Medications for Anxiety:

Understanding anxiety medication

Is medication helpful for anxiety disorders? Many different types of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs, antidepressants, and beta-blockers. These medications can be effective in controlling and alleviating the symptoms of anxiety. However, anxiety medication should not be thought of as a cure. While various prescription medications may provide temporary relief from anxiety, they don’t treat the underlying cause of the anxiety disorder. As a result, relapse rates are high when drug treatment is stopped.

Anxiety medications may also cause unpleasant and unwanted side effects. According to the Anxiety Disorders Association of America, the most commonly reported side effects of anxiety medications are headaches, nausea, stomach upset, dizziness, and sexual dysfunction. Anxiety medications can also be habit forming, and long-term use can make withdrawal difficult. It’s important to be aware of these drawbacks when considering drug treatment for anxiety. While anxiety medication can be helpful to some people, there is no magic pill.

An in-depth look of the major anxiety medications and how they are used to treat specific disorders is provided by clinical psychologist Reid Wilson at Common Medications for Anxiety Disorders. For an overview of the types of drugs used to treat anxiety, including their generic and brand names, the disorders they target, and how they are believed to work, take a look at the Medication Chart from the Anxiety Disorders Association of America.

Risks of anxiety medication

What are the risks involved with anxiety medication? As mentioned above, the medications prescribed for anxiety disorders come with their own risks and disadvantages. The biggest risks involve adverse effects, dependence, and withdrawal. Special warnings should also be considered.

Adverse Effects

All drugs, from over-the-counter cold medicine to prescription medications, have side effects. The medications used in the treatment of anxiety are no exception. The side effect profiles are different for each medication. It is important to learn about the common side effects of the anxiety medication you are considering. However, everyone reacts differently to drug treatment and so it is impossible to predict what side effects you will experience. Adverse reactions can range from mild nuisances such as tremors or dry mouth to severe nausea or considerable weight gain that you aren’t willing to tolerate. For any anxiety medication, you will have to weigh the side effects against the benefits.

Visit Adverse Drug Reactions for an overview of the hazards of prescription drugs and precautions for use. For more information about the side effects and health hazards of benzodiazepines and the antidepressants known as SSRIs—both of which are commonly prescribed for anxiety—read Psychology Today’s Sedative-Hypnotics and Coping with Side Effects of Antidepressants.

Dependence and Withdrawal

Drug dependence can be an issue with anxiety medication. The benzodiazepines (common brand names include Xanax, Klonopin, and Valium) in particular are extremely addictive with prolonged use. Within just a few weeks, tolerance to the drugs can develop. The result is that higher dosages are needed to get the same relief as before. As dependence on the anxiety medication increases, it becomes difficult to stop taking it.

Withdrawal is another problem with benzodiazepines. If you abruptly stop taking your medication, you may experience severe withdrawal symptoms such as agitation, insomnia, and rebound anxiety. For a complete look at benzodiazepine withdrawal and how to taper off the medication after long-term use, visit Benzodiazepines: How They Work and How to Withdraw.  

Withdrawal is also an issue with SSRIs such as Paxil, Prozac, and Zoloft. If discontinued too quickly, you may suffer from symptoms such as dizziness, nausea, fatigue, and memory problems. Severe anxiety and depression are also common withdrawal symptoms. Unfortunately, these symptoms are often mistaken for a return of the original problem and medication is restarted. Read Getting Off Antidepressants: Antidepressant Discontinuation Syndrome for more details about SSRI withdrawal symptoms and how to successfully go off the medication.

Non-drug treatment alternatives

What are the treatment alternatives to medication for anxiety? There are many treatment alternatives to medication, including cognitive-behavioral therapy, which is widely accepted to be the most effective treatment for anxiety. Lifestyle changes such as regular exercise, getting adequate sleep, and a healthy diet can also make a difference in your anxiety levels. Other effective treatments for anxiety include talk therapy, group therapy, meditation, biofeedback, hypnosis, and acupuncture. The advantage of non-drug treatments for anxiety is that they produce lasting changes and long-term relief. To learn more about the non-drug therapies for anxiety, visit Helpguide's Anxiety Attacks and Disorders: Symptoms, Types, and Treatment.

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.

