The Guide to Medications for Anxiety: Everything You Should Know
Prescription medications for anxiety have been the first-line treatment among physicians and psychiatrists for anxiety and panic attacks.
From the early Barbiturates to the Benzodiazepines and SSRIs used today.
Anxiety medications and antidepressants have consistently been among the most prescribed medications in the United States since their introduction.
The modern age of pharmaceutical anxiety treatment arguably began with the rise of Valium in the 1960s and 1970s and it's successor, Xanax, in the 1980s and beyond.
Both still remain among the most prescribed medications in the world today.
In the late 1980s and throughout the 1990s the “breakthrough” SSRI drug fluoxetine – otherwise known as Prozac – was a top medication of choice for anxiety and depression, and remains so.
After Prozac, other SSRIs became available, like Paxil and Zoloft (which is currently the most prescribed “psychiatric medication” in the United States).
Many of the adverse effects of these medications were known early on.
Over the past two decades, there has been a significant increase in awareness and research into the possible adverse effects of these medications.
Many people who have taken these medications for anxiety, have reported some degree of relief from anxiety and panic attacks.
Others claim these drugs were life-changing or even life-saving.
For those who have experienced the darker side of these medications – side effects, physical dependence, withdrawals and rebound anxiety- these drugs can be a nightmare.
If you are hoping to find the answers to our life’s problems in the form of a pill you will likely be disappointed.
However, these medications may provide the necessary relief you need and allow you to better manage your anxiety.
It is important to keep in mind, these drugs aren’t for everyone or needed by everyone.
The potential risks and disadvantages should be weighed in proportion to the supposed benefits.
There are many safer alternatives to prescription medications. This website is dedicated to providing those very alternatives. But for some, an anxiety medication may be an integral part of overcoming anxiety, panic and fear.
This is especially true if you are dealing with deep-seated trauma, depression, severe panic, intense reoccurring fear, or OCD.
You may be able to better manage many of these associated issues with the assistance of medication.
In this article, we will provide a comprehensive overview of medications for anxiety.
We will neither demonize nor blindly praise these drugs – but will instead provide information – and let you decide if these medications could be an option for you.
We will also be answering many of the most common questions about anxiety medications:
- Are these medications actually effective for anxiety?
- How do they work?
- What are the different types of anxiety medications?
- What questions should I ask my doctor before taking these meds?
- What are the potential risks involved with specific medications?
- Do the benefits outweigh the potential risks?
- Are there safer, effective alternatives to these drugs?
- How do I know if I need a medication for my anxiety?
If you have any other questions this article doesn’t answer – please leave a comment below and we’ll do our best to answer it for you.
So let’s dive in!
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The information provided in this article should not be used as medical advice. We have attempted to provide a comprehensive and honest overview of medications for anxiety but in no way is this meant to be taken as advice for medical treatment. Always discuss treatment options with a licensed healthcare professional. Never start or stop a medication without the advice and support of your doctor. If something in this article brings up a question or concern you may have about a medication discuss it with your doctor. This article is for informational purposes only.
How Anxiety Medications Work: The Truth
When anxiety and panic attacks get to the point where we think we may need medication – our first approach is typically to talk with our primary care physician.
Family physicians are the leading prescribers of anxiety medications.
In most cases, our doctor will recommend an antidepressant and go on to explain how we may have a chemical imbalance in the brain or how these medications help to increase serotonin.
While antidepressants can help some people feel calmer and reduce anxiety symptoms, the explanation on how antidepressants work isn’t exactly the truth – for one major reason – no one knows with 100% certainty exactly how antidepressants work to reduce anxiety, depression and panic attacks.
In fact, the whole “chemical imbalance” theory is just that – a theory. It’s a hypothesis based on studies and experiments but has never been truly confirmed.
In fact, there is little evidence that medications for anxiety are addressing any distinct underlying biological disorder at all!
There is also a different theory on how antidepressants work – that is changing the overall understanding of how these drugs benefit those who take them.
This theory states that antidepressant medications increase flexibility in the brain (through “remodeling” the neurons in the brain) so the brain can respond in new ways.
The alternative to antidepressants is typically a class of drugs known as Benzodiazepines.
If we are seeing a psychiatrist or have tried antidepressants without benefit, our primary physician may prescribe Benzodiazepines.
Benzodiazepines are much better understood than antidepressants for anxiety but carry significantly more risk for tolerance and addiction.
Whereas antidepressants are often prescribed and taken for longer periods of time (months or even years) – Benzodiazepines (like Xanax) are generally prescribed for much shorter periods of time.
As a whole; the medical and scientific community does not completely understand how any of these medications work for anxiety (or depression). This is why you will often see “The exact mechanism of action is unknown” within medical/scientific research for almost every anxiety medication.
Although we do not truly understand how these medications work – that’s not saying they are ineffective or we should avoid ever taking them. In fact, they can be highly effective for some of us (taking in to account possible side effects and other issues).
While understanding exactly how these drugs work is unnecessary to benefit from them, we should be aware that they may not be working for the reasons that we think they are.
Just because a medication seems to have worked for us doesn't mean it was because it corrected a chemical imbalance.
With that being said all the information provided represents how these medications are believed to work to the best of our understanding at this point in time.
Medications For Anxiety
There are several classes of anxiety medications that we will discuss in this article.
