4 Common Types of Anxiety Medications Doctors Prescribe (and Their Side Effects)
One-third of adults may be suffering from mental health problems, like anxiety, right now. Here's how anxiety medication may help.
Understanding anxiety disorders
When you have anxiety, you might view the world through a negative lens. Worries are amplified and, in many ways, feel uncontrollable. Even when others might not fret about something, people with generalized anxiety disorder (GAD) may be worrying inside.
According to the Anxiety and Depression Association of America (ADAA), 6.8 million adults have GAD. But that was before Covid-19. The pandemic has caused a significant jump in adults struggling with mental health issues. As of early last summer, 31 percent of adults are now dealing with symptoms of anxiety and/or depression, according to the Centers for Disease Control and Prevention (CDC).
Other anxiety disorders include obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and phobias. There are plenty of treatment options that often include anxiety medication.
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Using medication to manage anxiety
There are lots of ways to manage anxiety, including cognitive behavioral therapy—which focuses on finding and changing negative thoughts—as well as mindfulness and stress management strategies.
Your doctor or psychiatrist may also recommend anxiety medication. Almost 12 percent of adults in the U.S. take prescription medication for “problems with emotions, nerves, or mental health,” according to a research letter published in JAMA Internal Medicine in 2017. Women are twice as likely as men to take these meds.
There are four different categories of anti-anxiety medicine: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and tricyclic antidepressants. These medications can also treat other conditions, like depression.
In addition, other medications are used off-label to treat anxiety. This means they are not approved by the Food and Drug Administration (FDA) to treat anxiety symptoms, but doctors may prescribe them anyway.
For example, beta-blockers, which are drugs used to treat high blood pressure and heart conditions, are sometimes prescribed to treat anxiety.
Beta-blockers, such as propranolol (Inderal) and atenolol (Tenormin), can block physical anxiety symptoms, such as a racing heart or sweating. They are sometimes prescribed to treat short-term symptoms due to stage fright or social anxiety.
Here are the four main categories of anti-anxiety medications:
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Lorazepam (Ativan)
How they work:
Benzodiazepines increase the level of the neurotransmitter GABA in the brain. GABA is an amino acid that has a calming effect. Benzodiazepines also can reduce muscular tension, which generally promotes relaxation. However, “benzos,” as they are known, can become addictive.
For that reason, these drugs are only short-term solutions, says Gallagher. Ideally, you’d work with a therapist or psychologist to develop skills and tools to manage your anxiety. If your anxiety symptoms are severe, your psychiatrist may prescribe a benzodiazepine for a month or two while you wait for your antidepressant to work, says Steven L. Dubovsky, MD, professor and chair in psychiatry at the University at Buffalo in Buffalo, New York. Benzodiazepines are often used for situational type anxiety, too. For example, dental anxiety before a procedure. The following anti-anxiety medications are long-term solutions.
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
How they work:
SSRIs work by preventing the mood-regulating hormone and neurotransmitter serotonin from being reabsorbed by the brain. That makes more serotonin available to the brain to help improve your mood.
“We know that SSRIs can be effective for the management of anxiety symptoms,” says Thea Gallagher, PsyD, an assistant professor with the Center for the Treatment and Study of Anxiety in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. Side effects include nausea, upset stomach, headaches, and trouble sleeping, she adds, though these issues should dissipate after a few weeks of using the drug. Still, it’s smart to work with your healthcare professional to monitor and learn how to effectively manage these side effects.
The right choice of SSRI differs among patients. “It’s trial and error,” says Gallagher. “Patients usually start off with something that is generally well-tolerated by a lot of people, like Prozac, Zoloft, or Lexapro.” If you experience significant side effects from one drug, talk to your doctor. A different SSRI or another class of anxiety medication may be better suited to you.
Also worth noting: Research, including a large review of studies published in 2017 in BMJ, shows that SSRIs may increase the risk of suicide in teens and young adults who take the drug. That risk is more likely at the beginning of treatment or as the dose is increased, notes the U.S. National Library of Medicine.
