Anxiety is defined as an unpleasant feeling of nervousness or fear that is often accompanied by unrealistic thinking, dread, and panic. For some individuals, anxiety is an uncontrollable part of life – no matter what they do, they cannot escape the anxious thoughts, constant worry, and physical symptoms such as a fast heart rate. If left untreated, anxiety can become so extreme that a person can becomes afraid to leave the house, form social bonds, and hold down a job.
In the event that a person fails to adequately treat their anxiety, it may lead to a nervous breakdown and/or social isolation. Fortunately there are many effective treatment options for anxiety sufferers. Although many doctors will recommend natural treatment options such as cognitive behavioral therapy (CBT), meditation, and physical exercise – antidepressants (particularly SSRIs) are considered first-line treatments.
Antidepressants For Anxiety Disorders
Most people would agree that anxiety disorders are largely rooted in genetics, but can be intensified by a stressful environment. The genetic component of anxiety is thought to influence brain chemistry and increase beta brain waves (fast brain wave activity); preventing our brain from slowing down and relaxing. In order to target problematic brain chemistry, a psychiatrist will typically prescribe an antidepressant.
There are a variety of SSRI medications on the market that are prescribed for depression, but which ones are best for anxiety? It should be known that there are many different types of anxiety including: generalized anxiety disorder, OCD, panic disorder, etc. The best SSRIs for addressing anxiety include: Paxil, Lexapro, and Zoloft.
SSRI: This class of antidepressant drugs works by inhibiting reuptake of the neurotransmitter serotonin. This is thought to improve mood (in cases of depression) as well as increase relaxation (in cases of anxiety). Most drugs in this class are regarded as being effective for anxiety with comorbid depression and vice versa.
Best SSRIs for anxiety include: Paxil, Lexapro, Zoloft
Below is a list of various SSRIs that have been used specifically for the purpose of treating anxiety. Although Paxil, Lexapro, Zoloft, and Luvox are the only ones FDA approved for various types of anxiety, others have been found effective as well. Additionally it should be mentioned that the SNRI drug Effexor is also approved to treat anxiety.
- Paxil (Paroxetine): This drug is an SSRI that is arguably the best antidepressant for various types of anxiety. It has been approved to treat OCD, panic disorder, social anxiety disorder, PTSD, as well as generalized anxiety disorder. Some would argue that this drug is better geared towards individuals with anxiety as opposed to depression. It was the first antidepressant in the U.S. that got approval to treat panic attacks.
- Lexapro (Escitalopram): This SSRI has been approved in the United States to treat both generalized anxiety disorder and depression. It is slightly different than the drug Celexa in that it is thought to be more effective. Some people note significant improvement in generalized anxiety symptoms within the first week of taking this drug. Lexapro and Celexa are considered equally effective for panic disorder.
- Zoloft (Sertraline): This is an SSRI that has been approved for various types of anxiety including OCD, panic attacks, and social anxiety disorders. It has also been found effective at reducing the physical symptoms of anxiety such as heart palpitations and blushing. This is widely regarded as one of the best antidepressants for anxiety.
- Luvox (Fluvoxamine): This is an SSRI drug that is primarily used for OCD and various anxiety disorders such as panic disorder and PTSD. If your anxiety manifests itself in the form of obsessive-compulsive disorder, then this is considered one of the best treatment options. It is only approved to treat OCD in the United States.
- Celexa (Citalopram): In the United States this drug is primarily used to treat major depression. However, in European countries it is approved to treat panic disorder as well as agoraphobia. Throughout Spain it is also approved for the treatment of OCD. Although not an approved treatment for anxiety, it is commonly used in the United States off-label as a treatment for generalized anxiety disorder. Some research shows that it works in up to 85% of individuals with generalized anxiety.
- Prozac (Fluoxetine): This SSRI is mostly prescribed for major depression, but also is used for certain types of anxiety such as: OCD, PTSD, and panic disorder. Although it may reduce anxiety among certain individuals, it is not considered a first-line antidepressant option for anxiety disorders.
SNRI: This class of drugs works by inhibiting the reuptake of both serotonin and norepinephrine in the brain. The serotonin reuptake inhibition can create a sense of anxiety, but the norepinephrine reuptake inhibition can actually increase anxiety. For this reason, SNRIs are not as commonly used to treat anxiety disorders. Of all SNRIs, the drug Effexor is the only one that is approved to treat generalized anxiety disorder.
- Effexor (Venlafaxine): This is the only SNRI approved to treat generalized anxiety disorder. It is likely effective due to the fact that it acts on serotonin significantly more than other SNRIs. The ratio of serotonin to norepinephrine reuptake inhibition is approximately 30:1. Most other SNRIs have ratios 10:1 or less in favor of serotonin.