Antidepressants: which include SSRIs, SNRIs, Tricyclics and MAOIs
Benzodiazepines: drugs such as Xanax and Valium
Buspirone: similar to SSRIs but in a class of its own
Beta Blockers: drugs that reduce physical anxiety symptoms
Sedatives, Hypnotics and Z-Drugs: which are generally prescribed for insomnia related to anxiety, stress or trauma
We purposefully left out drugs that have an “off-label” use for anxiety (such as Gabapentin).
In other words; medications that were designed to treat a specific medical condition but have the potential for anxiety-reducing effects in certain people.
Beta Blockers would be considered off-label anxiety medications but we included them because they are commonly prescribed for physical anxiety symptoms.
We also left out medications that are rarely prescribed anymore – such as Barbiturates.
Antidepressants are typically a physician's first-line choice for patients with moderate to severe anxiety, panic attacks, OCD and/or depression.
They are arguably the most effective medications for anxiety over the long term, with the least risk of addiction.
Antidepressants are the second most prescribed class of prescription medications in the United States – accounting for hundreds of millions of prescriptions filled every year.
According to the CDC, in the United States during 2011-2014, 1 in 8 Americans (aged 12 and over), reported being on an antidepressant in the past month.
Over the years that number has only increased.
It’s not just in the U.S. however – in England 70.9 million prescriptions were written for antidepressants in 2018.
Often, depression can accompany anxiety – making antidepressants a potentially beneficial treatment option for both anxiety and associated depression.
There is a lot of controversy around these medications and they are often viewed in black or white terms. But for the right person, at the right time and used in the right way – they can be effective for reducing anxiety, panic attacks and obsessive-compulsive symptoms. They can help those taking them to make the necessary changes they likely wouldn’t have been able to make otherwise.
Unlike Benzodiazepines – which can reduce anxiety very quickly – antidepressants take time to work (typically between 2-4 weeks).
Many patients even experience a temporary increase in anxiety before the anxiety declines and comes under control.
While the safety of long-term use of these medications is questionable – many people take antidepressants for months or even years without major issues.
There are those – however – who stay on the medication because they find it too difficult to come off once taken for an extended period.
These people may also re-experience anxiety after coming off the medication if they haven't gone through therapy or learned effective techniques to cope with their anxiety.
Without the internal resources learned through strategies such as therapy or meditation – they may find the new anxiety symptoms difficult to handle.
While taking antidepressants for a shorter term is probably safer in the long run, the decision to come off of them should be discussed with your doctor and a tapering schedule (slowly lowering the dose) should be followed.
Discontinuation syndrome (a fancy way of saying withdrawals) can occur if these medications are abruptly stopped after daily, long-term usage.
Always discuss treatment options, questions and concerns with your doctor before starting these or any other medications.
SSRIs are the most commonly prescribed antidepressants and the likely first choice of most physicians for anxiety and depression.
SSRI stands for Selective Serotonin Reuptake Inhibitor.
What this means is that SSRIs inhibit the reuptake (reabsorption) of serotonin – ultimately leading to increased serotonin available to bind to receptors in the brain.
In other words: SSRIs increase the availability of serotonin in the brain.
Although SSRIs can weakly influence other chemicals in the brain such as norepinephrine – the first “S” for selective means it primarily has an affinity for serotonin.
The development of SSRIs was lead by the demand for effective antidepressant medications that were more targeted (serotonin) – without the many side effects and potential toxicity of the older MAOIs and tricyclics.
The first successful SSRI to hit the market was Prozac.
It was so successful and effective in fact – it seemingly confirmed to the medical community the involvement of serotonin in anxiety disorders and depression.
There are 6 SSRIs available today: fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft) and fluvoxamine (Luvox)
Side effects can be relatively common among antidepressants and SSRIs are no exception.
Although considered a major improvement over the older antidepressants, close to 40% of those prescribed SSRIs reported experiencing one or more side effects.
Possible Side Effects
In a study done in 2009 of 700 patients – 38% reported experiencing at least one side effect.
Below is a list of the side effects mentioned in order from most common to least common.
- Sexual problems
- Weight Gain
- Dry Mouth
SNRIs are a newer class of medication used primarily to treat anxiety and depression but are also prescribed for chronic pain and fibromyalgia.
SNRI stands for Serotonin Norepinephrine Reuptake Inhibitor.
Like SSRIs – SNRIs increase the amount of serotonin available in the brain – but they also increase norepinephrine.
Norepinephrine's important role in depression is thought to be due to its ability to improve attention, memory, motivation and focus (which can decline under depression), as well is it's role in pain modulation.
The combination of increased serotonin and norepinephrine has shown to be more effective in some studies for chronic pain and fibromyalgia symptoms than increasing serotonin alone.
There has been no clear advantage shown for SNRIs over SSRIs for anxiety or depression.
Some people respond better to SSRIs while others may find an SNRI works better for them.
Common SNRIs medications include: Cymbalta, Effexor, Pristiq and Fetzima
Possible Side Effects
Side effects with SNRIs are similar to SSRIs – nausea and headache are more likely to occur with an SNRI than with an SSRI. Weight gain and sexual problems are more common with SSRIs than with SNRIs.
Tricyclic antidepressants – often abbreviated TCAs – were among the first class of antidepressants to be released (releasing alongside the first MAOIs).
TCAs are approved by the FDA for treating depression, OCD and bedwetting but are also used for different types of anxiety.
