A Guide to Anti-Anxiety Medications and What They’re Used For

Author:

Emma Loker

B.S

Editor:

Ashley Pena

LCSW

Everyone feels anxious sometimes. Commonly, these feelings of uncertainty and worry are tied to events, such as job interviews, exams, family matters – the list goes on. Typically, feeling anxious because of an uncomfortable situation is short-lived and doesn’t affect day-to-day life.

However, other times, anxiety can be more general, like a state of nervousness without an identifiable cause. Life can be full of challenges and surprises, so in an anxious state, you might find yourself going over all sorts of scenarios in your head, even preparing yourself for the worst outcome.

When anxiety affects us intensely, it can be hard to “switch off”, affecting sleep, relationships, and the ability to function, as it continues throughout daily life. Physical symptoms may also occur, like a racing heart, sweating, shakes, and sometimes even panic attacks.

It can be distressing to live with an anxiety disorder, and equally so to see a loved one struggle. Even though you may feel alone, rest assured that anxiety is very common. In fact, the World Health Organisation (WHO) states that anxiety disorders are the world’s most common mental health disorders, affecting 301 million people worldwide in 2019.¹ Fortunately, anxiety is treatable. A mental health provider can discuss the best treatment for your needs, and, sometimes, this might include medications such as anxiolytics. This article takes you through what anti-anxiety medications are, step by step, helping you better understand if they’re the right fit for you. It covers:

What anti-anxiety medications are and the main types
How anti-anxiety medications work, and for how long
Comparing SSRIs and benzodiazepines for anxiety
Anxiety meds for generalised anxiety disorder and panic attacks
Common anti-anxiety medication side effects and the effects of long-term use
How to stop anti-anxiety medications safely
Where to find professional guidance for anxiety treatment

What Are Anti-Anxiety Medications?

If you or a loved one finds that anxiety is significantly affecting your quality of life, anti-anxiety medications could be an effective treatment option. This is especially the case when medications are used alongside other interventions such as talking therapy – which will be discussed later.

You may be wondering how anti-anxiety medications work. This varies depending on the type of medication, but generally, they help regulate chemicals in the brain that control mood, and in doing so, relieve symptoms of anxiety and achieve a more manageable, calm state. The following information discusses each type of anti-anxiety medication and how they work to improve anxiety symptoms.

What Are the Main Types of Medications Used to Treat Anxiety?

There are many different types of medications available for treating anxiety. We have simplified the treatments into categories below, giving you key information about how each works.

Antidepressants as an Anti-Anxiety Medication

1. SSRIs (Selective Serotonin Reuptake Inhibitors)

To understand how SSRIs work, it’s good to know what serotonin is. Serotonin is often called the “happy chemical.” This is because, when it’s released in the brain, it provides feelings of well-being, calmness, and happiness. It’s broken down as part of the body’s natural processes, so when this happens, the amount available in the brain lowers. This can cause people to feel low, sad, and tired.

In short, SSRIs prevent serotonin reuptake or absorption so that less is broken down and higher levels remain in the brain for longer. With this knowledge, it’s no surprise that SSRIs are a first-line antidepressant for people with depression and are considered one of the best medications for anxiety.

Examples of SSRIs include fluoxetine (Prozac), sertraline (Lustral), citalopram (Cipramil), escitalopram (Cipralex), paroxetine (Seroxat), and fluvoxamine (Faverin).

2. SNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors)

SNRIs work similarly to SSRIs, with the addition of increasing norepinephrine levels in the brain. Norepinephrine is a chemical associated with the body’s stress response, known as “fight or flight.” This is a state of high alertness when someone is presented with a threat. In appropriate situations, fight or flight can be useful as it encourages quick reactions in moments of danger. However, those with anxiety may experience it in situations where there isn’t any threat to their safety.

The fight or flight response presents the physical symptoms of anxiety, which usually involve a noticeably faster heart rate, shortness of breath, sweating, trembling, and muscle tension. SNRIs help reduce these symptoms by blocking the absorption of serotonin and norepinephrine. Commonly prescribed SNRIs include venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine.

3. TCAs (Tricyclic Antidepressants)

TCAs are shown to be as effective as SSRIs. They also work similarly, as they have an effect on serotonin levels. TCAs are approved by the FDA for depression, but are sometimes prescribed “off-label” for anxiety. This simply means it’s been started by a healthcare professional for a condition outside the FDA-approved list, but without compromise to patient safety.³However, TCAs are not usually prescribed first line as they have a greater chance of undesirable effects and a higher risk of overdose. For this reason, a provider will likely try other medication pathways first.