Other antidepressants used for anxiety
Although the SSRI class is considered a first-line treatment option for anxiety disorders, other classes of drugs such as atypicals, tricyclics, and MAOIs can act as anxiolytics. Below are several drugs from other classes that are thought to be effective for various types of anxiety.
Atypical antidepressants: There are a couple atypical antidepressants that have anxiolytic properties. In the United States, the two most commonly used atypical antidepressants to treat anxiety include Trazodone and Remeron.
- Trazodone: It is approved to treat anxiety disorder, depression, and insomnia. Functions as a serotonin antagonist and reuptake inhibitor. It is noted as having significant anxiolytic and sleep-inducing effects.
- Remeron: Although only approved to treat depression, it is commonly prescribed off-label for generalized anxiety disorder, social anxiety disorder, OCD, panic attacks, and PTSD.
Tricyclic Antidepressants (TCAs): This is an older class of medications that tends to affect various neurotransmitters. These compounds are noted for their tricyclic structure, containing three atomic rings. There are only a couple TCAs that are effective for anxiety.
- Clomipramine: An older TCA that is utilized to treat OCD, panic disorder, and agoraphobia.
- Doxepin: This is a TCA that is commonly used to treat anxiety disorders and insomnia.
MAOI (Monoamine Oxidase Inhibitors): These work by increasing levels of neurotransmitters in the brain. There are several MAOIs that are effective for managing anxiety.
- Marplan: This is one of the oldest antidepressants on the market, and it is used to treat both depression and anxiety disorders.
- Moclobemide: This drug has been found useful for social phobia and panic disorder. It is not approved in the United States, but is used in Australia and the United Kingdom.
- Nardil: Although not approved for anxiety, it is sometimes effective for treating panic disorder, social anxiety, and PTSD.
- Parnate: This drug is used primarily as an antidepressant, but has been found effective for managing symptoms of anxiety.
Personal Opinion: When to use Antidepressants for Anxiety Disorders
It is highly debatable as to whether antidepressants should be considered first-line treatments for anxiety. There are people that are in favor of antidepressants because they believe benzodiazepines are dangerous, while there are other people that believe antidepressants end up creating more problems over the long-term than a benzo. Most professionals will not hesitate to recommend antidepressants as a safe first-line treatment option for anxiety.
I believe that certain medications like Buspar and Clonidine for anxiety are superior to antidepressants in managing “pure” anxiety if they work. When it comes to treating anxiety, it is always best to start with medications that are specifically created for treating anxiety and not necessarily depression. I have personally used Clonidine for anxiety and found it to be a pretty effective option for generalized anxiety symptoms. Additionally it doesn’t seem to impede my focus like a benzodiazepine would nor did it affect my mood like an antidepressant.
Buspar is also relatively safe and is a non-benzodiazepine medication that has been approved specifically for anxiety. If you have just anxiety without depression, you may want to consider taking a medication specifically created for anxiety as opposed to an antidepressant. Why? Because over the long-term, using antidepressants can create a chemical imbalance and may even make you depressed.
Antidepressants should be considered a second-line option for anxiety based on safety and efficacy. If you aren’t getting relief from a medication like Clonidine or Buspar, then it may be time to try an SSRI. Only if you fail to respond to multiple SSRIs will a doctor consider prescribing a benzodiazepine. Benzodiazepines should be considered a last-line treatment option for anxiety.
Using antidepressants for anxiety and depression
It should be mentioned that SSRI antidepressants are a great first-line treatment option for people with anxiety and comorbid depression and individuals with depression and comorbid anxiety. Although most doctors will simply throw SSRIs at you if you mention anxiety and depression, they may tweak treatments based on whether you are experiencing more anxiety than depression or vice versa. Below are various scenarios of how a person may be affected by anxiety.
Anxiety with comorbid depression: In this diagnosis, a person is primarily dealing with anxiety. The anxiety may be causing them to feel depressed and/or may be significantly more problematic than the depression. In this case, treating the anxiety may help the depression. In other cases, both the anxiety and depression need to be targeted.
Depression with comorbid anxiety: In this diagnosis, a person primarily is dealing with major depression. The depression could be causing them to feel anxiety and/or may be significantly more problematic than the anxiety. In this case, treating the depression may help the anxiety. In other cases, a doctor may need to target the depression and the anxiety for a person to feel relief.