TCAs were the dominant antidepressant until SSRIs came along in the 1980s.
TCA’s work in a similar – but less targeted – way as SNRIs in that they increase both serotonin and norepinephrine – but they also reduce acetylcholine in the brain.
Acetylcholine is the neurotransmitter responsible for many functions in the brain and nervous system including: memory and learning, alertness, attention, promoting REM sleep and activating skeletal muscles.
Low acetylcholine has been linked to Alzheimer’s – making Tricyclics a poor choice for those struggling with memory problems.
Tricyclics' effect on the brain’s neurotransmitters can vary depending on the actual type of TCA taken.
Some prescription TCAs have a stronger affinity for serotonin while others affect norepinephrine more. Some block more acetylcholine than others. They can also affect dopamine to a certain degree.
While TCAs are less likely to be prescribed for anxiety or depression compared to SSRIs or SNRIs – they have many “off label” (non-FDA approved) uses for which they can still be effective including: chronic pain, panic disorder (panic attacks), generalized anxiety (GAD), migraines, chronic headaches, premenstrual symptoms and smoking cessation.
Like SSRIs and SNRIs – TCAs generally take time to work for anxiety and depression but can have more immediate effects for chronic pain.
TCAs generally have more side effects and aren’t as well tolerated as SSRIs – especially at higher doses.
This is the reason SSRIs eventually replaced them and why Tricyclics are not prescribed as often today.
They can – however – be just as effective for anxiety and depression as the newer antidepressants for those who can tolerate them.
At lower doses – such as those used for pain or chronic headaches – the side effects are less common and less severe.
Common Tricyclic medications include: amitriptyline (Elavil), clomipramine (Anafranil), nortriptyline (Pamelor), amoxapine and desipramine (Norpramin).
Possible Side Effects
Tricyclics are generally not as well tolerated as SSRIs/SNRIs and have a higher percentage of side effects among patients. There is also an increased risk of toxicity and overdose with TCAs. Tricyclics have a lot of the same side effects as SSRI/SNRI with a higher degree of reported dry mouth, dizziness and constipation.
MAOIs were the first antidepressants on the market – created in the 1950’s – and are still FDA approved for depression.
MAOI stands for monoamine oxidase inhibitor.
Monoamine oxidase is an enzyme that breaks down serotonin, norepinephrine and dopamine. By inhibiting this enzyme the availability of those neurotransmitters increases.
Doctors do not prescribe MAOIs as often for anxiety or depression as they used to – except in particular cases or as an alternative when other medications have failed to work such as in severe depression.
The reason for their falling out is the vast number of possible food and drug interactions.
If you’ve ever read the back of a medicine bottle of any kind, you’ve most likely seen the warnings regarding interaction with MAOI medications.
MAOIs can have numerous side effects and the use of MAOIs needs to be monitored closely by a doctor.
That being said, MAOIs can be very effective for anxiety and depression under the proper circumstances or where nothing else has worked before.
There are people that find that a particular MAOI is the only thing that works for them.
Common MAOI medications include: Parnate, Marplan, Nardil and Emsam.
Possible Side Effects
MAOIs have many of the same side effects as the other antidepressants listed above but also have a higher risk of causing low blood pressure. In addition, food and other medications need to be closely monitored to avoid possibly severe drug interactions.
Benzodiazepines – often referred to as “Benzos” – are often the first medications that come to mind when discussing anti-anxiety medications.
They are quite often the first medications prescribed to someone who is diagnosed with a clinical anxiety disorder.
Benzodiazepines are considered minor tranquilizers that work by binding to the GABA receptor sites in the brain – increasing GABA’s effectiveness to calm the mind and promote mental and physical relaxation.
GABA is an inhibitory neurotransmitter responsible for reducing the excitability of neurons in the brain and nervous system.
Increasing GABA acts as a nervous system depressant – which all Benzodiazepines are.
By inhibiting neurons – the brain and body are much more relaxed – leading to reduced anxiety, physical tension and agitation.
Benzodiazepines have proven to be effective for a range of anxiety issues including Generalized Anxiety Disorder (GAD) and Panic Disorder (panic attacks).
Benzodiazepines are generally recommended and prescribed for short term use (2-4 weeks).
Drugs in this class have not shown effectiveness for long-term use due to patients increased tolerance with these drugs over short periods of time.
Unlike antidepressants which are much more targeted to the brain chemicals they affect (serotonin, norepinephrine, etc.) – benzodiazepines have a widespread effect throughout the brain and body.
This is definitely not a good thing.
By inhibiting or sedating neurons throughout the entire body you are affecting more than just the anxiety you are trying to treat.
By inhibiting your brain and nervous system you are also inhibiting your ability to learn new things or form new memories.
These drugs have a strong impact on cognitive ability and cognitive decline can become significant after long-term use.
The biggest risks to taking Benzodiazepines are tolerance and dependence. These are the main reasons many physicians will not prescribe Benzos for long-term use.
Tolerance can build up within a matter of weeks or even days with these drugs.
The result of tolerance is the need for higher and higher doses to achieve the same benefits.
Physiological dependence can follow almost as quickly, with withdrawal effects seen even after short-term daily usage.
Due to their enormous potential for abuse and dependence – these drugs are typically only used and prescribed for short term (immediate) relief of anxiety or medical issues such as alcohol withdrawal, prolonged seizures or even prior to surgery or dental work.
