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Medical News Today: Everything you need to know about anxiety medications

The term anxiety encompasses feelings of worry, fear, and unease. Although it is normal to experience some level of anxiety at times, intense or persistent anxiety may be indicative of an anxiety disorder.

According to several large surveys, up to 33.7 percent of people experience some form of anxiety disorder during their lifetime.

Medications are available to treat anxiety disorders. Doctors may prescribe medication alone or in combination with cognitive behavioral therapy (CBT) or another kind of therapy.

In this article, we discuss the main types of anxiety medication and list their risks and side effects.

Types of anxiety medication

Several types of medication can treat the symptoms of anxiety. According to the Anxiety and Depression Association of America (ADAA), the four major classes of drugs for anxiety disorders are as follows:

1. Selective serotonin reuptake inhibitors

Pharmacist with medication in boxes
A doctor may prescribe medication to treat persistent anxiety.

Although selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant, doctors commonly prescribe them to people with anxiety and obsessive-compulsive disorder (OCD).

According to one article, doctors consider SSRIs to be the first-line drug treatment for anxiety.

SSRIs work by stopping nerve cells in the brain from reabsorbing serotonin, which is a chemical that plays a vital role in mood regulation.

Examples of SSRIs for anxiety include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil, Pexeva)
  • sertraline (Zoloft)

These medications typically begin to take effect within 2 to 6 weeks, but they do not work for everyone.

People usually take SSRIs for up to 12 months to treat anxiety, then gradually reduce the dosage. These drugs are not habit-forming, meaning that they do not lead to dependence.

2. Serotonin-norepinephrine reuptake inhibitors

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressant that treats depression and anxiety. Doctors may also prescribe them to treat some chronic pain conditions.

These medications work by reducing the brain’s reabsorption of the chemicals serotonin and norepinephrine.

Examples of SNRIs for anxiety are:

As with SSRIs, SNRIs can take several weeks to have an effect.

3. Tricyclic antidepressants

Tricyclic antidepressants (TCAs) are an older class of antidepressant drug. Although they may be effective for the treatment of depression and anxiety, doctors often prescribe SSRIs instead, as they cause fewer side effects.

However, TCAs may be useful for some people, especially if other medications do not provide relief.

Examples of TCAs for anxiety include:

  • amitriptyline (Elavil)
  • imipramine (Tofranil)
  • nortriptyline (Pamelor)

4. Benzodiazepines

Benzodiazepines are a type of sedative drug that reduces the physical symptoms of anxiety, such as tense muscles. These drugs also encourage relaxation, and their effects take place within a few minutes.

Benzodiazepines include:

  • alprazolam (Xanax)
  • chlordiazepoxide (Librium)
  • diazepam (Valium)
  • lorazepam (Ativan)

Although they are highly effective for short-term issues, doctors rarely prescribe benzodiazepines because they become less effective over time and can be addictive.

Due to these risks, experts suggest that doctors do not prescribe the continuous use of benzodiazepines for more than 1 month.

Some people may take benzodiazepines to manage short-term anxiety. For example, people with a fear of flying may take them before a flight.

At times, people may take a benzodiazepine alongside an SSRI for a few weeks until the SSRI takes effect.

Other medications for anxiety

Many other medicines may help treat anxiety, although doctors usually only prescribe them if SSRIs or similar drugs do not work.

Other medications for anxiety include:

Beta-blockers

Beta-blockers are a common medication for people with high blood pressure and heart conditions. However, doctors may prescribe them off-label for anxiety in certain situations.

Beta-blockers reduce the effects of norepinephrine, meaning that they can relieve some of the physical symptoms of anxiety. Examples of beta-blockers include atenolol (Tenormin) and propranolol (Inderal).

Buspirone

This anti-anxiety medication may treat short- or long-term anxiety symptoms.

Buspirone (BuSpar) works much more slowly than benzodiazepines and may not treat all types of anxiety disorder, but it causes fewer side effects and has a lower risk of dependency.

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) are one of the earliest types of antidepressant. Doctors may prescribe them off-label to treat the symptoms of panic disorder and social phobia. Types of MAOI include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Emsam)
  • tranylcypromine (Parnate)

Side effects

Woman with headache and dizziness holding side of head in pain
SSRIs may cause dizziness and headaches.

Antidepressants and other drugs for anxiety have the potential to cause side effects in some people.

