Health Education

Anxiety medication and treatments

Avatar By | September 18, 2019
Medically reviewed by Gerardo Sison, Pharm.D.

What is anxiety? | Anxiety diagnosis | Anxiety treatment options | Anxiety medications | Off-label drugs for anxiety | Best anxiety medications | Side effects of anxiety medication | Living with anxiety | FAQ | Resources

What is anxiety?

Anxiety is a feeling that everyone experiences sometimes; it’s a natural part of being human. But when this worry and fear is persistent and begins to interfere with your day to day life, you could be experiencing an anxiety disorder.

Anxiety disorders are the most common mental health disorders in America, affecting 40 million adults in the United States each year according to the Anxiety and Depression Association of America. You’re far from alone if you’re constantly feeling anxious.

There are several types of anxiety disorders, including:

  • generalized anxiety disorder,
  • panic disorder, as well as
  • various phobia-related disorders.

Fortunately, they are all highly treatable. Some common and effective treatment options include therapy, anxiety medication, and lifestyle changes.

How is anxiety diagnosed?

The cause of anxiety disorders is often a combination of factors, rather than a single element. Some factors that could trigger this type of mental illness include:

  • Family history. Some people may have a genetic predisposition towards anxiety. However, it’s important to note that having a family member with an anxiety disorder or other mental illness does not automatically mean you’ll get it.
  • Stressful events. This can include a job change, death or loss of a loved one, changes in living arrangements, or relationship issues.
  • Personality traits. Studies suggest that children who are perfectionists or like to control situations, are more likely to develop anxiety disorders as adults.
  • Physical health problems, such as thyroid disease. Too much thyroid hormone can cause an increased heart rate and palpitations which are symptoms linked to anxiety. Conditions like hypertension, diabetes, and asthma are also associated with anxiety.
  • Preexisting mental health conditions, like depression. Symptoms of depression are similar to those of anxiety and can often occur hand in hand.
  • Drug and alcohol use. Caffeine, amphetamines, and cocaine can cause anxiety symptoms. Withdrawal from drugs and alcohol can also cause irritability and anxiety.

Some symptoms of anxiety disorders that may help your doctor diagnose the condition include:

  • Restlessness, nervousness, and excessive fear or worry
  • Tightening of the chest and racing heart
  • Persistent, irrational thoughts
  • Trouble concentrating
  • Avoiding things that trigger your anxiety

You can use these symptoms as a guide, but you’ll need to see a doctor for diagnosis.

If you think you may be experiencing an anxiety disorder, speak with your primary care doctor. They’ll be able to check if there are any underlying illnesses that may be contributing to your feelings and refer you to a mental health specialist if necessary.

Medical professionals that specialize in mental health and anxiety disorders are psychiatrists, which are medically trained doctors, and psychologists.

As medically trained doctors, psychiatrists can prescribe medications as part of treatment. Psychologists, on the other hand, focus primarily on treating emotional and mental conditions through psychotherapy and behavioral intervention.

Some questions you may want to ask your doctor about your condition include:

  • Do I have an anxiety disorder? If so, which type?
  • Is my anxiety treatable? What are my treatment options?
  • Will anxiety medication help?
  • Do I need any tests?

If you’re experiencing intense anxiety, it may help ease your stress to prepare for some of the questions your primary care doctor, psychiatrist, psychologist or mental health professional may ask you in order to confirm a diagnosis and develop a treatment plan. There is no lab test to diagnose anxiety, so answering these questions openly and honestly is essential to getting the best anxiety treatment.

Here are some example questions your physician may ask:

  • Do you take any prescription drugs?
  • What are your symptoms?
  • Are your feelings of anxiety occasional or continuous?
  • Does anything in particular trigger your anxiety?
  • When did you first notice signs of anxiety?
  • Do you regularly take drugs and/or alcohol?
  • Have you ever experienced a panic attack?

Anxiety treatment options

There are various treatment options for anxiety disorders that can help you get back to enjoying life. The two most common treatments are:

  • psychotherapy
  • anxiety medications

Many patients experience great results using a combination of the two. Your doctor may also recommend lifestyle changes, such as reducing alcohol consumption, dietary changes, physical exercise, and meditation.

A popular type of psychotherapy, otherwise known as talk therapy, is cognitive behavioral therapy (CBT). It teaches patients skills to change negative thoughts and behavioral patterns. These techniques can also help treat and prevent panic attacks.

The type of medication prescribed depends on the type of anxiety disorder you have. These medications can include antidepressants, anti-anxiety medications like Buspar (buspirone), and beta-blockers. Beta blockers can provide rapid relief of the physical symptoms of panic attacks, such as rapid heartbeat and sweaty palms.