When long-term support is needed for anxiety – antidepressants are the safer and more effective option.
We personally recommend avoiding these medications if possible.
If you take them – try taking them for as short a period as necessary.
No matter how well these medications work at the outset or how pleasant the feelings – they will not last long and the dose will continually need to be increased to get the same benefits.
Addiction and dependence are real and can be brutal with Benzodiazepines.
I’ve heard first-hand horror stories of withdrawals from these medications.
Unfortunately, the issue of addiction with benzo drugs such as Xanax and Klonopin (whether taken legally or illegally) doesn't get the same level of attention as opioids, even though the withdrawals can be just as severe and longer-lasting.
The risk for overdose, when combined with other drugs, is also just as dangerous.
The most commonly prescribed benzodiazepines are: Xanax, Klonopin, Valium, Ativan and Restoril.
Possible Side Effects
- Memory problems
- Cognitive decline
- Coordination problems
- Muscle weakness
Buspirone is a medication for anxiety which has been found particularly effective for generalized anxiety.
It has not shown to be effective for more severe anxiety, OCD or panic.
Buspirone is a medication in a class of its own. It is more closely related to SSRIs/SNRIs than to Benzodiazepines. Like SSRIs, it targets serotonin receptors in the brain but it also affects dopamine receptors.
Like most prescription medications “the exact mechanism of action” is not clearly understood.
It is believed to work by changing neurons in a way similar to SSRIs/SNRIs but Buspirone affects dopamine levels as well.
While Buspirone is relatively safe to take long term – it’s effectiveness in reducing anxiety beyond 3-4 weeks has not been proven.
Possible Side Effects
- Dizziness (12%)
- Drowsiness (10%)
- Nausea (8%)
- Headache (6%)
- Nervousness (5%)
Beta blockers – or “beta-adrenergic blocking agents” – are medications approved for use for patients with heart problems and high blood pressure, but are commonly prescribed for physical anxiety symptoms.
Beta blockers work by blocking the effects of the hormone/neurotransmitter epinephrine – otherwise known as adrenaline. By blocking epinephrine’s effects – the usual physical effects of anxiety/panic (increased heart rate, sweating, trembling) are prevented or reduced.
Epinephrine is involved in the fight-or-flight response – thereby blocking epinephrine (adrenaline) you essentially block the fight-or-flight response.
Beta blockers are not anxiolytics (anti-anxiety) – they only reduce the physical symptoms of anxiety.
Mental/emotional/psychological anxiety can still be present. Therefore, Beta Blockers are not an effective medication for anxiety, other than for managing the physical symptoms.
Examples of their use could include; public performances where physical anxiety symptoms can interfere or for dealing with chronic intense physical symptoms of anxiety.
Physiological dependence can occur after daily use and result in increased blood pressure if discontinued abruptly.
Always talk with your doctor before stopping this medication.
Possible Side Effects
- Low blood pressure
- Cold hands/feet
Sedatives, Hypnotics and Z-Drugs
Sedatives, hypnotics and Z-Drugs are classes of medications used to treat insomnia (which is often a result of anxiety).
Sedatives or hypnotics include specific benzodiazepines that help with sleep and treating insomnia. These drugs work on GABA receptors in a similar way to other benzos such as Xanax.
These drugs work by inhibiting/sedating neurons in the brain and nervous system, slowing and calming the mind and body to induce sleep.
Although not a prescription medication – Benadryl and many of the older antihistamines are also sedatives/hypnotics.
If you've taken Benadryl for allergies, you may have found this out first hand if you began dozing off in the middle of the day.
Certain older antihistamines – like Benadryl – cross the blood/brain barrier and block histamine receptors that promote wakefulness – the end result being drowsiness.
Z-Drugs are a class of medications for insomnia appropriately named for the “Z” in the name. “Zolpidem” – otherwise known as Ambian – is one example of a Z-Drug.
These drugs are very much like Benzodiazepines but have different chemical structures. Both act on GABA receptors in the brain – however, Z-Drugs tend to cause more significant drowsiness versus anxiety-reducing effects.
Z-Drugs and the other benzo sedatives/hypnotics all possess the same potential risks and dangers of dependency and physiological dependence that other Benzodiazepines have.
Do not believe these drugs are safer than other benzo drugs because they are classified as insomnia medications.
Like Benzodiazepines – these drugs should be used intermittently or for short periods at a time only.
Dependence can build up rather quickly if taken every night.
They will begin to lose their effectiveness and more will need to be taken to achieve the same effect.
Another downside to these meds is that many people become reliant on them to fall asleep.
With continued use they will likely get to a point where they can not fall asleep without them.
Addiction to Z-Drugs and other sedatives/hypnotics can occur as soon as 3 weeks of use and can cause withdrawal effects similar to benzodiazepines.
These drugs can also cause some very strange – and dangerous – side effects such as fully functioning sleepwalking and acting out bizarre or nonsensical behavior.
Many of the side effects can be avoided by using the correct dosage and only taking the drug directly before going to sleep.
The majority of the adverse effects occur when people take these drugs and stay up.
For example – taking the medication and then staying up to do household chores.
We recommend avoiding these drugs unless you have no other option – even then only take as absolutely needed and for as short a duration as possible. The risks far outweigh the benefits.
Possible Side Effects
Although many of the side effects with these medications can be relatively minor – such as headaches or dizziness – there have been increasing reports over the past few years of some truly odd and dangerous effects of these drugs.