These often resolve after a few weeks, but it is crucial to see a doctor if they are intolerable or do not subside.

Some doctors may recommend taking anxiety medications with food to minimize side effects, or taking them before bed, as long as the drug does not interfere with sleep.

The side effects that a person experiences may vary depending on the type of medication.

SSRIs

The side effects of SSRIs can include:

SNRIs

The side effects of SNRIs are similar to those of SSRIs and include:

  • constipation
  • dizziness
  • drowsiness or fatigue
  • dry mouth
  • headaches
  • increased blood pressure
  • weight gain
  • loss of appetite
  • nausea
  • sexual problems or erectile dysfunction
  • sleep problems
  • sweating more than usual
  • an upset stomach

TCAs

Side effects vary among TCAs, as they work in different ways. Possible side effects include:

  • blurry vision
  • constipation
  • difficulty urinating
  • dry mouth
  • drowsiness
  • increase in appetite
  • lightheadedness
  • low blood pressure after standing up
  • sexual problems or erectile dysfunction
  • sweating more than usual
  • tremors
  • weight loss or gain

Benzodiazepines

These medications can cause several side effects, such as:

  • blurry vision
  • confusion
  • dizziness
  • drowsiness or fatigue
  • headaches
  • loss of memory or concentration
  • problems with balance, coordination, or speech
  • an upset stomach

Benzodiazepines also carry certain risks. For example, they can cause physical dependence, even after a short period of use. Withdrawal from benzodiazepines may lead to:

  • anxiety and restlessness
  • depression
  • sleep problems
  • sweating
  • seizures

More severe risks of benzodiazepines may include:

  • addiction
  • cognitive decline
  • hip fractures
  • motor vehicle accidents, as they can affect a person’s ability to drive
  • overdose, especially in combination with opioid drugs or alcohol

Beta-blockers

Possible side effects of beta-blockers include:

  • cold hands and feet
  • depression
  • extreme tiredness
  • low blood pressure
  • shortness of breath
  • sleep problems
  • weight gain

People with asthma should avoid beta-blockers. People with diabetes should take them with caution and speak to a doctor about the possible risks.

Buspirone

The side effects of buspirone may include:

  • blurry vision
  • diarrhea
  • dizziness
  • drowsiness
  • dry mouth
  • fatigue
  • headaches
  • muscle pains
  • nausea
  • poor concentration
  • restlessness or nervousness
  • sleep problems
  • sweating
  • weakness

MAOIs

Potential side effects of MAOIs include:

  • constipation
  • diarrhea
  • difficulty urinating
  • dizziness
  • drowsiness
  • dry mouth
  • headaches
  • low blood pressure
  • nausea
  • sexual dysfunction
  • sleep problems
  • sweating
  • weight gain

These medications also interact with several other drugs as well as some foods and drinks. Anyone taking MAOIs should ask their doctor for a complete list of the medicines, foods, and drinks that they need to avoid.

Suicide risk and antidepressants

Young man in therapy session speaking to counselor during psychotherapy
Anyone experiencing suicidal thoughts should speak to a doctor or therapist.

The United States Food and Drug Administration (FDA) require all antidepressants to carry a black-box warning relating to the risk of suicide in children and young adults.

People under 25 years of age may experience an increase in suicidal thoughts and behaviors while taking antidepressants, particularly within the first few weeks of use.

The National Suicide Prevention Lifeline is 1-800-273-TALK (8255), and it is available 24 hours a day, 7 days a week.

When to see a doctor

Anyone experiencing symptoms of an anxiety disorder should see their doctor, who can recommend therapy, medications, or a combination of both.

To diagnose an anxiety disorder, doctors will typically carry out a physical examination to check for any underlying conditions and ask a person about their symptoms.

They may also perform a psychological evaluation and compare the person’s symptoms to the American Psychiatric Association’s criteria for anxiety disorders.

Takeaway

Anxiety is a common condition that affects many people during their lifetime. Several types of medication can treat anxiety, especially in combination with therapy.

People who have an anxiety disorder should work with their doctor to find the right treatment plan for their needs. If a person notices any side effects from their medication, they should speak to a doctor or pharmacist.

To alleviate side effects, a doctor may adjust the dosage slowly or recommend another medication or form of therapy.

It is essential never to stop taking medication without medical supervision as it may cause withdrawal symptoms.