The anxiety drug decision

How do I decide whether anxiety medication is right for me? When looking into drug treatment for anxiety, there are many important factors to consider. Here are some questions that should help you make your decision:

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 and meditation?
• What self-help strategies might help me get my anxiety under control?
• If I decide to take medication, should I pursue other anxiety therapy as well?

Questions to ask your doctor

• How will the medication help my anxiety?
• What are the 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 medication?
• Will withdrawing from the medication be difficult?
• Will my anxiety return when I stop taking the medication?

Medication guidelines

What guidelines should I follow if I decide to take anxiety medication? If you decide to take medication for your anxiety disorder, educating yourself about your drug is essential. The more you know about the anxiety medication you are taking, the better equipped you’ll be to identify side effects and avoid dangerous drug interactions. Open communication with your doctor is also important. For tips on what to discuss with your doctor and pharmacist, see How to Talk About Your Medications. Read 10 Rules for Safer Drug Use for a comprehensive guide to keeping safe while using anxiety medication. The article includes a Drug Worksheet (PDF) that you can use to keep track of how to take your medication, problems to watch out for, and new side effects you’re experiencing.

Here are some other suggestions to keep in mind when taking 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 during the early weeks following the start of drug therapy. It takes some time to adjust the dosage and to evaluate the medication’s effectiveness.  
• Monitor carefully – You and your doctor (and your spouse, family, or caregiver) should carefully monitor your reaction to your anxiety medication. As previously mentioned, every medication has side effects and every person reacts differently. Keep track of any physical and emotional changes you’re experiencing and don’t be afraid to talk to your physician about discontinuing the medication if you are unhappy with how it makes you feel.  
• Continue therapy – Medication can control the symptoms of anxiety, but it doesn’t treat the underlying problem. Therefore, it’s crucial to pursue therapy with a mental health professional. Through therapy you can work on the issues that are causing the disorder and develop coping skills.

Types of anxiety medications

What types of medications are prescribed for anxiety disorders? There are three classes of drugs commonly prescribed for the treatment of anxiety.

• Anti-anxiety medications – Benzodiazepines and azapirones are mild tranquilizers used to treat the symptoms of anxiety and panic.
• Antidepressants – Many medications originally approved for the treatment of depression have been found to relieve symptoms of anxiety. These include certain SSRIs, tricyclic antidepressants, MAOIs, and the newer atypical antidepressants.
• Beta blockers – Beta blockers control physical symptoms of anxiety such as rapid heart rate, trembling voice, and shaky hands.  

Traditional anti-anxiety drugs

How do anti-anxiety medications work and what are the side effects?

Benzodiazepines – Benzodiazepines are fast-acting sedatives which work by slowing down the Central Nervous System. They typically relieve anxiety symptoms within 30 minutes to an hour. The rapid relief benzodiazepines provide makes them very effective when taken during a panic attack or another overwhelming anxiety episode. However, benzodiazepines are highly addictive. If taken regularly for more than a couple of weeks, physical and psychological addiction is likely to occur. Benzodiazepine tolerance is also common, with larger doses needed to achieve the same effect. Because of this drug dependency risk, the benzodiazepines are usually recommended only for short-term use. It can also be difficult to stop taking benzodiazepines. Serious withdrawal symptoms can occur when going off the medication, including increased anxiety, depression, and insomnia. To minimize the withdrawal reaction, it is important to slowly taper off your medication.

BENZODIAZEPINES
Generic and Brand Drug Names
Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium)	Flurazepam (Dalmane) Lorazepam (Ativan) Oxazepam (Serax) Temazepam (Restoril) Triazolam (Halcion)
Most Common Side Effects
Drowsiness Impaired coordination Fatigue Confusion and disorientation Dizziness	Decreased concentration Short-term memory problems Dry mouth Blurred vision Pounding or irregular heart beat
Other precautions & warnings
Because of their addictive potential, benzodiazepines are usually prescribed only for short periods of time. When going off benzodiazepines, it is important to gradually reduce the dosage amount to prevent withdrawal symptoms.
For further information
About Benzodiazepines Benzodiazepines: How They Work and How to Withdraw Facts About Benzodiazepines

Azapirones – Azapirones are a newer type of anti-anxiety drug prescribed for generalized anxiety disorder (GAD) and obsessive compulsive disorder (OCD). Compared to benzodiazepines, the azapirones are slow acting, taking from two to four weeks to provide anxiety symptom relief. However, they have several advantages over the benzodiazepines. The azapirones are not as sedating as benzodiazepines, they don’t impair memory and coordination, they aren’t as addictive, and withdrawal effects are minimal. Currently, buspirone is the only azapirone approved for medical use.

