There are many anti-anxiety medications (anxiolytics) on the market designed to help individuals with various types of anxiety disorders. People with bad anxiety may try natural treatments and making lifestyle changes, but no matter what they do, they still are unable to feel normal and function in society. Anxiety can be so debilitating for certain individuals that they’d rather sit at home all day in isolation than even take a walk around the block.
For people struggling with severe forms of anxiety, medications can be among the most effective treatment option. The most commonly prescribed classes of drugs to treat anxiety include SSRIs (selective-serotonin reuptake inhibitors) and benzodiazepines. In addition to these classes, there are other alternative anxiolytic options such as buspar that have demonstrated clinical efficacy. Most drugs do a good job at addressing genetic or uncontrollable causes of anxiety or cases that cannot be overcome by making lifestyle changes.
Anti Anxiety Medications List (Anxiolytic Drugs)
Understand that the list below isn’t organized with any particular hierarchy. Most doctors will generally prescribe an SSRI drug for those with mild or moderate anxiety. Someone with severe anxiety and/or panic may be prescribed a benzodiazepine. It is important to understand that each class of medication and specific medication has benefits and drawbacks – there is no utopian pharmacological option for anxiety.
This is widely regarded as the most effective class of medications for reducing anxiety. For severe anxiety and panic, there’s nothing that will work better than taking a benzodiazepine. They work by targeting GABA receptors in the brain to increase feelings of relaxation.
Unfortunately this class is associated with a high risk of tolerance and addiction. (Read: Most addictive drugs). Additionally, long-term usage has been linked with development of dementia and other permanent memory impairment. Withdrawing from benzodiazepines is also thought to be dangerous if not done properly and can lead to worsening of anxiety.
- Ativan (Lorazepam)
- Klonopin (Clonazepam)
- Valium (Diazepam)
- Xanax (Alprazolam)
The Selective Serotonin Reuptake Inhibitors (SSRIs) can be very effective for treating certain types of anxiety. Some are thought to work better for PTSD, while others are thought to work better for things like OCD or Social Anxiety. The SSRIs can work great and are a better long-term option than benzodiazepines.
However, most people do eventually build up a tolerance to these drugs (after years). Additionally common side effects include weight gain and sexual dysfunction – which most people don’t like. For most people, withdrawal from SSRIs is no picnic – psychological symptoms can be very severe and linger for months after use.
- Celexa (Citalopram)
- Lexapro (Escitalopram)
- Luvox (Fluvoxamine)
- Paxil (Paroxetine)
- Prozac (Fluoxetine)
- Zoloft (Sertraline)
Despite getting approved for anxiety disorders, many people who use it find that it doesn’t do a damn thing. For some people it works extremely well with minimal side effects. Buspar isn’t thought to be as powerful as an SSRI medication, making for easier withdrawals and no major unwanted side effects. Based on this drug’s safety profile, it should probably be tried ahead of many other medications.
Note: Since Buspar doesn’t fall into a particular drug classification, it is in its own category under alternative or atypical anxiolytics.
The Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) target multiple neurotransmitters to help improve mood. Not all SNRIs are considered effective for anxiety because the norepinephrine reuptake component can actually cause more anxiety. SNRIs like Cymbalta and Effexor still target serotonin to a greater degree than norepinephrine, which results in clinically effective anxiety reduction.
- Cymbalta (Duloxetine)
- Effexor (Venlafaxine)
The tricyclic antidepressant medications can be beneficial for anxiety in some cases. Many of these drugs affect serotonin, but some also affect norepinephrine to a significant extent. Generally the ones that influence serotonin tend to be better for anxiety. Since this is an older class of medications, it is less likely that you’ll be prescribed one for your anxiety. However, in cases of atypical anxiety or refractory anxiety, many people find these drugs beneficial. The only major drawback is that side effects tend to be more severe than newer classes like SSRIs.
- Amitriptyline (Elavil)
- Clomipramine (Anafranil)
- Desipramine (Norpramin)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
The MAOI drugs work differently than all other classes of antidepressants and function by raising levels of neurotransmitters like serotonin, norepinephrine, and dopamine. Although these are considered a third or fourth line treatment option, they can be helpful for managing anxiety. They are not commonly prescribed though because they have dangerous interactions with foods containing tyramine. Additionally their side effect profile is regarded as being pretty severe compared to other medications.
