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Drugs & Medications for Anxiety – The Anxiety Guide

Micah Abraham, BSc
Drugs & Medications for Anxiety – The Anxiety Guide

For those that struggle with anxiety, there is something inherently disturbing about the idea of taking medicine. The idea of taking a medicine that is going to affect how your brain thinks and works is a scary thought – it almost sounds like taking a medicine will make you someone else.

You shouldn’t be afraid of anxiety medication. Those that struggle  with severe anxiety find that it can help you receive some much needed  relief from your anxiety symptoms.

But you also shouldn’t depend on your anxiety medication. Anxiety  medications only work when you take them, and someday, you want to be  able to stop taking anxiety drugs without your anxiety coming back.  Think of anxiety medications as more of a tool to help you control your  anxiety while you treat it.

Anxiety Medications: Where Are We Now?

There are hundreds of anxiety medications available. Some are mild.  Others are strong. Some may be for those with Panic Disorder. Others may  be better for those with Generalized Anxiety Disorder or OCD. Some may  interact with medications. Others are relatively safe for most  medicines. Some are taken daily at the same time, and others are taken  only when you need them.

That is a lot to consider. But first, let’s look at the benefits and weaknesses of anxiety drugs:

Potential Advantages

Potential Disadvantages

Some also may not work, because your own anxiety may have different  causes or different needs. For example, some people respond well to  anxiety medicines that affect serotonin levels, others respond better to  medications that affect GABA levels. That means the first medicine you  take may not work, even though an effective medicine is available.

With this in mind, medications shouldn’t be a first choice, but they  also shouldn’t be a last resort. They should be something you consider  along with all other treatment options. Be open minded, but don’t depend  on the treatment either.

Types of Anxiety Drugs

Anxiety drugs generally fall into one of the following categories:

There is often going to be trial and error when determining the one  that is best for you. Below is a breakdown of the types of medications  available, along with information about their effects and usage  patterns.

Type 1: Antidepressants

Contrary to popular belief, not all antidepressants were specifically  designed to treat depression. Many were found to treat anxiety over the  course of their antidepressant testing, and because many of those that  suffer from anxiety also have depression (and vice-versa), these  medications may benefit both.

There are many different types of antidepressants, which we will describe below:

Serotonin Selective Reuptake Inhibitors (SSRIs)

Examples:

A brain chemical (neurotransmitter) known as serotonin has a powerful  effect on mood. SSRIs work by preventing the brain from absorbing  serotonin after your body has already used it. The effect of this is  that serotonin starts to build up in your brain, causing more of it,  which in turn helps improve your mood and decreases your anxiety.

Side effects of this type of medication differ, but may include  nausea, vomiting, reduced sex drive, sexual dysfunction, insomnia, and  digestive issues. Talk to your doctor about specific risks with each  medication.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Examples:

Similar to SSRIs, SNRIs prevent the synapses in the brain from  absorbing two different neurotransmitters – serotonin and  norepinephrine. This differs from SSRIs, which only prevent the reuptake  of serotonin.

Their success is similar to SSRIs, and so are their side effects. But  some people with anxiety find that their bodies require norepinephrine  to combat anxiety, while others do not. One of the few differences is  that SNRIs may also increase anxiety as well as a side effect in some  patients, which is why most psychiatrists recommend SSRIs first.

Tricyclic Antidepressants (TCAs)

Examples:

TCAs are also similar to SSRIs and SNRIs. Tricyclic Antidepressants  increase serotonin and norepinephrine, like SNRIs, but also decrease  another neurotransmitter known as acetylcholine, which in high levels  was found to contribute to both anxiety and depression in studies in  mice.

TCAs may be more powerful for severe anxiety and depression, but they  also tend to have more side effects. They have fallen out of favor with  psychiatrists and are less likely to be used unless anxiety has not  responded to treatment.

Side effects include dry mouth, blurred vision, constipation, weight  gain, sexual dysfunction, drowsiness, and low blood pressure. Overdose  can be fatal.