Anxiety medications

There are numerous types of medications that can treat anxiety disorders. Your doctor will recommend which type is best for you based on your medical history, any current medications you’re taking, and the specific type of anxiety disorder you’re experiencing.

These are some of the most common classes of drugs your doctor may prescribe.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant medications, and are often used to treat anxiety symptoms. They work by increasing levels of serotonin (a neurotransmitter) in the brain, which helps regulate your mood, sleep, and energy levels.

Popular brand names of SSRIs are Lexapro (escitalopram), Zoloft (sertraline), Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram). They are longer term anxiety solutions.

Bear in mind, SSRIs may take four to six weeks to reach full effect, and side effects can include drowsiness, nausea, insomnia, erectile dysfunction, and dizziness.

Serotonin-norepinephrine reuptake inhibitors (SNRI)

Like SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing neurotransmitter levels in the brain. They do this by blocking the reabsorption of two neurotransmitters, serotonin and norepinephrine. The resulting increased levels of serotonin and norepinephrine help regulate patients’ moods, which is how they treat symptoms of both depression and anxiety.

Commonly prescribed SNRI’s are Effexor (venlafaxine) and Pristiq (desvenlafaxine). Few people report side effects when using these medications. Possible side effects can include dizziness, headache, dry mouth, insomnia, constipation, and erectile dysfunction.

Tricyclic antidepressants

Tricyclic antidepressants are another class of antidepressants that physicians sometimes prescribe to treat the symptoms of anxiety disorders. Much like SSRIs and SNRIs, they work by rebalancing the levels of neurotransmitters in the brain. Popular brand names include Tofranil (imipramine), and Vivactil (protriptyline).

Some disadvantages of taking tricyclic antidepressants is their delayed onset—they can take 4-12 weeks to take effect. Like some other antidepressants, side effects can include dizziness, dry mouth, constipation, insomnia, and rapid weight gain.

Tricyclic antidepressants also have some antihistamine activity similar to other prescribed antihistamines (such as hydroxyzine). This activity can be useful for its sedative effects.

Benzodiazepines

Benzodiazepines are a group of medications commonly prescribed for their anti-anxiety and tranquilizing effects. They induce a state of relaxation by influencing the gamma-aminobutyric acid (GABA) receptors of the brain, resulting in the slowing of the central nervous system.

Because of their fast acting and sedative effects, benzodiazepines are prescribed for insomnia and muscle spasm, as well as panic attacks and anxiety.

Like all medications, you should only take them as prescribed by your doctor. This is especially important with benzodiazepines, as the dosage can vary significantly between individuals. They can be taken once per day, multiple times per day or on an as-needed basis, and are often initially prescribed in small doses that are increased gradually as needed.

Because they work to slow down a patient’s central nervous system, the most common side effect of this class of drug is drowsiness and impaired coordination. They work best as short term solutions to anxiety as they can be addictive. If you decide to stop taking benzodiazepines, speak with your doctor first as there is a risk of withdrawal symptoms.

It’s important never to mix benzodiazepines with alcohol, as it can cause a lethal drug interaction.

The most common benzodiazepines include Xanax (alprazolam), Librium (chlordiazepoxide), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam).

What about off-label medications?

If one of the more popular anti-anxiety medications above does not work to ease your symptoms, your doctor may recommend an off-label medication to treat your anxiety. Off-label means prescribing the medication for your anxiety, even though the drug is officially approved for another condition.

These are some of the more common off-label medications your doctor may prescribe:

Beta-Blockers

Most often used to treat high blood pressure, beta-blockers like Inderal (propranolol), can be used to treat the physical symptoms of acute anxiety, such as rapid heart rate and tightness of the chest.

However they will not improve the emotional factors of anxiety, such as worry or fear.

Because they only treat physical symptoms of anxiety and panic attacks, beta-blockers are often prescribed for event-triggered anxiety like stage fright or social anxiety disorders.

Buspirone (Buspar)

Buspar is an anti-anxiety medication prescribed in tablets of 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg, most commonly used for generalized anxiety disorder (GAD).

It helps alleviate anxiety by regulating serotonin and dopamine receptors in the brain.

Buspirone is not commonly prescribed as a first-line treatment. Instead, it’s more commonly used in conjunction with selective serotonin reuptake inhibitors, or when other medications have not been effective or trigger too many side effects.

Monoamine oxidase inhibitors (MAOIs)

The first antidepressant available, monoamine oxidase inhibitors (MAOIs), are no longer considered a first-line treatment for depression and anxiety. However if other options have not been effective, they are a second-line option.

Like most antidepressants, MAOIs work by balancing brain neurotransmitters, thereby improving mood levels. One reason other antidepressants are more popular is because, when combined with certain foods and medications, MAOIs can cause dangerously high blood pressure. That said, they can still be very effective for some people.

