent on an anxiety medication, it’s difficult to stop taking it. The body is used to the medication, so withdrawal symptoms occur if the dose is decreased or discontinued.

Psychological dependence can be an issue, too. If you’ve been relying on an anti-anxiety drug to keep your anxiety in check, you may lose confidence in your own abilities to deal with life’s difficulties and start to think you “need” the medication to survive.

You may be dependent on benzodiazepines if:

  • You have taken benzodiazepines for four months or longer.
  • You rely on your pills to cope.
  • You have ever cut down or stopped taking your pills and have felt ill or anxious or experienced unusual symptoms.
  • You feel your pills are not having the same effect as when you first started taking them.
  • You take an extra pill during a stressful time.
  • You tried cutting down or stopped taking your pills and could not sleep a wink.
  • You have increased your dose.
  • You have increased your alcohol intake.
  • The benzodiazepines are interfering with your life in some way (sick days off work, family or relationship problems, difficulty coping, difficulty remembering things).
  • You always make sure you never run out of your pills.
  • You carry your pills with you “just in case.”

Source: Reconnexion Inc.

If you’re physically dependent on anti-anxiety medication and would like to quit, it’s important to do so under the guidance of a medical health professional. The key is to slowly decrease your dose over a period of time. If you abruptly stop taking your medication, you may experience severe withdrawal symptoms such as:

  • Increased anxiety
  • Insomnia
  • Confusion
  • Pounding heart
  • Sweating
  • Shaking

Gradually tapering off the drug will help minimize the withdrawal reaction. However, if you’ve taken anti-anxiety medication for a few months, you may still experience some withdrawal symptoms. Anxiety, insomnia, and depression may last for months after you’ve quit. Unfortunately, these persistent withdrawal symptoms are frequently mistaken for a return of the original problem, causing some people to restart the medication.

More help for anxiety medication

Types of anxiety disorders

Resources and references

Anti-anxiety drugs and their side effects

Benzodiazepines – Covers the short and long-term effects of the benzodiazepine medications for anxiety. (Center for Substance Abuse Research, University of Maryland)

Benzodiazepines: Side Effects, Abuse Risk and Alternatives – In-depth article, written for health care professionals, on the benefits and risks of benzodiazepines. (American Family Physician)

Toxicity and Adverse Consequences of Benzodiazepine Use – Looks at the drawbacks, including oversedation, impaired memory, and depression. (Benzodiazepine Addiction, Withdrawal & Recovery)

Benzodiazepines and Pregnancy (PDF) – A guide to the risks of taking benzodiazepines during pregnancy or while breastfeeding. (Organization of Teratology Information Specialists)

Taking anxiety medication

10 Rules for Safer Drug Use – Helpful tips for keeping safe while taking medication. Includes guidelines for tracking symptoms and avoiding drug interactions. (Public Citizen)

Guidelines for Medication Use – Offers advice to help you decide whether or not to take anxiety medication. (Anxieties.com)

Withdrawal from anti-anxiety medication

Benzodiazepine Blues: Living With (and Without) Minor Tranquilizers – Straightforward guide to benzodiazepines, including addiction and withdrawal. (Do It Now Foundation)

Benzodiazepines: How They Work and How to Withdraw – Comprehensive article on anxiety medication dependency and how to withdraw safely. (Benzodiazepine Addiction, Withdrawal & Recovery)

Other anxiety medications

Beta Blockers and Performance Anxiety in Musicians – Learn how beta blockers work for anxiety, what their side effects are, and how they affect performance. (Ethan Winer)

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: October 2014.