Equal anxiety and depression: If you feel a combination of anxiety and depression, most doctors will recommend pursuing an SSRI like Paxil, Lexapro, or Zoloft. If you don’t get relief from an SSRI, your psychiatrist may try various combinations of antidepressants and anxiolytics. In other words, you may get put on an antidepressant plus Buspar or Xanax.
Pure anxiety: For individuals with pure anxiety, it may be better to pursue anxiolytics prior to using antidepressants. If you get no relief from any drugs that your psychiatrist prescribes, you may get put on a benzodiazepine.
Why antidepressants are preferred over benzodiazepines for anxiety
There are many reasons why a doctor may prefer to prescribe an antidepressant as opposed to a benzodiazepine for anxiety. Although benzodiazepines are highly effective and arguably the most potent anxiolytic drugs on the market, they should be reserved for only the most extreme cases of anxiety. Unlike benzodiazepines, antidepressants have a low potential for addiction, aren’t associated with neurodegeneration, and are safer in regards to both usage and withdrawal.
- Addiction: Although the addiction potential of benzodiazepines is regarded as being low if utilized for their intended purpose, many people have become addicted to these drugs. It is relatively easy to take a benzodiazepine every time you feel anxiety to cope with it. The problem is that tolerance is easily built and people continuously require more of the drug to feel the same anxiolytic effect. Antidepressants aren’t considered addictive and aren’t associated with developing a rapid tolerance which is why they are preferred.
- Controlled substance: Benzodiazepines are considered “Schedule IV” controlled substances. They are classified as such due to the fact that they are associated with physical and psychological dependence. Therefore it is important that people who are taking benzos only take them if absolutely necessary. Antidepressants are not considered a federally regulated substance and are safer to distribute.
- Dementia risk: Recently, it was discovered that consistent usage of benzodiazepines can significantly increase risk of developing dementia. Although people with severe anxiety may be willing to take the risk of developing dementia, if an antidepressant works well to control anxiety, there’s no need to even risk it. It is always important to consider the long-term effects of benzodiazepines before taking them.
- Dependence: The consistent usage of benzodiazepines for anxiety can create dependence, both physically and mentally. People who use benzos on a daily basis will eventually become reliant on them for functioning. If the supply is cut or dosage is dropped, the individual may experience heightened anxiety and various physical symptoms. The risk of dependence is low with antidepressants, hence them being a preferred option.
- Interactions: Benzodiazepines tend to interact with many other drugs and thus can intensify their effects. For this reason, a psychiatrist should keep close tabs on your medication profile if a benzo is prescribed. As a potent depressant, these drugs can have a lethal reaction when ingested with alcohol and/or other depressants. It is already known that combining an antidepressant and alcohol can be dangerous, but if a benzo is thrown into the mix, it could be a fatal combination.
- Safety: Operating a motor vehicle and/or heavy machinery is strongly advised against while taking a benzodiazepine. While on these drugs, it is easy to become heavily sedated, while losing coordination and motor skills. Additionally if you play sports or require hand-eye coordination for your job, most antidepressants will not impair you nearly as much as a benzo.
- Tolerance: It is extremely easy to become tolerant to the effects of benzodiazepines. If you are taking them every day, tolerance can build rapidly. Before you know it, you’re taking a very high dose just to get the same initial anxiolytic effect. Ultimately consistent benzodiazepine usage is unsustainable – tolerance develops quickly.
- Withdrawal: Another difficult aspect that those who’ve been on benzodiazepines have to deal with is that of withdrawal. The withdrawal process is thought to be among the toughest of any drugs and if not conducted properly, can be fatal. A very gradual taper needs to be conducted and during withdrawal, a person will typically experience a significant increase in overall anxiety. In fact, anxiety during withdrawal may be higher than the person has ever experienced.
Debate: Should antidepressants be used to treat anxiety?
Although antidepressants can be difficult drugs to deal with in terms of side effects and withdrawal, many have proven to be clinically effective at managing various types of anxiety. Many people simply could not live productive lives without using an antidepressant to help keep their anxiety under control. So what should you do if you are considering trying an antidepressant for your anxiety?
Assuming you’ve already pursued obvious natural cures for anxiety and various therapies such as CBT, vigorous physical exercise, meditation, dietary changes, etc. – it may be time to try an antidepressant. If you have pure anxiety without depression, you may want to try a non-benzodiazepine anxiolytic before you try an SSRI. Understand that once you’ve tried a few SSRIs, you will likely discover whether antidepressants will be effective for your specific anxiety.
There are cases of people successfully managing their anxiety for years with antidepressants, while others find no relief and/or experience worsening anxiety when they use antidepressants. What do you think about using antidepressants like SSRIs for anxiety? Feel free to share your comments and personal experiences in the comments section below.