More common examples of TCAs include amitriptyline (Elavil/Vanatrip), imipramine (Tofranil), nortriptyline (Aventyl/Pamelor), bupropion (Wellbutrin), and trazodone (Desyrel).

Anxiolytics as an Anti-Anxiety Medication

1. Benzodiazepines

Benzodiazepines enhance a chemical released in the brain called “GABA” (gamma-aminobutyric acid). GABA reduces the excitability of the neurons in the brain. Therefore, to put it simply, benzodiazepines help calm and slow down the nervous system. This is why they’re known as sedatives; they make you feel relaxed and sleepy, reducing anxiety and relaxing muscles.

Benzodiazepines offer more rapid relief than other treatments and are known as one of the fastest-acting anxiety medications available. Examples of benzodiazepines include diazepam (Valium), lorazepam (Ativan) alprazolam (Xanax), and chlordiazepoxide (Librium).

It’s worth noting that benzodiazepines are intended to be a short-term solution only, as there are concerns regarding their addictive properties and side effects, which we’ll discuss in more depth later.

2. Buspirone (BuSpar)

Buspirone has an effect on serotonin – the “happy chemical” we mentioned earlier – and has been approved by the FDA for short-term relief of anxiety symptoms.

Typically, it is used second line, after someone has been treated with an SSRI and found it didn’t work for them or couldn’t tolerate the side effects (which will be discussed later).² Studies have shown reduced side effects compared to other anxiolytic treatments, so buspirone has been more favourably prescribed over recent years.⁴

Other Medications Used as Anti-Anxiety Drugs

Aside from the categories of medications already mentioned, the following are also sometimes used as anxiolytics.

1. Antihistamines – Hydroxyzine (Atarax / Vistaril)

You may recognise antihistamines as they’re traditionally used to treat hayfever, but some second-generation antihistamines have proven useful for anxiety symptoms. For instance, the FDA has approved hydroxyzine for anxiety. Additionally, a review of 39 different studies showed that hydroxyzine was comparable in effectiveness to benzodiazepines and buspirone.⁵

2. Antipsychotics – Quetiapine (Seroquel)

Quetiapine is usually prescribed for schizophrenia, but in smaller doses, it has been shown to have some effectiveness in the management of anxiety. It takes less time to work than other antidepressants, but due to adverse effects, it isn’t approved by the FDA for anxiety. Instead, it is sometimes used off-label for this use. ⁶

3. Pregabalin (Lyrica)

Primarily used for nerve pain and epilepsy, pregabalin is also used off-label for anxiety. Studies have shown its effectiveness in reducing the physical and psychological symptoms of anxiety. There is also evidence that pregabalin is useful as a second-line treatment for those who tried SSRIs or SNRIs and found them ineffective. However, pregabalin comes with its downsides as there is an associated potential for tolerance, addiction, abuse, and more severe symptoms when it is discontinued.⁷

4. Propranolol (Inderal)

Propranolol is known as a beta blocker, and it’s mainly used to treat heart and blood pressure-related conditions. However, it’s proven to be particularly effective in reducing the physical symptoms of anxiety we mentioned earlier. For example, it’s not uncommon for public speakers and singers to use propranolol for “stage fright,” but research on propranolol as a long-term solution is limited.⁸

What Are Common Side Effects of Anti-Anxiety Medications?

As with all medications, anti-anxiety medications do come with risks of side effects. Not everyone will experience these, and they should fade after an initial adjustment period. However, each medication tends to be tolerated differently, so the following information discusses the most common risks associated with each.

SSRIs and SNRIs: Common side effects include agitation, nausea, indigestion, diarrhea or constipation, loss of appetite, dizziness, insomnia or drowsiness, headaches, reduced libido, and erectile issues. These side effects usually improve within a few weeks but may occasionally persist.
Tricyclic Antidepressants (TCAs): Common side effects include dry mouth, blurred vision, constipation, difficulty urinating, drowsiness, dizziness, weight gain, excessive sweating, and heart rhythm issues. These side effects typically ease after a couple of weeks. ¹⁰
Benzodiazepines: Common side effects of diazepam, affecting more than 1 in 100 people, include drowsiness, confusion, coordination issues, and shaky hands (tremors).¹¹

If these side effects persist, there are ways to manage them, such as adjusting the dosage or switching to another medication. For this reason, it’s important to speak to your provider about your concerns.

What Are the Effects of Long-Term Use of Anxiety Meds?