AZAPIRONES
Generic and Brand Drug Names
Buspirone (BuSpar)
Most Common Side Effects
Nausea Headaches Dizziness Drowsiness	Upset stomach Constipation Diarrhea Dry mouth
Other precautions & warnings
You should not take azapirones and MAO inhibitors at the same time, as combined use may cause an increase in blood pressure.
For further information
Buspirone - Medline Plus Buspirone - Psychiatric Medications Pharmacology

Antidepressants for anxiety

How do antidepressants work for anxiety and what are the side effects? Many antidepressants can be used in the treatment of anxiety. However, antidepressants take up to 4 to 6 weeks to begin relieving symptoms, so they aren’t helpful if first taken during a panic attack. Antidepressants are often prescribed instead of benzodiazepines because the risk for dependency and abuse is smaller. But antidepressants come with risks of their own. 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.

SSRIs (selective serotonin reuptake inhibitors) – SSRIs act on a chemical in the brain called serotonin. The SSRIs have been used to treat panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). They are often prescribed because they have less severe side effects than the older antidepressants. Common side effects are nausea, nervousness, headaches, sleepiness, and sexual dysfunction. The SSRIs can also cause serious withdrawal symptoms, including flu-like symptoms, severe depression and anxiety, balance problems, and sleep disturbances.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Generic and Brand Drug Names
Fluoxetine (Prozac) Fluvoxamine (Luvox) Sertraline (Zoloft)	Paroxetine (Paxil) Escitalopram (Lexapro) Citalopram (Celexa)
Most Common Side Effects
Nausea Insomnia Headaches Decreased sex drive Dizziness Weight gain or weight loss	Nervousness and tremors Sweating Drowsiness or fatigue Dry mouth Diarrhea or constipation Skin rashes
Other precautions & warnings
SSRIs can cause an increase in suicidal thoughts and behaviors. SSRIs also carry a risk for increased hostility, agitation, and anxiety. SSRIs should not be taken at the same time as MAOIs. Taking an SSRI within two weeks of an MAOI can cause a fatal reaction.
For further information
Medications for Treating Depression - Making Informed Choices SSRIs – Harvard Medical School Getting Off Antidepressants: Antidepressant Discontinuation Syndrome

Tricyclic antidepressants – Tricyclics are older antidepressants that may be prescribed for panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). Tricyclics can also be prescribed for anxiety disorders co-occurring with depression. The tricyclics typically take around two weeks to provide symptom relief. The tricyclicis have many side effects, including weight gain and drowsiness. Drowsiness is particularly common in the first few weeks after starting the medication. The tricyclics can cause many withdrawal symptoms when discontinued abruptly.

TRICYCLIC ANTIDEPRESSANTS
Generic and Brand Drug Names
Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin or Pertofrane) Doxepin (Sinequan or Adapin) Imipramine (Tofranil)	Maprotiline (Ludiomil) Nortriptyline (Pamelor or Aventyl) Protriptyline (Vivactil) Trimipramine (Surmontil)
Most Common Side Effects
Dry mouth Blurred vision Constipation Difficulty urinating Increased heart rate	Loss of sex drive and erectile failure Increased sensitivity to the sun Weight gain Drowsiness Dizziness and nausea
For further information
Tricyclic Antidepressants

MAOIs (Monoamine oxidase inhibitors) – The oldest of the antidepressants, MAOIs are sometimes prescribed for people with panic disorder and social phobia. Common side effects of MAOIs include weight gain, dizziness, drowsiness, and loss of sex drive. MAOIs also have severe interactions with certain foods, drinks, and medications. If you choose to take an MAOI, you will have to carefully monitor what you eat and what drugs you take. Items that are restricted include many cheeses, chocolate, wine, and beer. If you have previously taken an SSRI, you should wait at least five weeks before taking an MAOI. Combining SSRIs and MAOIs can lead to a life-threatening condition called serotonin syndrome.

