These days everyone wants to know what medications are the best for treating anxiety. Hypothetically, it would be nice to have a chart of medications with specific criteria comparing each specific drug and showing people which drug is regarded as the “best.” The problem is that the criteria would be considered too complex to adequately determine a specific “best” and “worst” drug.
Generally if a medication is approved for a certain condition, it is considered effective. Individuals will have different reactions to a drug based on genetics, whether they are using other drugs, how long they’ve been taking it, and their dosage. A medication that works well for one individual, may not have much of an effect in another. For this reason, psychiatrists must experiment to find out what medication (or combination) works for addressing anxiety on a case-by-case basis.
What is the best anxiety medication?
In order to determine the “best” drug for anxiety, it is important to weigh the: efficacy, side effects, withdrawal symptoms, tolerance, and addictive potential. Assuming we are taking these factors into consideration, one medication clearly jumps ahead of the pack. This medication is associated with minimal side effects, a relatively easy withdrawal, no major sedation, and is clinically effective for anxiety.
The best anti anxiety medication (anxiolytic) should be one that treats anxiety, but has minimal side effects. Additionally it should be a medication that is not associated with rapid development of tolerance. Plus, for the sake of safety, it should be a drug that is non-sedative and doesn’t impair cognition or physical performance. Based on that criteria, the best pharmaceutical option for treating strictly anxiety is Buspar (Buspirone). It has been on the market to treat generalized anxiety disorder (GAD) since 1986.
- Classification: Azapirone – It is a uniquely classified medication that is considered an anxiolytic. It’s pharmacology is different than that of benzodiazepines, barbiturates, and SSRIs.
- Long term effects: There are no major unwanted long term effects as a result of using Buspar to treat your anxiety. Its effects may wear off over time, but most people tolerate it for an extended period of time. Drugs like benzodiazepines are associated with causing permanent memory impairment when used over the long-term; this won’t be a problem with Buspar.
- Sedation: Buspar is favorable to many anxiolytics because it doesn’t tend to result in the same degree of sedation that other classes do. Although energy levels may fluctuate as your body gets used to the drug, feeling sedated isn’t usually a major side effect.
- Side effects: Mild – The side effect profile for this medication is considered the best out of most anxiolytics. It can actually improve a person’s libido and isn’t associated with any major weight gain. Additionally it doesn’t result in slower cognitive functioning like a benzodiazepine.
- Withdrawal: Mild – Withdrawal from Buspar is considered so mild, that most psychiatrists will tell you that there is no withdrawal. Although there is usually still a withdrawal, most people do not have as much difficulty getting through it in comparison to an antidepressant.
Why Buspar is the best anxiety medication…
There are several reasons why a person may want to consider Buspar as a first-line treatment for anxiety disorders. It isn’t known to cause any memory impairment, it’s not going to cause you to feel groggy or sedated, and there are no major unwanted side effects or withdrawal symptoms.
- Doesn’t cause dementia – Many people who need anxiolytics may turn to benzodiazepines. Unfortunately, the benzo class is linked to increased risk of developing dementia when used over a long-term. Buspar does not pose any risk of dementia, cognitive impairment, or other neurodegeneration.
- Doesn’t impair concentration – In fact, there is some evidence suggesting that it could even help improve focus and symptoms of ADHD as an adjunct.
- Minimal side effects – The side effects from Buspar are considered minimal compared to most other medications. Although you may experience side effects, they will likely be mild compared to other drugs.
- Minimal withdrawal symptoms – Some have argued that there is no withdrawal when coming off of Buspar. No withdrawal would mean that the drug had no effect – that notion isn’t true. However, the withdrawal is thought to be relatively easy compared to most SSRIs.
- No memory impairment – Some drugs can permanently diminish memory functioning such as benzodiazepines. If you take Buspar for your anxiety, you won’t need to worry about experiencing any major memory issues.
- No sedation – Many anxiolytics are of sedative-nature – meaning when you take them, you’ll feel tired. Buspar doesn’t depress functioning in the CNS, making it safe to operate heavy machinery and drive motor vehicles.
- Specifically for anxiety – A reason that Buspar should be considered one of the best medications is that it was developed specifically for anxiety. It is not targeting neurotransmitters for depression, it isn’t for bipolar disorder or schizophrenia – just anxiety. For individuals with pure anxiety that don’t want to experience a change in mood from an SSRI, Buspar may be an ideal option.