Monoamine Oxidase Inhibitors (MAOIs)

Examples:

MAOIs differs from SSRIs, SNRIs, and TCAs. MAOIs inhibit the  production of monoamine oxidase, which is the enzyme responsible for  breaking down serotonin, epinephrine, and dopamine. With less enzyme to  break those neurotransmitters down, you end up having more in your  system, which ultimately means an improved mood.

These have also fallen out of favor in recent years, because  monoamine oxidase is needed to break down other chemicals, and that may  cause more side effects, interact with more medications, and possibly  lead to other concerns.

Possible side effects include initial worsening of anxiety, weight  gain, sexual dysfunction, edema, light-headedness and assorted  neurological symptoms. Using these drugs may imply dietary restrictions  and bears risk of toxicity. Overdose can be fatal.

Atypical Antidepressants

Examples:

Atypical antidepressants are drugs that do not fit into the typical  antidepressant categories above. Each one may affect the body in  different ways. Bupropion inhibits reuptake of dopamine, serotonin, and  norepinephrine. Trazodone is a serotonin antagonist and reuptake  inhibitor, which is similar to an SSRI but also blocks their uptake from  other receptors.

Every atypical antidepressant tends to work in different ways. It’s  not always clear if they help those with anxiety. Your psychiatrist may  determine whether to use an atypical antidepressant depending on other  symptoms. For example, those with severe insomnia and anxiety may be  recommended Trazodone, which also doubles as a sleeping pill.

Side effects are based on the type of drug.

Type 2: Benzodiazepines

Examples:

Perhaps the most commonly prescribed anxiety-only medications are  benzodiazepines. There are dozens of these anxiety drugs available, but  most work a similar way – by enhancing the effects of GABA, a  neurotransmitter that relaxes the body.

Compared to anti-depressants, benzodiazepines have both advantages  and disadvantages. The advantages are that they’re designed specifically  for controlling the symptoms of anxiety. They generally provide a  sedation effect, which ensures that your body responds more calmly to  stressors.

They can also be adjusted fairly easily, and are generally well  tolerated - although some minor gastrointestinal side effects are fairly  common.

Disadvantages are that they cannot be taken daily. Benzos are  generally used as a short term anxiety drug, because it’s possible to  develop tolerance, which decreases how effective they are in the long  term. They may be also addictive when used on a daily basis. Daily use  may also increase their toxicity.

Side effects are largely mild, and are more common with long term  use. Some of the possible side effects of benzodiazepines include:

Benzodiazepines are also not ideal for some types of anxiety, and  they often interact with drugs and alcohol that can be dangerous. They  can be misused as well, so those that have addiction problems may want  to avoid these anxiety drugs.

Note: Given the way they contrast each other, antidepressants and benzodiazepines are often prescribed together.

Type 3: Beta Blockers

Examples:

Beta blockers are most commonly used for heart attack patients. They  block specific receptor sites inside the body responsible for initiating  the fight or flight response. For heart attack patients, this ensures  that nothing speeds up the heart more than it can handle.

But the fight or flight response is also responsible for anxiety, and  so these anxiety drugs may also be used off label for certain types of  anxiety disorders – most commonly social anxiety disorder and panic  disorder. It is technically not approved by the FDA, but studies have  shown it to be effective. Some surgeons use beta blockers to reduce  anxiety during a major operation, for example.

Beta blockers are not meant to be taken every day. Side effects  include nausea, dizziness, hair loss, insomnia/sleepiness, sexual  dysfunction, and shortness of breath. In some, beta blockers may  actually increase anxious thoughts, although symptoms may be more  tolerable.

Type 4: Tranquilizers

Examples:

The only mild tranquilizer used for anxiety at the moment is buspirone.

Buspar is a very mild tranquilizer that decreases dopamine and  increases serotonin. This improves mood while slightly decreasing the  amount of energy the body can release. Despite the term “tranquilizer,”  Buspirone is considered very mild – so mild, that those with severe  anxiety generally report no real benefits.

But for those with mild to moderate anxiety that want to start with a  slow, gentle anxiolytic, buspirone may be a good choice, as the anxiety  drug is not addictive, can be used every day, and comes with fairly  mild side effects such as dizziness, blurred vision, and temporary  restlessness. It is not meant for short term relief, as buspirone may  take several weeks to work.

