Treatment for Anxiety: Medications and Options

Anxiety medications cannot cure anxiety. They can, however, help control symptoms and allow you to function better in your daily life.

These medications can be prescribed by a physician, typically through a psychiatrist, family physician, pediatrician or OB-GYN. Some states allow nurse practitioners to prescribe them, as well. Many of these medications are also used to treat depression.

Your primary care provider is a good starting place if you want help with anxiety and you’re considering anti-anxiety medications. Your primary care provider will be aware of your other medical conditions that may mimic or contribute to anxiety symptoms, such as sleep apnea, ADHD or hyperthyroidism, Taylor says. That provider can also refer you to mental health specialists as needed. For instance, some psychiatrists combine medications with psychotherapy, also known as talk therapy. That's because some patients find it more effective to use both types of therapy, while others will prefer one or the other.

Anxiety medications may be prescribed for short- or long-term relief. There are four common classifications, or types, of medication used to treat anxiety:

"Relatively acute or time-limited anxiety – for example, a fear of flying for someone who flies infrequently – are easily treated by benzodiazepines," says Dr. Michael Thase, professor of psychiatry and division chief of Mood and Anxiety Disorders Treatment and Research Program at the University of Pennsylvania. "More longstanding or recurrent anxiety disorders are better treated with antidepressants (SSRI/SNRI), though many doctors will prescribe a benzodiazepine at the beginning while the antidepressant is being initiated and the dose adjusted."

These medications are considered generally safe and effective, but mild to serious side effects can sometimes occur. It often takes time, patience and experimentation to find the drug that works best for you. "A lot of things can cause anxiety and depression, and some patients respond more to different meds," Ramsey says.

It's not uncommon for a person with anxiety to also have depressive symptoms. There are some estimates that 60% of people with anxiety also will have symptoms of depression.

SSRIs block the reabsorption of the neurotransmitter serotonin, a brain chemical that improves mood, to make serotonin more readily available to receptors in the brain. They're considered first-line therapies to treat anxiety and depression.

Commonly prescribed SSRIs include:

Commonly reported side effects may include:

Medications in the SNRI class increase levels of two neurotransmitters, serotonin and norepinephrine, to help restore balance in the brain. Physicians also prescribe these as a first-line of treatment for anxiety.

SNRI drugs include:

Side effects include:

This large class of drugs is used for short-term management of anxiety or as second-line therapies for treatment-resistant anxiety disorders.

Benzodiazepines have a variety of uses, including being the first-line treatment for seizures. Anesthesiologists will often give benzodiazepines prior to procedures to help relax patients as they go into surgery. Benzodiazepines can also be used for less involved procedures such as colonoscopies as an alternative to anesthesia in what is often referred to as "twilight anesthesia."

Benzodiazepines work through an internal "calming" process controlled by the neurotransmitter gamma-aminobutyric acid, or GABA, which helps inhibit or "turn off" brain activity and aids in sleep, muscle relaxation and calming the brain. "They can be remarkably and rapidly effective – within a few minutes or within an hour," Thase says.

Benzodiazepines include:

Possible side effects include:

These drugs should never be mixed with alcohol or opiates as this can significantly increase the risk of overdose, respiratory depression, coma and even death. Because of the risk for dependence, benzodiazepines are not safe for long-term use and should always be used under professional supervision. Long term use of benzodiazepines can also cause cognitive decline when taken for moderate-to-long periods of time, especially in elderly populations.

Tricyclic antidepressants are effective in treating certain types of anxiety disorders. However, they carry the risk of significant cardiac issues, such as long QT syndrome, a disorder of the heart's electrical system that can cause arrhythmias and can potentially lead to sudden fainting, seizures and death. They can also cause orthostatic hypotension (a drop in blood pressure on standing), constipation, urinary retention (difficulty emptying the bladder), dry mouth and blurry vision.

Tricyclic antidepressants include:

Because safer alternatives are available, tricyclic antidepressants are used less often.

Along with the four common drug classes, doctors may prescribe other medications to help treat anxiety. Some of these include:

Using a drug off-label means that a provider is prescribing it for a reason other than it's approved for by the FDA. Drugs used off-label haven't gone through the same clinical trials for a specific treatment. A health insurer may be less likely to cover a drug that's used off-label. However, many off-label drugs provide relief to patients. In fact, 1 in 5 medication prescriptions are for off-label use, according to the Agency for Healthcare Research and Quality.

Anxiety medications are safe and usually effective when used as prescribed, but they need monitoring by your physician.

Some anxiety medications such as benzodiazepines or beta blockers can start working within minutes-to-hours and are generally for momentary or short term use such as to help abort a panic attack, decrease stage fright in someone about to give a performance or to decrease anxiety during a flight for someone with a phobia of flying. Other medications such as SSRIs, SNRIs, Tricyclics, and MAOIs can take weeks or even months to help decrease anxiety, although they generally do not cause dependence and are often taken for months, years and even decades when necessary.

Contact your provider if you have any side effects, questions or concerns about your medications. Ask your provider if you can drink alcohol while using anxiety medications, as alcohol may worsen side effects with some types of drugs. Never stop taking medication without talking to your prescribing provider first. Stopping too quickly may cause withdrawal symptoms or other health risks, including thoughts of suicide. New data reveals the need to taper off these meds more slowly, Ramsey says.

Children are also sometimes prescribed anti-anxiety medication, usually along with psychotherapy. The only FDA approved medication for childhood anxiety disorders is Duloxetine (Cymbalta) which is FDA approved for children ages 7 and older. There are other similar medications that are often used “off-label” to treat childhood anxiety. Some of these medications have FDA approval for adult anxiety disorders (ages 18 and over) and even carry FDA approval for other conditions in childhood. Examples of these include: 

Other medications, such as Fluvoxamine/Luvox, Paroxetine/Paxil, Citalopram/Celexa, Venlafaxine ER/Effexor XR and Clomipramine/Anafranil (FDA approved for OCD in children ages 10 and older), are sometimes used off-label for childhood anxiety disorders as well. Benzodiazepines, beta-blockers and some other medications are also used for short-term treatment in some cases. Dosages depend on the age and weight of the child.

The American Academy of Child and Adolescent Psychology has a treatment guide for parents about childhood anxiety and includes information on medications.

Anxiety can be managed with lifestyle practices to help reduce symptoms.

These practices include:

Ultimately, a combination of both medication and lifestyle approaches is an effective way to treat anxiety. Speak with your health care provider about what options are right for you.

If you're in emotional distress due to anxiety or contemplating suicide, you can reach out to the Suicide and Crisis Lifeline by dialing or texting 988. Trained counselors are available to provide support and resources 24/7.

Four of the common types include:

If you have anxiety, keep in mind that there are many treatments to help. Using the available treatments can help you lead a happier, healthier life.