Sleepwalking: I’ve heard some pretty crazy stories of patients waking up on park benches or several blocks from their home.
Amnesia: not remembering anything that happened for the few hours after taking the medication.
Strange behavior: some truly odd behaviors can occur on these medications that someone normally wouldn’t do otherwise.
- Strange/bizarre behavior
- Risk of falls
The Benefits of Anxiety Medication
All of the medications discussed in this article can have major advantages and disadvantages.
Even discussing medication for anxiety can polarize those who have taken them or know someone who has.
While one person may claim a specific SSRI changed their life and helped tremendously with their anxiety and depression – another person may have taken the same drug and experienced nothing but side effects and withdrawals.
These medications are not without controversy.
With an increased risk of suicide with antidepressants and the potential for addiction with benzos and insomnia medications – these drugs shouldn't be considered harmless just because a doctor prescribed them.
They are powerful psychoactive medications that have a significant effect on the brain and nervous system.
That being said, they can be an effective option for anxiety, panic attacks, OCD and social anxiety – as well as depression which can often accompany anxiety.
Despite the potential side effects and negative publicity – these medications can work for some of us.
They may improve our lives to a point we were not able to reach without them.
Whether it’s finally coming out of the hole of a long depression – or finally calming our anxiety after months or even years of daily struggle.
Prior to medication, we may not have been able to leave the house without severe anxiety – now we are back doing the things we want to do.
To be clear – none of the drugs on this list are magic potions. Many of the medications listed can reduce anxiety symptoms or help you relax or sleep, but the true benefits come from medications that help you to adapt, change and work through your anxiety.
These benefits can include: improving your response to therapies such as CBT or allowing you to better cope with and accept the feelings of anxiety in social situations.
Antidepressants are really the only anxiety medications available at this time that can actually support your efforts and allow for change and improve therapeutic approaches.
Anxiety is often a complex issue requiring more than just a temporary fix.
We often need more than just a pill to reduce our symptoms.
We need to have the skills to manage our anxiety – especially after we decide to stop taking the medication.
Simply taking a pill for a prescribed amount of time and then stopping, usually doesn't “fix” our anxiety if we haven't made the necessary changes or developed the internal resources to better handle stress and anxiety.
The ideal way to use these medications would be in conjunction with therapy or while practicing techniques (such as the ones provided on this website) so you can develop the internal resources and skills to deal with whatever arises.
You can then choose to come off of the medication without relying on it to manage your anxiety.
Unfortunately, medications like benzodiazepines only numb us to our anxiety.
Benzodiazepines actually prevent new learning from occurring.
They can also make anxiety worse once stopped.
They are more of a hindrance to overcoming anxiety than a help.
All of the medications we've discussed in this article can provide the benefit of reducing anxiety.
Only antidepressants have the potential to support our change and growth – especially for the long term.
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The Dark Side of Anxiety Drugs
We touched on the polarizing opinions of these medications above.
There are many people who have been prescribed these medications (or know someone who has) and only experienced the dark side of these drugs.
There are valid reasons for caution, dislike or even hatred of these medications.
While the negative effects can vary from one type of medication to another – there are many common factors that should be discussed as a possibility with all of these drugs.
This is something not all doctors are quick to talk about when prescribing.
It should be noted that everyone is different and will respond to a specific medication differently.
While one antidepressant may cause significant side effects in one person – another person may respond well to the same medication with little to no side effects.
This is one reason doctors will have a patient try different medications until they find the one that works best for that individual.
There are common potential risks among different types of medications but there are no definite rules that apply to every person that takes them.
Antidepressants can cause sexual side effects and fatigue in a large percentage of those taking them – for others they may not or may even have the opposite effect.
Tolerance and physical dependency can build up quickly with benzodiazepines leading to moderate to severe withdrawals – but there is also a percentage of people that can take these drugs as needed for an extended period and stop without issue.
The items discussed below are possible problems that can arise for these medications. They are not definite rules that say – “You will experience these problems if you take a medication for anxiety.”
It is information so you are aware and can discuss it further with your doctor if you haven’t done so already.
For most of us, the number one concern with anxiety medications is usually side effects.
We want to know what the potential side effects are and how likely we are to experience them.
Most of the side effects for medications for anxiety have been well documented and most people are aware that all of these drugs can have side effects to some degree or another.
The degree of intensity is what matters most.
The majority of us would probably put up with some minor fatigue if a medication took our daily anxiety from an 8 to a 4.
But if the fatigue was so bad we started falling asleep at work every day, we would probably want to switch medications.
The type of side effect can impact people differently.
Some people experience a minor to moderate increase in anxiety when first starting an antidepressant that diminishes over time.
This temporary increase in anxiety may lead them to believe the medication isn’t working for them or they may want to quit the medication early.
Other side effects like erectile dysfunction and other sexual side effects may be a deal-breaker for many.
The cognitive side effects of drugs like benzodiazepines or the fatigue experienced when first starting an SSRI or SNRI may be a problem for those whose jobs require clear and focused attention.
Often side effects may disappear or reduce in intensity after we have taken a medication for a longer period of time. As our brains and nervous systems become accustomed to the medication the side effects tend to lessen. Usually after the first 1-2 weeks.
That doesn’t mean you need to suffer through side effects or not discuss them with your doctor. Always speak up. If the side effects are bothering you let your doctor know.