- Venlafaxine (Effexor XR)
- Duloxetine (Cymbalta)
How they work:
SNRIs work by preventing both serotonin and norepinephrine from being reabsorbed in the brain. This increases the amount of these substances in your brain to balance your mental state and focus. These drugs carry the same risk of suicide as SSRIs. Other possible side effects include drowsiness, dizziness, nausea, sexual dysfunction, and weight gain, according to a review of studies published in 2016 in Psychotherapy and Psychosomatics.
Venlafaxine is prescribed for GAD, social anxiety disorder, and panic disorder, and may take six to eight weeks to work. Duloxetine is prescribed for GAD, and can take one to four weeks to start to be effective.
- Amitriptyline (Elavil)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
How they work:
These are used to treat anxiety disorders, with the exception of social anxiety disorder, according to the ADAA. (They carry the same suicidal warning as SSRIs and SNRIs.) They work in a similar way as SNRIs, by increasing the amounts of serotonin and norepinephrine in the brain to balance your mood. However, SSRIs or SNRIs are now more commonly prescribed, as they come with fewer side effects. Common side effects include blurred vision, constipation, dry mouth, drowsiness, and dizziness.
Non-drug solutions for anxiety
Using a combination of medication and cognitive or stress-management strategies may help you get anxiety under control. Learning about your triggers can also help, says Gallagher.
Exposure therapy can also help. “Doing the things you are afraid to do—facing your fears—and learning to live with uncertainty,” are effective methods in treating anxiety, she says. (You don’t have to do this alone. You can do this with a therapist.)
Anxiety usually involves worrying about the future, but a professional can also help you lean into what you can control now, so you can let go of the anxiety of what might be.
Taking stock of how you can add things to your life that make you feel good, whether that’s spending time on a puzzle, knitting, or playing with your kids, and releasing the things that add stress (like getting absorbed in a constant negative news cycle), are also important to help you find balance in your mood, adds Gallagher.
What to ask your doctor before taking anxiety medication
If you have anxiety, “it’s a good idea to tell your doctor, because anxiety is treatable,” says Dr. Dubovsky. If your doctor recommends a medication, then ask the following questions, suggests the ADAA:
- Will this medication interact with any other medication, over-the-counter drug, or supplement I’m taking?
- What side effects can I expect and what should I do if I notice them?
- How should I take this medication (e.g. timing, with or without food)?
- How long will it take to start working?
Anxiety can be a chronic or acute problem. “Chronic anxiety often requires long-term treatment,” says Dr. Dubovsky. “Acute anxiety is a response to stress, and once that specific stress is over, then you may be able to stop the medication.”
Before you do that, however, talk to your doctor before stopping any medication. “Sometimes patients will say that they’re feeling better, but maybe the thing that was helping them was the medication,” says Gallagher.
If you or someone you know has had thoughts of self-harm or suicide, contact the National Suicide Prevention Lifeline (1-800-273-8255), which provides 24/7, free, confidential support for people in distress.
- Anxiety and Depression Association of America (ADAA): "Generalized Anxiety Disorder (GAD)"
- Anxiety and Depression Association of America: "Treating Anxiety Disorders"
- Centers for Disease Control and Prevention: "Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic – United States, June 24 – 30, 2020"
- Anxiety and Depression Association of America: "Medication"
- JAMA Internal Medicine: "Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race"
- Thea Gallagher, PsyD, assistant professor with the Center for the Treatment and Study of Anxiety in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia
- Steven L. Dubovsky, MD, professor and chair in psychiatry at the University at Buffalo in Buffalo, New York
- BMJ: "Antidepressants and murder: case not closed"
- U.S. National Library of Medicine: "Venlafaxine"
- U.S. National Library of Medicine: "Duloxetine"
- Psychotherapy and Psychosomatics, "The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature"
- National Institute on Drug Abuse: "Benzodiazepines and Opioids"
- Mental Health America: "Tricyclic Antidepressants (TCAS)"