Anxiety
34 min read
Written by Stephanie Anderson Witmer
Published: Nov 19, 2024
Medically Reviewed by Dr. Paul Hetrick
It’s a myth that anxiety is “all in your head.” Anxiety is a mental health disorder that can affect mood and thought patterns and tightness in the chest, elevated heart rate, sweaty palms, upset stomach, and more. And anxiety can feel debilitating at times, especially if it’s untreated.
Plenty of treatment options exist to help with anxiety disorders, including prescription medication. How do you know which one might be right for you? We’ve created an anxiety-medications list to help you learn this important information:
Online anxiety treatment is available. And if you’re struggling with anxiety, you can find a provider on Klarity Health today who can help.
Anxiety medications are prescribed by a physician or other healthcare provider to treat anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder.
Different anxiety medications work in different ways in the brain to manage the physical and mental symptoms of anxiety disorders. There’s no single best medication for anxiety, nor does one size fit all. A medication that works well for one person may not be as effective or cause unmanageable side effects in someone else.
Medication can be an effective way for many to manage the symptoms of anxiety, including debilitating anxiety, and feel more in control of your life.
Not all anxiety medications are the same or work the same. Not every patient responds to anxiety medications in the same way, either. Some types are better suited for some people than others.
Here are the 4 most common types of anxiety medication prescribed by healthcare providers:
Other medications used to treat other health conditions have been found effective for anxiety, too, and are prescribed off-label, which means for a use they’re not U.S. Food and Drug Administration (FDA) approved specifically to treat. These include beta-blockers, anticonvulsants, and antihistamines.
Brand name (active ingredient/generic if available) | FDA-approved use(s) | Pros and cons (including some side effects) |
Valium (diazepam)1 | Anxiety disorders, alcohol withdrawal symptoms, muscle spasms, seizures | Pros: Fast-acting, effective for acute anxiety, lasts longer than other benzodiazepines for anxiety Cons: High risk of dependence, drowsiness, memory impairment, interacts with many other drugs, severe side effects for elderly patients |
Xanax (alprazolam)1 | Anxiety disorders, panic disorders | Pros: Fast-acting relief for panic attacks Cons: High risk of addiction, sedation, short duration |
Ativan (lorazepam)1 | Anxiety disorders, short-term anxiety relief, anxiety with depressive symptoms | Pros: Effective for anxiety and sleep Cons: Sedation, potential for abuse, withdrawal symptoms |
Librium(chlordiazepoxide)1 | Anxiety disorders, short-term anxiety relief, management of acute alcohol withdrawal, pre-operative anxiety | Pros: Long-lasting effects, useful for alcohol withdrawal Cons: Sedation, dependence risk, cognitive impairment |
Klonopin (clonazepam)1 | Seizure disorders and panic disorders | Pros: Fast-acting, longer duration, effective for panic and seizures Cons: Sedation, risk of dependence, withdrawal symptoms |
Neurontin, Horizant, Gralise (gabapentin)1 | Seizure disorders nerve pain caused by shingles or diabetes, prescribed off-label for anxiety, Horizant for restless leg syndrome | Pros: Effective for anxiety and nerve pain Cons: Drowsiness, dizziness, potential for misuse |
Celexa (citalopram) | Major depressive disorder (MDD) in only adult patients, off-label for anxiety disorders | Pros: Effective for anxiety and depression, taken just one a day Cons: Sexual dysfunction, nausea, weight gain |
Desyrel (trazodone) | MDD, off-label to treat insomnia and anxiety | Pros: Effective for sleep and depression Cons: Sedation, dizziness, priapism (rare) |
Lexapro (escitalopram) | MDD in adults and adolescents, generalized anxiety disorder (GAD) in adults and children | Pros: Fewer drug interactions, well-tolerated, taken just one a day Cons: Sexual dysfunction, nausea, headache, may take several weeks to reach full effect |
Prozac (fluoxetine) | MDD, obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, off-label social anxiety and post-traumatic stress disorder (PTSD) | Pros: Energizing, long half-life Cons: Insomnia, sexual dysfunction, initial anxiety |
Zoloft (sertraline) | MDD, OCD, panic disorder, PTSD, social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD) | Pros: Effective for various anxiety disorders Cons: Nausea, diarrhea, sexual dysfunction |
Paxil (paroxetine) | MDD, GAD, SAD, panic disorder, OCD, PTSD | Pros: Effective for anxiety and panic Cons: Weight gain, sexual dysfunction, sedation |
Cymbalta (duloxetine) | MDD, GAD, chronic pain | Pros: Also treats chronic pain; effective for anxiety and depression Cons: Nausea, dry mouth, constipation |
Strattera (atomoxetine) | Attention-deficit/hyperactivity disorder (ADHD) in both children and adults, off-label for anxiety | Pros: Non-stimulant option for ADHD, potential anxiety benefits Cons: Insomnia, nausea, dry mouth |
Pristiq (desvenlafaxine) | MDD | Pros: Effective for depression and anxiety Cons: Insomnia, nausea, sexual dysfunction, elevated blood pressure |
Effexor XR (venlafaxine) | MDD, GAD, SAD), panic disorder | Pros: Effective for anxiety and depression Cons: Raises blood pressure, withdrawal symptoms |
Inderal (propranolol) | Hypertension, angina, migraine prevention, off-label for performance anxiety | Pros: Effective for physical anxiety symptoms, fast-acting Cons: Fatigue, dizziness, may worsen asthma |
Tenormin (atenolol) | Hypertension, angina, acute myocardial infarction, off-label for physical symptoms of performance anxiety | Pros: Fewer CNS side effects compared to propranolol Cons: Bradycardia, dizziness |