Long-term side effects need to be taken into account as well.
While benzodiazepines like Xanax may work very well for someone at first, they can also lead to memory and cognitive problems in the long run.
Someone taking Xanax may experience more severe anxiety after stopping the medication than what they experienced before taking the meds.
Always discuss side effects you experience with your doctor – even if it is not considered an “official” side effect in the medical books.
I’ve heard many physicians claim a particular medication “couldn’t cause that side effect” only to find that the side effect is gone after discontinuing the medication.
Always speak up!
Tolerance occurs with many prescription medications when they are taken repeatedly for an extended period.
This occurs due to the body's adaptation to the drug.
The body can adapt to medications due to faster metabolizing of the drug and/or reduced affinity between brain receptors and that particular medication.
Tolerance is a serious problem with benzodiazepine drugs like Xanax and Klonopin – which can build up in a few short weeks to the point where the prescribed dosage no longer has the same (or any) effect.
This increased tolerance eventually leads to higher and higher dosages to achieve the same results. These higher dosages lead to a higher risk of side effects and increased risk for physiological and psychological addiction.
The issue of rapid tolerance is why benzodiazepines should be avoided if possible or only taken for a short period of time.
While not as often discussed – tolerance can also occur with antidepressants and other medications.
Although typically occurring much slower than with benzos – after months of daily use some may find they need to increase their dosage of antidepressants to deal with anxiety or their depression seems to be “breaking through.”
Tolerance is an issue that should be discussed with your doctor.
It can be wise to ask how long they believe you should take the medication and if higher doses will be needed over time.
Of all the negative effects of anxiety medications – the potential for physiological and/or psychological dependency and addiction are probably the worst.
Benzodiazepines have a well-known potential for physical dependency, abuse and addiction.
While most in the medical field know of this potential, there is no real widespread effort to curb their use.
Many people are being prescribed these medications without being made aware of this.
Addiction to benzos is real and can be excruciatingly difficult to come off of. I’ve often heard stories of withdrawals described as worse than heroin – with withdrawal symptoms lasting for weeks or even months.
Drugs like Xanax, Valium and Klonopin are often sold on the street in the same way opioid medications like Percocet and Vicodin are illegally sold.
There is a real problem here that needs to be brought to public awareness in the same way the opioid epidemic has been.
Less often discussed – and not fully accepted by the medical community – is the physiological dependence of antidepressants after extended daily use.
After years of denying the fact that antidepressants can cause physiological dependence, the medical community has finally given a name to the severe effects that some people experience after stopping these medications: “discontinuation syndrome.”
The name is really just a fancy term for withdrawals.
The withdrawals that some experience from stopping antidepressants is due to the brain and body’s dependence on the medication after months or years of daily intake.
You brain can become reliant on these medications to produce specific brain chemicals such as serotonin.
When the meds are stopped – it can take days, weeks or even months to get back to a balanced state.
While not everyone who stops taking antidepressants experiences these side effects – they can be severe for some, causing the person to go back on the medication.
I personally experienced severe withdrawals after stopping the antidepressants I was on after almost a decade of daily use. It took many attempts and almost 2 years of trying to successfully come off of my medications. Even then, I experienced the so-called “brain zaps”, severe anxiety, restlessness, inability to concentrate, severe brain fog and other side effects for months on end.
In all circumstances – discontinuing any of the medications discussed in this article should be done under the supervision of your doctor and almost always involves tapering the dose slowly over a period of several weeks.
While it may not eliminate all the withdrawal symptoms, it is the safest and easiest way to stop.
Never stop these meds cold turkey- especially if taken for a long time or taking a moderate to high dose.
The goal for any of us with anxiety should ultimately be to find a way to not only reduce anxiety symptoms, but improve our ability to handle anxiety and stress, calm and relax ourselves, and overcome our fears and resistances.
Whether we achieve this through psychotherapy, CBT, meditation, relaxation or any number of techniques or practices (like the ones discussed throughout this website) makes no difference.
All anxiety medication should ultimately be viewed as either helping us on this path or interfering.
Taking a pill to feel less anxious sounds much easier for most of us than learning breathing techniques or going through therapy.
Often we may feel a lot better on medication than we did before, so we neglect to learn how to cope with our anxiety when it does arise.
We may think a pill will solve our problems and we can avoid ever feeling our anxiety, facing our fears or dealing with the underlying causes.
Unless we plan to stay on medication permanently, there will come a time when we will need the skills and resources necessary to handle our anxiety. Learning strategies for anxiety or going through therapy can help us in this regard.
Exposure is common in many therapies.
This is where someone does the thing that makes them anxious and feels the anxiety to it’s fullest – seeing that it is safe.
Many medications would block us from experiencing these feelings so we do not learn to see these anxious feelings as uncomfortable but not dangerous.
Medications can numb us to our anxious feelings so we do not discover how to cope with them.
That’s not to say certain medications can’t help us on our journey or improve our therapy sessions.
Certain medications (particularly antidepressants), can actually improve our ability to cope with stress, life changes and processing unresolved emotions.
When therapy seems to be a dead-end or we are overwhelmed with anxiety, an antidepressant can help.
But eventually, most of us will need to face our anxiety without meds.
Benzodiazepines on the other hand – interfere with therapy and anxiety strategies because benzos inhibit new learning from taking place.
