Anti-Anxiety Medication List and Management Guide
If you’re one of over 300 million people affected by an anxiety disorder, anti-anxiety medication can be a lifeline.
Over the years, our understanding of anti-anxiety medication has shifted. Today, patients have more treatment options than ever before as newer, safer treatments replace older, more dangerous medications.
In this anti-anxiety medication list and management guide, we’ll discuss everything you need to know about managing your anti-anxiety medication, from the origins of modern anti-anxiety pharmacology to the cutting edge of treatments available today.
Introduction to Anti-Anxiety Medications
People have recognized and studied anxiety disorders since ancient Greek and Roman times, but it wasn’t until the 1960s that doctors and scientists began studying modern anti-anxiety medication. Early anti-anxiety medication names included:
- Monoamine oxidase inhibitors (MAOIs), a drug originally developed to treat tuberculosis which doctors found helpful in treating anxiety symptoms. However, MAOIs have fallen out of favor in recent years due to their side effects and interactions with other medications. Some MAOIs still available today include phenelzine (brand name, Nardil) and tranylcypromine (brand name, Parnate).
- Benzodiazepines (BZDs) were introduced in the 1960s and remain one of the most widely prescribed anti-anxiety medications. Today, common benzodiazepines (or “benzos” for short) include alprazolam (brand name, Xanax), clonazepam (brand name, Klonopin), and diazepam (brand name, Valium).
- Beta-blockers primarily treat heart conditions but also have an “off-label” use as anti-anxiety medication. Modern beta-blockers include metoprolol (brand names Lopressor and Toprol), carvedilol (brand name, Coreg), and atenolol (brand name, Tenormin).
- Tricyclic antidepressants (TCA) have been used to treat major depressive disorder since 1959 and are still in use today, but mostly for off-label use to treat migraines and insomnia. Common tricyclics available today include amitriptyline (brand name, Elavil) and doxepin (brand name, Silenor).
Together with benzodiazepines and tricyclics, there are three other major medicines on the anti-anxiety medications list still in common use today:
- Buspirone, sold under the brand name Buspar, is an alternative to BZDs or benzos that avoids triggering the receptors that make them addictive. While buspirone was synthesized back in the 1960s, it wasn’t until the ‘80s that the FDA approved it to treat anxiety disorders.
- Selective serotonin reuptake inhibitors (SSRIs) target the protein that helps serotonin move between neurons, slowing its reuptake and thereby increasing the amount of serotonin in the body, a neurotransmitter that affects mood. Some common SSRIs include citalopram (brand name, Celexa), escitalopram (brand name, Lexapro), fluoxetine (brand name, Prozac), and sertraline (brand name, Zoloft).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) function similarly to SSRIs but slow the reabsorption of two different neurotransmitters: serotonin and norepinephrine. SNRIs include duloxetine (brand name, Cymbalta) and venlafaxine (brand name, Effexor).
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- Benzodiazepines (BZDs) work by telling the brain to release gamma-aminobutyric acid, a neurotransmitter that slows down the entire nervous system. Because they decrease activity in the nervous system, they can also be dangerous (or deadly) if improperly used and are only available via prescription.
- Buspirone is believed to activate serotonin receptors in the brain, which can lead to an elevated mood, but experts are unsure how exactly it works.
- Tricyclics block the reuptake of serotonin and norepinephrine, causing them to stay active for longer in the brain and increasing the levels of both neurotransmitters. If this sounds familiar, it’s because tricyclics perform a very similar function to SNRIs but do so through a different mechanism. Partially due to this similarity, tricyclics are less popular today because SNRIs work similarly with fewer side effects.
- Selective serotonin reuptake inhibitors (SSRIs) block the reabsorption of serotonin in the brain, making more of it available to transmit messages between neurons. SSRIs are the most prescribed medication for depression but are also widely used to treat anxiety.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) bridge the gap between tricyclics and SSRIs: they perform a similar function to tricyclics but do so by a mechanism more similar to SSRIs. SNRIs make more serotonin and norepinephrine available in the brain, which can reduce anxiety symptoms.
How Anti-Anxiety Medications Work
While the medical field doesn’t fully understand the causes of anxiety, it can manifest itself in many different ways such as trauma, an underlying medical condition, or by a combination of genetic, personality, and environmental factors.
Since anxiety is not a monolith — people experience it in many different ways — anxiety treatment is not a monolith either.