What is the best medication for anxiety?

In order to figure out which medication is going to best treat your anxiety and alleviate symptoms, you must speak with your doctor.

The best anxiety medication and treatment depends on a number of factors, including what is causing the anxiety disorder. Your doctor will recommend a prescription based on your medical history, taking into account any other medications or conditions you may have. They’ll also be able to monitor your progress and alter treatment according to your response.

Here is a comparison of the most commonly prescribed anxiety medications:

Brand name Drug class Administration route Standard dosage How it works Common side effects
Zoloft (sertraline) SSRI Oral tablet or liquid solution 50 mg tablet in the morning or evening Increases serotonin in the brain Drowsiness, nausea, dry mouth, erectile dysfunction
Prozac (fluoxetine) SSRI Oral capsule, tablet, or liquid solution 20 mg capsule in the morning Increases serotonin in the brain Drowsiness, nausea, dry mouth, erectile dysfunction
Lexapro (escitalopram) SSRI Oral tablet or liquid solution 10 mg tablet in the morning or evening Increases serotonin in the brain Drowsiness, nausea, dry mouth, erectile dysfunction
Paxil (paroxetine) SSRI Oral tablet 20 mg tablet in the morning Increases serotonin in the brain Drowsiness, nausea, dry mouth, erectile dysfunction
Cymbalta (duloxetine) SNRI Oral capsule 60 mg capsule once or twice a day Increases the neurotransmitters, serotonin and norepinephrine, in the brain Dizziness,

headache, constipation

Tofranil (imipramine) Tricyclic Antidepressant Oral tablet 25 mg tablet up to four times a day Rebalance neurotransmitters in the brain Dizziness, dry mouth, constipation
Xanax (alprazolam) Benzodiazepines Oral tablet 0.25 to 0.5 mg tablet given three times a day Slow down the central nervous system Drowsiness, impaired coordination
Valium (diazepam) Benzodiazepines Oral tablet 2 to 10 mg tablet given two to four times a day Slow down the central nervous system Drowsiness, impaired coordination

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight.

Other possible side effects exist. This is not a complete list.

Common side effects of anxiety medication

As with most medications, the drugs most commonly prescribed for anxiety disorders have a risk of some side effects. These can include:

  • Drowsiness
  • Fatigue
  • Headaches
  • Loss of appetite
  • Weight gain
  • Impaired coordination
  • Dry mouth

This, of course, is not a full list of side effects of all medications your doctor may prescribe. For more specific information, talk with you doctor who can advise you on any potential adverse reactions or drug interactions.

How can I treat anxiety naturally?

If you’d like to complement your treatment with natural options, your doctor may suggest some other strategies. Some natural remedies patients may find effective include:

  • Meditation and mindfulness practices
  • Physical exercise
  • Hypnosis
  • Dietary changes, such as increasing the amount of fresh fruit and vegetables
  • Reducing alcohol and illicit drug consumption
  • Vitamins and supplements, such as magnesium
  • Acupuncture

Before starting any natural treatment or trying home remedies for anxiety, be sure to speak with your doctor and get their professional medical advice.

Frequently asked questions about anxiety

Which SSRI is best for anxiety?

Given the many contributors to anxiety disorders, and your own personal medical history and lifestyle, only a doctor can determine which SSRI is best for you. Your physician can make a recommendation based on your particular type of anxiety, symptoms, and any other health concerns you may have, as well as monitor your progress and response to treatment.

Some popular SSRI medications are Zoloft, Prozac, and Lexapro.

How do antidepressants help anxiety?

Antidepressants work by preventing the brain from absorbing serotonin and norepinephrine, both of which are neurotransmitters. This allows their levels to increase and stabilize. When the levels of serotonin and norepinephrine are balanced, it stabilizes a person’s mood, decreases anxiety, and impacts overall well-being.

What over-the-counter medicine can you take for anxiety?

There are no recommended over-the-counter (non-prescription) drug treatments available for anxiety disorders. Your doctor, however, may recommend some specific vitamins or supplements to complement your treatment.

What does it feel like to be on anti-anxiety medications? 

Some anti-anxiety medications work within 30 minutes, others take days to build up in your system and become effective. Once working, patients often feel a physical sense of relief and decrease in worry and stress—they’re back to their ‘normal’ selves. That said, how it feels is different for each individual.

It’s not uncommon to feel some side effects, such as headaches, nausea, and fatigue in the first few weeks of taking anti-anxiety medications. However many patients find they eventually subside. If you think you’re experiencing any side effects, tell your doctor immediately.

Does anxiety medication cause weight loss?      

There are some reports that anxiety medication causes weight loss, while other reports claim weight gain. At this stage, more research is required to understand exactly how anxiety drugs affect a patient’s weight.

Related resources for anxiety