Beta blockers can also interfere with therapy by blocking the physical sensations of anxiety – eliminating the need to learn how to calm and relax our physical response to stress and anxiety.
Rebound anxiety refers to increased anxiety and panic experienced after withdrawal from a benzodiazepine.
In most cases, rebound anxiety is more severe than the anxiety experienced before starting the medication.
The resulting anxiety and panic symptoms directly result from withdrawal from the medication.
Most people will run back to taking the medication to reduce the feelings of intense anxiety.
Their physicians will normally oblige with a higher dose to combat the increased anxiety.
This creates a vicious cycle of higher and higher doses and intense anxiety and panic when trying to reduce or eliminate the drug.
Yet another reason to limit or avoid benzodiazepines if possible.
A common issue with almost all medications for anxiety is drug interactions – particularly with other medications and alcohol – but can also include herbs and supplements and even certain foods.
You are probably well aware of the potential for drug interactions with most of these medications but you should always discuss with your doctor if in doubt.
There are many potential interactions even with potentially benign supplements that can lead to health issues.
For example: combining antidepressant medications with herbs or supplements that affect serotonin (such as 5-HTP or St Johns Wort) can lead to serious issues such as “Serotonin Syndrome.”
There are also potentially fatal interactions that can occur with anxiety meds and other medications or drugs.
Combining nervous system depressants such as benzodiazepines or sedatives with other nervous system depressants such as alcohol or opioids can lead to overdose, coma or even death.
With these medications, alcohol should be limited or even avoided and the use of other medications, supplements or herbs discussed with your doctor before taking.
MAOIs are known for having the most interactions and are possibly the strictest of the medications discussed – all medications (even over the counter medications) and foods need to be closely monitored for possible interactions with any MAOI medication.
When taking anxiety medications – being open and honest with your prescribing physician about the supplements, herbs and other drugs (including alcohol and street drugs) you are taking can help to avoid likely interactions.
Taking a medication for anxiety can be extremely helpful for many people – and even necessary for some.
There is no denying the fact medications have helped many people deal with their anxiety and depression, where nothing else would.
That being said – there tends to be an over-prescribing of these meds by overly eager family physicians and psychiatrists.
These medications CAN help – but they are not always necessary or needed.
Therapies such as CBT, changes in diet, exercise, meditations such as Yoga and Mindfulness training, and many other techniques have proven to be just as effective as medication for anxiety and depression without the potential for side effects or physiological dependence.
Often anxiety medications are prescribed without so much as a look at the patient's current diet or lifestyle.
Rarely are blood tests ordered to rule out possible biological causes for the patient's anxiety.
Doctor’s are much faster to prescribe medication than they are to recommend a therapist or that the patient practice meditation.
I’ve experienced this over-prescribing first hand. My family physician prescribed Prozac for my anxiety when I was 15. I was never asked what was going on in my life, whether or not I had a healthy/safe/loving home environment nor did he recommended seeing a therapist. No tests were done. There were no questions on my diet or physical activity. A 10-minute doctor visit lead to a decade of my life on antidepressants.
Medications for anxiety are not always necessary.
While some people may need them – whether for the short term or the long term – there are many of us who do not.
There are many who will do just as well or better with any of the techniques discussed throughout this website.
Physicians – especially here in the US – really need to take a closer look at the patient as an individual before prescribing these powerful psychotropic drugs. With the many alternatives available today for anxiety, medication no longer needs to be the first option unless necessary.
How to Determine if Medication May Be Needed
You should make the decision to take medication for anxiety with the help of a knowledgeable physician.
You should also be aware of and discuss the potential side effects and other possibilities of these medications with your doctor.
Ideally, you would discuss lifestyle and health factors with your doctor beforehand to eliminate other possible causes of your anxiety.
While there isn’t a 100% accurate test to determine if medication is needed – there are a few questions you can look deeper into to determine if anxiety medication would be the right choice for you.
Questions To Determine if Medication Could Be Helpful
- How severe is your anxiety on a daily basis? (On a scale of 1-10)
- Does your anxiety consistently interfere with your life and keep you from doing the things you want/need to do?
- Do you have moderate or severe depression along with your anxiety?
- Do you experience panic attacks regularly?
- Are you currently in therapy or have you done therapy in the past and you're still overly anxious?
- Have you tried practices or techniques for anxiety such as deep breathing, meditation or yoga?
- Have you seriously looked at your diet and physical activity?
- How long have you had anxiety?
- Have you had any medical tests done to rule out potential biological causes (such as thyroid, or vitamin/nutritional deficiencies)?
- Are you too anxious to even try therapy or meditation?
- Does your anxiety keep you from leaving the house?
- Have you tried herbs or supplements?
Questions like the ones above can give you a better perspective on your anxiety and whether medication may be needed.
If you answered yes to most or all of the questions above, your anxiety is consistently above a 6 on a daily basis and you've had moderate to severe anxiety for more than a few weeks now – it may be time to talk to your doctor.
Ultimately, it is your decision whether to take medication. The advice of your doctor along with information can help you to make a more informed decision.
You can use the information provided in this article to help you with questions or concerns you may have about potential medications so you can communicate these concerns with your doctor.
Alternatives to Prescription Medications
Over the past few decades, medical studies have been conducted to determine the efficacy of various treatment options for anxiety.
Many of these studies have proven the effectiveness of many techniques and therapies.
Some of these strategies have proven to reduce anxiety as much as or more than prescription medications – without the side effects or dependency.