Many anti-anxiety medications perform different chemical functions that can alleviate the symptoms or feelings associated with anxiety in different ways.
Prescribing Anti-Anxiety Medications
Before prescribing any medications, licensed prescribers must first evaluate the patient’s symptoms. To do this, they may ask the patient questions about their symptoms, perform bloodwork or urinalysis, have the patient fill out a questionnaire, or perform a physical inspection if they suspect the anxiety is caused by an underlying medical condition.
If you suspect you could have anxiety or another mental health issue, self-assessments are valuable tools. They don’t replace the insight of a medical professional, but they can help contextualize your experiences.
Since anxiety can present in many different ways and stem from many different causes (both environmentally and chemically), there is not one right way to diagnose or treat anxiety. Prescribers must consider several factors when prescribing anti-anxiety medication:
Short- Or Long-Term?
Patients experiencing anxiety that’s acute, recent, or caused by a specific event may benefit from short-term anti-anxiety medication. Patients who experience chronic or generalized anxiety may benefit from long-term treatment. Short- and long-term anti-anxiety medications perform a similar function but are each best suited to a different context.
Symptoms
Anxiety is not a disorder, but a category of disorders that can have different symptoms. No two people with anxiety are alike, so treatment should target the most acute symptoms. For example:
- SSRIs are primarily antidepressants, making them useful in alleviating symptoms of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD). and panic disorder.
- Benzodiazepines and buspirone provide short-term relief for anxiety symptoms and can help treat panic attacks and insomnia.
- Beta-blockers primarily alleviate the physical symptoms of anxiety such as shaky hands or a racing heart.
Side Effects and Risks
While anti-anxiety medication can be beneficial, it can also come with side effects and risks that prescribers should take into consideration:
- Benzodiazepines. Since benzos slow down the nervous system, normal side effects can include drowsiness and lightheadedness. However, benzodiazepines can also have dangerous interactions with other drugs and alcohol which can lead to respiratory depression, coma, and even death. Additionally, benzodiazepines have a high potential for abuse and addiction, and stopping use can cause life-threatening withdrawal symptoms. For all these reasons, benzodiazepines have fallen somewhat out of fashion as other medications (like buspirone) can achieve similar effects.
- Buspirone. According to the FDA, buspirone holds little to no abuse potential. However, it does come with side effects that can be worsened by interactions with alcohol. Buspirone’s most common symptoms include restlessness and nervousness, but rare side effects can be much more serious, such as chest pain, depression, and uncontrolled body movements.
- Tricyclics. Tricyclic medications typically have side effects that include constipation, dry mouth, and dizziness. It can also interact dangerously with other medications, including the epinephrine used in life-saving Epi-Pens. It’s these symptoms that have caused tricyclics to wane in popularity in recent years.
- Selective serotonin reuptake inhibitors (SSRIs). Despite being the most widely prescribed class of antidepressants, SSRIs can carry several unpleasant side effects, including nausea, insomnia, and sexual dysfunction.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs). Since SNRIs function similarly to SSRIs, they carry similar side effects as well: nausea, dizziness, and sexual dysfunction, among others.
Use in Combination with Other Treatments
The 1960s led to a long list of anti-anxiety medications that are still in use today, but it also heralded the advent of one of the most common and effective treatments for anxiety: psychotherapy.
Psychotherapy (more commonly just called “therapy”) is an approach to treating mental health issues such as anxiety disorders through conversation with a mental health provider.
Therapy is, by definition, therapeutic, not pharmaceutical. The goal of therapy is often to equip patients with healthy coping skills, not to rebalance any neurotransmitters in the patient’s brain.
Therapy and medication share a common goal — treating anxiety — but they target different areas. Because they don’t naturally overlap, therapy and medication often work well in tandem.
Integrative psychotherapy combines the helpful aspects of different approaches to treating mental health issues. While each person is unique and no specific therapy is one-size-fits-all, many patients experience positive outcomes from combining medication with psychotherapy. Integrative psychotherapy may also incorporate elements of religion, diet, or other lifestyle factors.
Use With Other Drugs
It’s not unusual for patients to receive prescriptions for anti-anxiety medications alongside other drugs. The most common type of drug associated with anti-anxiety medications is anti-depressants. This is because depression and anxiety are often co-morbid and often share symptoms. Pairing an anti-anxiety medication with an anti-depressant can help alleviate a broader range of symptoms, but only when done by a licensed prescriber.
