The Most Common Anxiety Medications, Explained

Endless worry, irritability and insomnia are all symptoms of a possible anxiety disorder.

Luckily, there are numerous anxiety medications that can help ease the condition.

Joy Alonzo, a specialist in the pharmacotherapy of mental disorders at Texas A&M’s College of Pharmacy, said recently, “If you understand the different types of medication, then you can become a better advocate for your anxiety treatment. Anxiety is one of the most under-treated mental illnesses, and we need to talk more about it.”

So, what medications can bring relief from crippling anxiety?

According to the Anxiety & Depression Association of America (ADAA), the most common classes of drugs for the treatment of anxiety include:

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Benzodiazepines
Tricyclic antidepressants

Here is a rundown on medications for anxiety.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs work by preventing the body from reabsorbing serotonin, which leaves more available for use. The ADAA describes serotonin as a neurotransmitter that plays a role in feelings of well-being and happiness.

SSRIs are considered the first-line treatment for all types of anxiety disorders. A higher dose may be required when treating obsessive-compulsive disorder (OCD).

Common side effects:

Insomnia
Sleepiness
Sexual dysfunction
Weight gain
Dry mouth

Common SSRIs:

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac, Sarafem)
Paroxetine (Paxil, Paxil CR, Pexeva, Brisdelle)
Sertraline (Zoloft)

What else you should know about SSRIs:

SSRIs may make it easier to engage in psychotherapy and other wellness activities
They may help improve other symptoms of anxiety, including headaches and sleep disturbances
Initial side effects typically disappear after four to eight weeks
SSRIs are safe for long-term use
Check with your provider before stopping their use or changing your dose

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

This class of medication is also a first-line treatment for anxiety disorders, except for OCD. It works by inhibiting the brain cells’ reabsorption of both serotonin and norepinephrine. Serotonin is the neurotransmitter that helps with a sense of well-being. According to Anxiety.org, norepinephrine is considered important for its role in the body’s stress response.

Common side effects:

Anxiety.org states that SNRIs may have more side effects because they affect serotonin and norepinephrine. These side effects may include:

Dry mouth
Nausea
Nervousness
Insomnia
Drowsiness
Dizziness
Headache
Sexual dysfunction
Loss of appetite
Agitation

Common SNRIs:

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

What else you should know about SNRIs

Anxiety.org reports that these medications promote neuroplasticity in the brain. This may make your brain more flexible. There is evidence that these medications work best in combination with psychotherapy.

But there is one important caveat.

“SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief,” Alonzo said. “They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.”

Benzodiazepines

Benzodiazepines are considered a second-line therapy for the treatment of generalized anxiety disorder. According to the ADAA, they work by strengthening the GABA neurotransmitter. This neurotransmitter plays a primary role in feeling calm, muscle relaxation, reduction in brain activity and sleep.

Most common side effects:

Drowsiness
Confusion
Dizziness
Depression
Impaired coordination
Vision problems

Common benzodiazepines:

Alprazolam (Xanax)
Lorazepam (Ativan)
Diazepam (Valium)

What else you should know about benzodiazepines for the treatment of anxiety:

They act quickly, but do not stay in the system for long
They are not safe for continuous use, and can be addictive
May be initiated with a first-line treatment, and then tapered off
Do not operate heavy equipment while taking
Do not mix with alcohol
Not recommended for people with suicidal or addictive tendencies

Tricyclic antidepressants

According to the Mayo Clinic, tricyclic antidepressants are among the earliest antidepressants. They are often recommended when newer drugs have not been effective. They are not typically used for social anxiety disorder or OCD. They also work by blocking the reabsorption of serotonin and norepinephrine, but their mechanism of action is different and they typically cause more side effects than newer treatments.

Common tricyclic antidepressants:

Imipramine (Tofranil)
Nortriptyline (Pamelor)
Desipramine (Norpramin)
Clomipramine (Anafranil)

Common side effects:

Drowsiness
Blurred vision
Constipation
Dry mouth
Drop in blood pressure when going from sitting to standing
Urine retention
Weight loss/weight gain
Excessive sweating
Tremor
Sexual dysfunction

What else you should know about tricyclic antidepressants:

You should not stop taking these medications abruptly
You may need to have blood work done to determine the correct dose
Disorientation can occur in older people at higher doses
May cause a rapid or irregular heart rate
Can increase seizure activity if prone to seizures

When to seek treatment for anxiety

The National Institute of Mental Health lists these as common symptoms of anxiety:

Feeling restless, wound up or on edge
Being easily fatigued
Having difficulty concentrating
Being irritable
Having headaches, muscle aches, stomach aches or unexplained pains
Difficulty controlling feelings of worry
Having sleep problems, such as difficulty falling or staying asleep

The ADAA recommends seeking medication for anxiety when you are having physical symptoms, are unable to do what you want because of how you feel or are unable to make life choices because of fear. It is never too early to start treatment.

Anxiety treatment can be more effective when used with therapy. It is essential to keep all your appointments with your provider. Do not stop your medication or change the dose without discussing it with your provider. If the side effects affect your daily activities, inform your provider immediately.

If, at any time, you feel as though you may be suicidal, reach out to your provider or go to the nearest emergency room. You can also call or text the national suicide prevention hotline at 988.