MONOAMINE OXIDASE INHIBITORS (MAOIs)
Generic and Brand Drug Names
Phenelzine (Nardil) Tranylcypromine (Parnate)	Isocarboxazid (Marplan) Selegiline (Eldepryl)
Most Common Side Effects
Lightheadedness upon standing Dizziness Insomnia Weight gain	Headaches Insomnia Sexual problems such as impotence Sleepiness
Other precautions & warnings
When taking an MAOI, you must follow strict dietary restrictions, avoiding all foods and drinks containing tyramine. Combining MAO inhibitors with foods or drinks containing tyramine can cause dangerously high blood pressure, which can lead to a stroke or heart attack.
For further information
Monoamine oxidase inhibitors MAOIs and Diet: Restricting tyramine prevents serious side effect

Atypical antidepressants – There are several newer atypical antidepressants which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephine and dopamine. Effexor, Remeron, Cymbalta, and Desyrel are atypical antidepressants which can be used to treat anxiety problems. Drowsiness, weight gain, and dizziness are common side effects.

ATYPICAL ANTIDEPRESSANTS
Generic and Brand Drug Names
Duloxetine (Cymbalta) Mirtazapine (Remeron)	Trazodone (Desyrel) Venlafaxine (Effexor)
Most Common Side Effects
Nausea Nervousness Sexual dysfunction Dry mouth	Fatigue Sleepiness Weight gain Blurred vision
For further information
Atypical antidepressants

Beta-blockers for anxiety

How do beta blockers work for anxiety and what are the side effects? Beta blockers are type of drug 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. They can be used to alleviate the physiological symptoms of anxiety, including heart palpitations, sweating, dizziness, and tremors. Because they don’t affect the emotional symptoms of anxiety such as worry, beta blockers are most helpful for phobias, particularly social phobia and performance anxiety. If you are anticipating an anxiety-producing situation (such as giving a speech), taking a beta blocker in advance can help reduce your body’s anxiety response.

BETA BLOCKERS
Visit Psychiatric Medications Patient Information Sheets for further details about specific anxiety drugs, including side effects, special warnings, recommended dosages, and food and drug interactions.
Generic and Brand Drug Names
Propranolol (Inderal)	Atenolol (Tenormin)
Most Common Side Effects
Light-headedness Sleepiness Short-term memory loss Unusually slow pulse	Fatigue Insomnia Diarrhea Cold hands and feet
For further information
Beta blockers for Anxiety Beta blockers - Mayo Clinic

Related links for anxiety medications

Anxiety Medications and Side Effects

PDR Family Guide to Prescription Drugs – Browse through an alphabetical database of prescription drug information from the Physicians’ Desk Reference. The easy-to-read fact sheets include the latest updates from the FDA and photos of the pills. (PDRhealth- Thompson Healthcare)

The Medications – Find descriptions of the commonly-prescribed psychiatric medications, including specific warnings and precautions, adverse reactions to look out for, and potential drug interactions. (WhatMeds.com)

Anxiety Medication Profiles – Review the possible benefits and disadvantages of the various anxiety medications, as well as side effects and recommended dosages. (Anxiety Disorders Treatment Center)

Anxiety Medication Drawbacks and Precautions

When Antidepressants and Anti-Anxiety Drugs Don't Work – This section of a larger article describes some of the problems with medication for anxiety and depression. Learn how to proceed when your drug doesn’t seem to be working. (HealthyPlace.com)

Misprescribing and Overprescribing of Drugs – Article from Public Citizen describes the evidence and causes of overprescribing in the U.S. Learn the “seven all-to-deadly sins” of prescribing. (Public Citizen - WorstPills.org)

Anxiety Medication and Children

Anxiety Medication and Kids (Anxiety Disorders Association of America)

Delving Deeper into Anxiety Medication

Psychiatric Medications Pharmacology – Find in-depth profiles of the various psychiatric medications, including specific anti-anxiety drugs and antidepressants. Learn about indications and usage, adverse reactions, overdosage, and brand names both in and outside the U.S. (HealthyPlace)

Melinda Smith created this article with contributions from Robert Segal, M.A., and Jeanne Segal, Ph.D. Last modified on: 10/16/06.