Type 5: Anticonvulsants

Examples:

If “anticonvulsant” sounds familiar, it is because these drugs are  used to control seizures. But do not let that scare you. These drugs  control seizures by preventing the brain from releasing large quantities  of neurotransmitters at once, and altering GABA production. Both of  which appear to improve anxiety levels.

They are non addictive, may improve sleep, and have been shown to  have a positive effect on anxiety disorders. They are similar to  benzodiazepines but with less risk of addiction, and many psychiatrists  are starting to recommend them in place of benzos.

However, they are not right for everyone and should not be used  without a recommendation by your doctor, who will need to choose a safe  dose. Side effects include dizziness, sleepiness, blurred vision,  changes in sexual desire, constipation, and euphoria.

Type 6: Other - Not Otherwise Specified

Anxiety conditions may respond to treatments that do not fit into the  above categories. For example, Prazosin, a drug that is meant for high  blood pressure and nighttime urination, also seems to block adrenaline  without many side effects, making it an intriguing choice for PTSD.

Several drugs over the past decade that have been prescribed for  anxiety and anxiety disorders have no connection to anxiety or mental  health at all, but studies have shown positive benefits for those with  anxiety. Thus, it is possible that the drug prescribed to you may not be  listed as an anxiety drugs.

Type 7: Natural Anxiety Drugs and Side Effect Free Anxiety Treatments

Many of those with anxiety look for so called “natural” anxiety drugs or natural herbal treatments. Examples include:

Given all the possible side effects of anxiety, it is easy to see why  most people would want to try a side effect free treatment first. Some,  like Kava, actually do have research supporting the idea that it may  reduce anxiety when used in the right doses, and it may be something you  will want to consider.

BUT WORD OF CAUTION: One of the things that herbal supplement  marketing companies do not tell you is that many of the side effects of  anxiety medications are because the medication is working.

For example, most of the gastrointestinal issues caused by SSRIs are  because there are also serotonin receptors in the stomach. Creating more  serotonin in the body can help boost mood, but it may also stimulate  receptors in the stomach, causing you to feel nausea or stomach  discomfort.

The reason that most herbal and natural medications cause no side effect is because many, in all likelihood, don’t do anything.  It is currently impossible to increase serotonin in the brain without  increasing serotonin elsewhere, and if you increase serotonin elsewhere,  you may feel sick. Anxiety medication side effects are a result of them  working, not because they are chemicals.

There are promising herbal supplements for anxiety, like kava, and  promising nutritional supplements, like magnesium. But be careful about  trusting supplements simply because they say they work and are side  effect free. Most do nothing at all, or at best do very, very little.

Anxiety Drugs By Disorder

Every anxiety disorder responds differently to each medication. That  means that your doctor may recommend a different medication depending on  the type of anxiety. The following is a list of the most likely  recommended medications for each condition, but always talk to your  doctor and determine the one that is best for your symptoms.

Generalized Anxiety Disorder Medications

Most of the medications above may be recommended for GAD: All  Benzodiazepines, all SSRIs, Buspirone, all SNRIs, and some  anticonvulsants. Some of the most commonly prescribed generalized  anxiety disorder medicines include:

Panic Disorder Medications

Common panic attack and panic disorder medications include:

Common social anxiety disorder medications include:

Obsessive Compulsive Disorder (OCD) Medications

Common obsessive compulsive disorder (OCD) medications include:

Post Traumatic Stress Disorder (PTSD) Medications:

Common post-traumatic stress disorder (PTSD) medications include:

The Benefits and Dangers of Anti-Anxiety Drugs

Anxiety is a complex disorder, and may respond to anxiety drugs in  different ways. There is no perfect anti-anxiety drug, as many create  side effects or cause dependency in a way that make them less than idea  for regular use, and not everyone benefits from the same drug or dose.  Trial and error is involved.

In addition, anxiety medications only work while you’re taking them.  You still need to combine the drugs with therapy, lifestyle changes,  self-help techniques, and more, even when you do not have anxiety. That  way, someday, you can stop taking the medications and start living  anxiety free.

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