Techniques and therapies proven effective for anxiety include:
- Cognitive Behavioral Therapy (CBT)
- Meditation and Mindfulness Practices
- Deep Breathing and Breath Practices
- Improving/Changing Diet
- Certain Forms of Psychotherapy
- Progressive Relaxation
Extensive research has also been done on herbs, herbal extracts and supplements for anxiety.
Comparisons have been done in controlled studies between many of these herbs and supplements and anxiety medications.
While much of the research is still continuing, the current research – as well as the experience of those taking them – has provided evidence that many of these herbs and supplements can be a safer alternative to prescription meds.
Herbs and supplements proven to be as effective as prescription medications for anxiety:
- Valerian Root
You can also find our extensive list of recommended supplements here
Websites like examine.com also provide an extensive overview of hundreds of herbs and herbal supplements cited and supported by all the known available research.
If you're looking for alternatives to anxiety medications – look no further than our website. We have dedicated our site to providing alternatives to medication – with techniques, therapies and supplements that have been proven effective for anxiety.
While medication can be an effective treatment option – and in some cases a necessary one – it is not the only option available for those of us with anxiety.
Talking With Your Doctor About Anxiety Medications
If you’re considering medication for anxiety or if your doctor has recommended medication, taking the extra time to ask questions or discuss concerns with your doctor first can help you better understand what to expect.
Reading through this article may have brought up information that you were not aware of and something you would like your doctor to clarify.
Many physicians may gloss over the potential side effects of these medications as well as other important information that you need to know before starting.
If you have questions or concerns – ask!
Any doctor worth their title will be open and honest and take the time to explain the whats, hows and whys of these medications.
No physician or psychiatrist should try to pressure you into taking a medication you do not want to take.
If you’ve had a negative experience in the past with a particular medication, let them know.
If you’ve heard horror stories about a particular med – ask them about what you’ve heard.
Not everything you read on the internet is true or as dramatic as it may seem – but there are medications that cause problems for many people that doctors and the drug companies do not want to admit to.
When discussing medication options with your doctor – it’s best to be as clear and honest as possible. Doing so can help your doctor prescribe the medication best suited to your particular anxiety issues.
For example; don’t feel embarrassed to tell them if you’re extremely anxious in social situations or have panic attacks every time you go to the store.
This information is important in order to find the best medication.
There are some meds that work better for social anxiety and panic than others.
If you constantly obsess over things, have intrusive obsessive thoughts or uncontrollably repeat particular behaviors – tell your doctor.
OCD can respond well to medication but you need to let them know what you are experiencing to find the best possible medication.
Important questions you may want to ask your doctor before taking an anxiety medication:
- “Why do you think this particular medication would be best for me?”
- “What side effects do most people report?”
- “How long do you think I'll need to take it?”
- “Are there any drug interactions I should be aware of?”
- “Do you think this medication will help with _____________?”
- “Is this medication habit-forming or hard to come off of?”
- “I currently take ______________ (any medications or supplements), could there be any potential interactions with this medication?”
- “I heard this medication can __________________ , is that true?”
- “Are there any negative effects of taking this long term?”
- “Will this medication interfere with my ability to _____________ ?”
- “How long does it normally take to start working?
- “Will I be able to take the same dose or will I have to increase it over time (tolerance)?”
Being clear, open and honest with your doctor while bringing up any questions, fears or concerns you may have is the best approach to discussing medications.
There are no stupid questions.
As the patient you’re not expected to know all of the details of medications.
The doctor is there to provide that information – to give his advice based on his knowledge and experience.
So be clear with him/her and ask questions!
We’ve tried to provide a clear, comprehensive and honest overview of the various anxiety medications available.
Hopefully, you now have a better understanding of the possible benefits as well as the potential risks of these medications.
Too often we only hear one side of the story.
Searching through forums or reviews online you may come across horror stories regarding these medications from (rightfully) upset patients.
Talking with a doctor or reading medical websites you may only hear of the benefits of these meds – neglecting the very real potential for side effects, dependency and withdrawals.
Although the way in which these medications help those with anxiety (and depression) is still not totally clear, they can provide great benefit and relief from moderate to severe anxiety for some people.
If you are thinking of taking prescription medication for anxiety – discuss options and potential risks thoroughly.
If you're hesitant to try a medication due to something you’ve heard or read or from previous experience – bring that up to your doctor.
We've tried to be as thorough as possible in this article but if you have any questions about medications for anxiety, please leave a comment down below and we will do our best to answer.
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- American Family Physician: Antidepressant Discontinuation Syndrome
- NBC News: 1 in 6 Americans Take Antidepressants, Other Psychiatric Drugs
- NCBI: Serotonin-Norepinephrine Reuptake Inhibitors for Pain Control: Premise and Promise
- Medscape: Buspirone (Rx)
- Science Direct: Tricyclic Antidepressant
- NCBI: Antidepressant Efficacy and Side-Effect Burden
- NCBI: The Clinical and Forensic Toxicology of Z-drugs
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- NCBI: Cognitive Effects of Long-Term Benzodiazepine Use: A Meta-Analysis
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- Nursing: Meditation, Not Medication, To Relieve Anxiety
- Mayo Clinic: Beta Blockers
- Wikipedia: Development and Discovery of SSRI Drugs
- Forbes: America's Most Popular Mind Medicines