The first-line treatment options, including SSRIs and SNRIs, are well tolerated. This means they come with fewer side effects and less risk of long-term effects. For this reason, they are considered among the safest anxiety medications.

Benzodiazepines, on the other hand, increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fractures in older adults. The risk of benzodiazepine overdose is particularly high when combined with sedative drugs such as opioids or alcohol. For these reasons, if used, benzodiazepines generally should not be prescribed continuously for more than one month.¹²

Your provider will continuously monitor your emotional and physical reactions to medication throughout treatment, but if any concerning symptoms arise, it’s important to communicate this immediately.

Stopping Anti-Anxiety Meds Safely

Stopping anti-anxiety medications safely typically follows one approach: slowly and under professional guidance. The following information covers the best techniques for stopping different types of medications, but consulting your healthcare provider is always advised.
Safely Discontinuing Antidepressants:

When considering stopping antidepressant medication, it’s crucial to consult your doctor beforehand. Suddenly stopping can lead to withdrawal symptoms, so a gradual reduction in dosage is recommended – usually over weeks or months, depending on the person’s needs.

Common antidepressant withdrawal symptoms include restlessness, insomnia, dizziness, sweating, gastrointestinal issues, sensations akin to electric shocks in the head, and mood changes such as irritability or anxiety. These symptoms usually appear within five days of reducing the medication and may last one to two weeks; however, some people may experience prolonged effects.¹³
Safely Stopping Benzodiazepines:

When discontinuing benzodiazepines, it’s crucial to consult a healthcare professional beforehand. Stopping suddenly can lead to withdrawal symptoms, such as anxiety, insomnia, muscle tension, headaches, and in rare cases, seizures.

To minimize these effects, a gradual tapering process is recommended, typically reducing the dose by 5–10% every 1–2 weeks. This approach helps the body adjust and reduces the risk of severe withdrawal symptoms. Withdrawal symptoms usually begin within a few days of dose reduction and can last from a few weeks to several months. In some cases, symptoms may persist longer, but with proper medical guidance and support, most people can safely discontinue benzodiazepines.¹⁴

Frequently Asked Questions About Anti-Anxiety Medications

While this article covered the different medications used for anxiety and their effects in depth, the following commonly asked questions may help shed light on any remaining queries you might have.

Which Is Better? SSRIs vs Benzodiazepines for Anxiety

The best anxiety medication for you comes down to your symptoms and needs. However, to help you understand SSRIs vs benzodiazepines for anxiety, we’ll begin by comparing how long these meds take to work. Benzodiazepines reach their max effect rapidly, but these effects level off after about 4 weeks of regular treatment. SSRI treatment, on the other hand, takes about 4-8 weeks to achieve maximum benefit), but can be used effectively for long-term treatment.

Adverse effects should also be weighed up between the two. Long-term use of benzodiazepines needs some consideration, as they have been shown to lead to cognitive impairments and an increased likelihood of developing dementia over time.⁹ The potential for addiction to benzodiazepines is also important. In summary, research has shown both of these options to be effective in managing anxiety. The time they take to work, their side effects, and long-term effects are all considerations that should help inform the decisions of the prescriber and the person requiring treatment.

What Are the Best Anti-Anxiety Medications for Panic Attacks?

Panic attacks are characterised by a sudden wave of fear or discomfort or a sense of losing control, even when there is no clear danger or trigger. They often include physical symptoms that might feel like a heart attack, such as trembling, tingling, or rapid heart rate. SSRIs and SNRIs are used as a long-term preventative treatment for panic attacks, and benzodiazepines are recommended for treating panic attacks as and when they occur.

Mission Connection: Supporting Mental Health Care and Medication

Managing anxiety can be challenging, as two people can respond differently to the same medication. Mission Connection is dedicated to ensuring that the process of navigating anxiety is as smooth as possible. Our team offers comprehensive medication monitoring alongside various treatments and therapies, enhancing your chances for successful and sustained recovery.

Medication alone may not address the root causes of mental health issues – alternatives to anxiety meds are available. Additionally, combining medication with therapy options, holistic approaches, and lifestyle changes can increase its benefits and improve your outcomes.

Recognizing that life doesn’t pause while you’re focusing on your mental health, Mission Connection provides online telehealth services to accommodate your schedule. This flexibility allows you to receive care that fits seamlessly into your daily routine.

If you’re ready to explore our treatment options or have questions about medication, our team is here to assist you. Contact us today or complete our confidential contact form for more information.

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