- Nardil (Phenelzine)
- Parnate (Tranylcypromine)
The atypical antidepressants function differently than standard SSRI and SNRI medications. Their properties are unique from the other classes of medications and they do not fit into any particular classification or category. Although they were created to treat depression, a couple are also regarded as effective for anxiety. In particular, the two listed below are considered sedating; this results in drops in anxiety levels.
- Remeron (Mirtazapine)
- Trazodone (Desyrel)
Off-Label Treatments for Anxiety
Many people are not able to tolerate the side effects from antidepressants and benzodiazepines. Although taking antidepressants for anxiety can be helpful for certain people, not everyone will respond well. Others may not like how antidepressants make them feel, and may want to avoid benzodiazepines because they are addictive, increase anxiety over the long term, and can permanently impair memory.
Therefore many psychiatrists and patients alike tend to consider other options that may be effective for managing anxiety. Certain off-label treatments like Clonidine are regarded as being effective and safe, despite not having FDA approval for anxiety disorders. Other off-label options like antipsychotics should be avoided by most people unless a comorbid condition like schizophrenia is diagnosed.
Many people use Clonidine for anxiety associated with medication withdrawal. It’s primarily used to treat hypertension, but has also gotten FDA approval for ADHD. It tends to reduce stimulation, yet doesn’t dampen cognition like benzodiazepines – allowing us to still think clearly without anxiety. Although it probably won’t work for all cases of anxiety, some psychiatrists believe it should be used ahead of benzodiazepines and antidepressants.
This is a medication class that is commonly prescribed for seizures, but can also be used to stabilize mood among those with bipolar disorders. They can reduce anxiety by inhibiting sodium channel activity in the brain and influencing GABA activity. It is believed that they reduce cortical arousal and thereby are able to prevent mania and anxiety.
- Depakote (Valporate)
- Gabapentin (Neurontin)
- Lyrica (Pregabalin) – It should be noted that Lyrica is actually approved for anxiety in Europe.
It’s no secret that many top performers, surgeons, and professionals use beta blockers to reduce performance anxiety. In general, these can be helpful for minimizing the physical symptoms of anxiety, but generally do not target psychological influences. This class of drugs is used primarily for heart conditions, but many people have had success using them off label for various types of anxiety. (Read: Beta blockers for anxiety).
- Propranolol (Inderal)
These can help for certain individuals experiencing rare forms of anxiety and panic triggered by abnormally low arousal or low dopamine. In some cases medications like Adderall for anxiety work extremely well. Whether they will work for your panic attacks will sometimes require an unorthodox psychiatrist and experimentation.
- Focalin (Dexmethylphenidate)
- Ritalin (Methylphenidate)
- Vyvanse (Lisdexamfetamine dimesylate)
I cringe when I hear about people taking antipsychotics for their anxiety. Many will work very well for anxiety, but they also significantly impair cognition. It should also be noted that there are many risks associated with taking antipsychotics such as: significant weight gain, sexual dysfunction, permanent brain impairment, diabetes, and tardive dyskinesia. Withdrawal from this class of medications is thought to be extremely difficult as well. Despite the fact that doctors are sometimes quick to dispense antipsychotics, taking one for anxiety should only be done if you’ve tried every other approved class and are personally willing to accept the risks.
- Abilify (Aripiprazole)
- Geodon (Ziprasidone)
- Latuda (Lurasidone)
- Risperdal (Risperidone)
- Seroquel (Quetiapine)
- Zyprexa (Olanzapine)
What medication should you take for your anxiety?
It is important to work with a psychiatrist when trying to figure out what drug would best work for your anxiety. Certain classes of medications may work wonders for one person, while they may actually make anxiety worse in another. The most commonly prescribed medication class for anxiety disorders are SSRIs.
This class has been proven as clinically effective for the treatment of various types of anxiety. However, not everyone will respond to an SSRI and in many cases other drugs will need to be considered. The most common second-line treatment option for those who fail to respond to an SSRI are benzodiazepines. Although benzodiazepines are the most effective drug for anxiety, they carry more risk of tolerance, addiction, and unwanted long-term effects such as permanent memory impairment.
Knowledgeable psychiatrists will typically try a medication like Buspar (an approved anxiolytic) or Clonidine for anxiety (a safer off-label option) before benzodiazepines. With trial and error, most people will be able to find at least one medication or medication combination effective for managing anxiety. In cases of treatment-resistant anxiety, counterintuitive medications like stimulants may be explored. Taking an anti anxiety medication can be extremely helpful for debilitating cases of anxiety, but most people will also need to make healthy lifestyle changes as well for maximum anxiety reduction.