Will Buspar work for everyone?
No. No medication class other than benzodiazepines are considered universally effective for anxiety. Although Buspar may not adequately address anxiety in some individuals, it was approved for anxiety because it is significantly effective for many people when compared to a placebo. If Buspar doesn’t work for you, it doesn’t mean that it’s a bad drug for everyone – it may work for another individual.
It should also be mentioned that many people find that Buspar takes awhile to work. For many individuals, it can take several weeks to a full month before they notice their anxiety levels drop. It is considered a slow-acting drug and requires constant administration for weeks before a person may feel the anxiolytic effects. For people seeking immediate relief, this discomfort while waiting for the drug to work may be a drawback.
Clonidine: A Good Second-Line Treatment
Many people are not aware of the medication Clonidine, which is primarily used to treat hypertension. Although not approved by the FDA for anxiety, its anxiolytic effects have been documented in various studies. Many doctors use it to help patients with anxiety during drug withdrawal and favor it over benzodiazepines due to its non-addictive nature. People using clonidine don’t typically build a tolerance and it can actually help improve cognition.
- Reduces anxiety: There is substantial evidence suggesting that Clonidine for anxiety is a great option. It is primarily used to reduce a person’s blood pressure, thus treating hypertension. However, many have found that upon reducing blood pressure, it produces an anxiolytic response – eliminating many symptoms of anxiety.
- Improves cognition: Not only will Clonidine not impair your memory over the long-term like a benzodiazepine, it can actually improve cognitive functioning. This medication is clinically approved by the FDA for the treatment of ADHD, suggesting that you may be better able to concentrate while taking it.
- Long-term option: This medication is considered relatively safe when taken over a long-term. Despite the fact that there isn’t a lot of long-term research regarding Clonidine, most published research suggests that it is pretty safe. You aren’t going to experience memory impairment or increased dementia risk like you would with other classes.
Benzodiazepines: Most Effective, But Most Problematic
For short-term treatment of anxiety or treating anxiety on an as-needed basis, there’s nothing that will work better than a benzodiazepine. The problem with benzodiazepines is that using them can deplete the brains GABA levels, which results in rapid-tolerance development and increased anxiety upon withdrawal. Additionally, many people don’t like the impaired cognition and sedation that this class of drugs causes.
- Universally effective: For most people with severe anxiety, there is nothing that will work better than taking a benzodiazepine like Xanax. These are drugs that affect GABA in the brain, which depresses the central nervous system, and leads to sedation. They have a powerful anxiolytic effect in nearly everyone who takes them.
- Rapid anxiety relief: This class of drugs works quicker than any other class as well. Meaning you should notice reductions in anxiety within a few minutes of taking the drug. Certain benzodiazepines work for a longer period of time than others (e.g. Xanax XR).
- Powerful anxiolytic: Benzodiazepines tend to result in the most potent anxiolytic effects. Meaning you should feel highly relaxed after taking this class of medication. Unfortunately these powerful anxiolytic effects cannot be maintained due to tolerance.
Problems with Benzodiazepines…
Although the most effective class of medications for anxiety, they are also the most problematic and unsustainable option over the long-term.
- Addictive: There is evidence to suggest that this class of drugs is pretty addictive when taken consistently. People develop rapid tolerance and rely on benzos as a crutch to cope with anxiety. The problem is as a person becomes tolerant to the benzos, the anxiolytic effects diminsh – leading the person to take more of the drug for the same initial effect. (Read: Most addictive drugs).
- Anxiety increase: Over time, this class of drugs affects GABA activity in the brain, causing an imbalance. As a person continues to use benzodiazepines, their anxiety levels will continue to increase in between doses. It takes an extended detoxification period for neurotransmission to readjust and anxiety to return to a baseline.
- Cognitive slowing: These medications tend to slow cognition and reduce mental performance. It may be difficult to focus on school-related tasks or work-related functions because you may feel so slow. Any depressants of the CNS are likely to impair cognition.
- Dementia: There is significant evidence suggesting that frequent usage of benzodiazepines increases a person’s risk of developing dementia. Most people do not want to risk developing dementia and therefore should avoid benzodiazepines.