This is because anti-anxiety medications can have dangerous interactions with other drugs. For example, combining SSRIs with benzodiazepines can cause serotonin syndrome, a dangerous drug reaction that can be fatal.
Always consult with your healthcare provider before using anti-anxiety medications with other drugs, including alcohol.
Special Population Considerations
While anti-anxiety medications are safe when properly used under the supervision of a healthcare provider, some populations have special considerations:
- Elderly patients respond well to some types of anti-anxiety medications, but not to others. So what’s the best anti-anxiety medication for the elderly? Medications such as SSRIs and SNRIs are generally safe for elderly patients, but the side effects of tricyclics and benzodiazepines can be dangerous.
- Pregnant and breastfeeding parents should always consult with their healthcare provider before taking anti-anxiety medication, but SSRIs and SNRIs are generally safe and effective during pregnancy and breastfeeding. By now, it’s clear why SSRIs and SNRIs are so highly-prescribed — despite their side effects, they’re safe in circumstances when other anti-anxiety medications like benzodiazepines or tricyclics are not.
- Pediatric anxiety management is a unique challenge because children metabolize medications differently than adults, worsening many of their side effects. For this reason, healthcare providers generally recommend other treatments as a first-line treatment and only prescribe SSRIs and SNRIs in unique cases.
Tapering Off Anti-Anxiety Medications
While anti-anxiety medication can often help manage unpleasant symptoms, it can be unpleasant or dangerous to stop taking them all at once. People who stop taking anxiety medication can experience unpleasant withdrawal symptoms that are protracted for months or even years in some cases.
Symptoms of withdrawal can include depression, insomnia, dizziness, and anxiety. To avoid these symptoms, consult your healthcare provider who can help you make a plan to safely taper off your anti-anxiety medication.
Only about 20% of patients experience withdrawal symptoms from SSRIs, but less than 5% experience severe or painful symptoms.
Latest Research and Developments
Anxiety has most likely been a part of the human experience for as long as humanity has existed. However, our understanding of anxiety has evolved over time. As we’ve learned more about our bodies in the last century, our knowledge of anxiety medications and treatments has exploded, and breakthroughs are happening all the time.
New medications are in the development pipeline, such as:
- Gepirone is a drug that’s shown promise in treating patients with anxious depression and depression.
- Aloradine is a nasal spray that may help treat social anxiety.
- SRX246 is a promising candidate in the early phases of testing that could help treat PTSD, anger disorders, and generalized anxiety.
While these medications are still in development, other treatments are available today, such as transcranial magnetic stimulation (TMS), a noninvasive treatment approved by the FDA that’s been beneficial to many patients.
Conclusion and FAQs
While the side effects of anti-anxiety medication should be weighed against their potential benefit, anti-anxiety medication helps many patients deal with anxiety symptoms. Anti-anxiety medications like SSRIs and SNRIs are popular because they treat shared symptoms of anxiety and depression with less severe side effects than some other forms of anti-anxiety medication.
Anti-anxiety medication is often most useful when it’s part of a larger treatment plan that includes other treatments such as psychotherapy, TMS, and other medications.
To learn more about TMS, a safe, non-invasive treatment for some mental health conditions, contact us at Pulse TMS.
If you are having thoughts of harming yourself or someone else, call 9-1-1 immediately. This constitutes a mental health emergency and should be taken seriously.
The National Suicide Prevention Lifeline is 9-8-8 (or you can also reach it by dialing 1-800-273-8255) and is open 24 hours a day. 988lifeline.org also has a chat option.
The Substance Abuse and Mental Health Services Administration is free, open 24 hours a day, and can be reached by calling 1-800-662-HELP (4357).
For other non-emergency resources, Panic Anxiety Community Support (PACS) maintains a list of emergency helplines you can view here.
Your healthcare provider can diagnose anxiety disorder using a variety of diagnostic tools like questionnaires, bloodwork, and interviews. Always consult a healthcare provider before taking prescription anti-anxiety medication.
Different types of anti-anxiety medications address different symptoms and affect each person differently. However, anti-anxiety medication generally aims to create a sense of calmness and restfulness.
The National Institute of Mental Health (NIMH) has many free resources for learning more about anxiety. Healthline recommends these support groups for individuals with anxiety disorders. Some groups meet via video calls, while others offer support through chats and discussion forums, so no matter your preference, there is a group that fits your needs.