- Long-term: Using benzodiazepines is unsustainable over the long-term. The building of tolerance, increased side effects from raising the dosage, and increases in anxiety between doses is not favorable.
- Memory impairment: Many people notice that their ability to remember things suffers while taking benzodiazepines. Whether it’s short term memory or long-term memory, a decline in both is possible. Some people use these drugs for years notice that they become permanently impaired.
- Side effects: The side effects from this class of drugs are considered severe. Although you may not experience weight gain or sexual dysfunction like you would on an SSRI, you may become tired, lack motivation, and have difficulty staying focused. Additionally your coordination may suffer and it memory may decline.
- Tolerance: People develop rapid tolerance from using benzos. This means as you consistently use a drug within this class, the anxiolytic effects will continue to diminish unless you constantly increase the dosage. In other words, you will constantly be fighting an uphill battle of diminishing returns if you get hooked on this class of drugs.
- Withdrawal: Withdrawing from benzodiazepines can be as difficult as any drug. Not only can it be dangerous to quit cold turkey (causing seizures), it is usually debilitating. When withdrawing, anxiety may resurface to a more extreme level than ever before. Additionally, some individuals may be so addicted to the effects of the benzodiazepines that they cannot seem to kick the habit.
Best Anxiety Medications (Recap)
In summary, the best anxiety medications in order would be: Buspar, Clonidine, SSRIs, and Benzodiazepines. There may be medications in other classes such as atypical antidepressants, tricyclics, and MAOIs that may work for anxiety as well. Keep in mind that the rankings below are based on: long-term safety, efficacy, side effects, and withdrawal symptoms. Also keep in mind that there is no universally “best” medication – in most cases, finding what works best for your specific case will take some individual trial and error.
1. Buspar (Buspirone)
This is a drug with minimal side effects and withdrawal symptoms, it is considered very effective for treating anxiety, and tends to be effective over the long-term. The only major drawback is that Buspar tends to take several weeks before it yields anxiolytic effects.
This drug is considered an off-label treatment option, so it is not FDA approved – which is a drawback. However, it is regarded as being effective for various types of anxiety, it is well-tolerated over the long term, and has a favorable side effect profile. Additionally withdrawal from this medication isn’t thought to be major.
Many antidepressants in the SSRI and SNRI classes are approved to treat anxiety. Unfortunately, many people are unable to tolerate their side effects and have a very difficult time coping with withdrawal symptoms. For other individuals, they simply don’t work and/or may cause unwanted changes in mood. These drugs tend to work well for anxiety, but are mostly used to help manage clinical depression.
The most favorable aspect of benzodiazepines is that they work rapidly and are universally effective. Although they are highly effective, they also have the most drawbacks including: severe withdrawals and unwanted side effects. Over the long-term, they are not considered safe and efficacy tends to diminish. This class of medications has been found to cause dementia when used over a long-term.
There are certainly more anti anxiety medication options than what were listed above. The above treatments are considered the best based on efficacy, side effects, long-term safety, and withdrawals. However, there are plenty of other options that a person may want to consider if the options above are ineffective. Other options include older classes of antidepressants such as tricyclics, MAOIs, and counterintuitive options like Adderall for anxiety.
What anxiety medication should you take?
Assuming you’ve already explored natural cures for anxiety and have tried making lifestyle changes such as eating healthy, getting adequate sleep, daily relaxation techniques, and exercise – trying a medication may not be a bad idea. Prior to taking a medication, you may even want to consider various herbal remedies for anxiety just to see if they have an effect. If nothing seems to work, considering a medication can be beneficial.
Deciding what drug to try first can be difficult. Most general practitioners will prescribe an SSRI or other antidepressant for anxiety. Although most antidepressants are considered effective for anxiety, many find their side effects and discontinuation symptoms to be problematic. For individuals with just anxiety, Buspar should be considered a first-line treatment option.
If Buspar doesn’t work, you will need to work with your psychiatrist to figure out another option. Although an off-label treatment, Clonidine should be regarded as a good second-line option for anxiety due to its minimal side effects and favorable withdrawal symptoms. If both of these medications fail to work, it may be worth trying an SSRI. In only the most severe cases of refractory anxiety should a benzodiazepine like Xanax be utilized on an as-needed basis.
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071705/