Lopressor (metoprolol) | Hypertension, off-label for performance anxiety | Pros: Effective for hypertension and anxiety symptoms Cons: Fatigue, dizziness |
Marplan (isocarboxazid)1 | MDD | Pros: Effective for resistant cases Cons: Dietary restrictions, risk of hypertensive crisis |
Nardil (phenelzine)1 | MDD, panic disorder, SAD | Pros: Effective for severe anxiety and depression Cons: Dietary restrictions, sedation |
Emsam (selegiline) | MDD (in transdermal patch formulation) | Pros: Transdermal option, fewer dietary restrictions at low doses Cons: Insomnia, application site reactions |
BuSpar (buspirone) | GAD and short-term relief of anxiety symptoms | Pros: Non-sedating, low dependence risk Cons: Takes weeks to work, requires multiple doses daily |
Onyda XR (clonidine), clonidine | Hypertension, Tourette syndrome, ADHD in children, off-label for managing withdrawal symptoms from opioids, alcohol, and nicotine | Pros: Effective for physical anxiety symptoms Cons: Sedation, hypotension |
Vivactil (protriptyline) | MDD, narcolepsy, ADHD, off-label for anxiety | Pros: Effective for depression and anxiety Cons: Dry mouth, constipation, arrhythmias |
Elavil, Endep, Vanatrip (amitriptyline) | MDD, off-label for anxiety, chronic pain, migraine, PTSD, and insomnia | Pros: Also effective for chronic pain and sleep Cons: Sedation, weight gain, anticholinergic effects |
Lamictal (lamotrigine) | Epilepsy, seizures, off-label for panic disorder, bipolar disorder, migraine, and binge-eating disorder | Pros: Stabilizes mood, effective for anxiety Cons: Rash (rarely severe), dizziness |
Lyrica (pregabalin) | Chronic pain, seizures, off-label for GAD and SAD | Pros: Effective for GAD and nerve pain Cons: Weight gain, drowsiness |
Vistaril, Atarax, Hyzine, Rezine (hydroxyzine) | GAD, short-term anxiety management, and itching due to allergic conditions | Pros: Non-addictive, effective for short-term anxiety Cons: Drowsiness, dry mouth, multiple doses needed |
1 A controlled substance nationally or in some states that may have a risk for abuse and dependence and that some providers choose not to prescribe.
Benzodiazepines are the strongest and fastest-acting anxiety medications. Some start to work within minutes, making them a good choice for managing panic attacks.
Some benzodiazepines prescribed for anxiety are Valium (diazepam), Xanax (alprazolam), and Ativan (lorazepam).
“Benzos” have a calming effect by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA), which inhibits brain activity and prevents excess stimulation. This creates a slightly sedative effect in the body.
Benzodiazepines have a sedative effect, which can cause some of their main side effects, including:
Benzodiazepines are a controlled substance and typically recommended for short-term use due to risks of dependence, withdrawal, and side effects. Don’t drink alcohol while taking a benzodiazepine medication.
Benzodiazepines can also interact with other medications and shouldn’t be used by some people. Don’t use opioid medications while taking benzodiazepines. Before taking them in any form, talk to your healthcare provider or pharmacist and read the medication guide.
SSRIs are the first-line treatment for anxiety disorders and are generally safe and well-tolerated. Some of the best-known medications for treating anxiety, as well as depression, are SSRIs. These include Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram), Cymbalta, (duloxetine), Luvox (fluvoxamine), and Viibryd (vilazodone).
Serotonin is one of the body’s “feel-good” neurotransmitters. More serotonin can equal better mood, better sleep, and less anxiety. Serotonin is released from 1 neuron to send a chemical message to another to regulate sleep, mood, and other important functions. After the message has been transmitted, any leftover serotonin gets absorbed back into the neuron. SSRIs increase serotonin levels by slowing down this reabsorption, or reuptake, so its positive effects can be felt for longer.
Common side effects of SSRIs include the following:
Some people may experience an increase in their anxiety when they first start taking SSRIs, but that goes away. The FDA issued a boxed warning with some SSRI medications, as they have been known to cause suicidal thoughts in people under 25. Seek medical care immediately if this occurs.
SSRIs shouldn’t be used while also taking monoamine oxidase inhibitors (MAOIs) and other medications that increase serotonin, as this can put people at risk of dangerous serotonin syndrome. They also should not be used during pregnancy.
SNRIs are often prescribed if SSRIs aren’t working, either for anxiety or depression. SNRI medications include Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine).
SNRIs are similar to SSRIs in that they keep more serotonin available in the brain. SNRIs though also keep more of another neurotransmitter, norepinephrine, or the “fight or flight” hormone, available in the brain. Both serotonin and norepinephrine are important for mood, but the increase in norepinephrine can also improve focus, motivation, and energy to produce an anti-anxiety effect.
The FDA issued a boxed warning for SNRIs, as they can cause suicidal thoughts in people under age 25. Seek immediate medical attention if this happens.
SNRIs also shouldn’t be combined with other serotonin-increasing medications. They increase the risk of bleeding in people taking blood thinners, such as warfarin and apixaban.
TCAs are prescribed for anxiety, obsessive compulsive disorder (OCD), and chronic pain. TCAs FDA-approved to treat anxiety disorders include medications that use amitriptyline as the active ingredient — Elavil, Endep, Vanatrip — and generic amitriptyline, as well as Aventyl and Pamelor and generic nortriptyline with nortriptyline as the active ingredient.
TCAs block the reuptake of serotonin and norepinephrine. TCAs can be a treatment option when SSRIs and SNRIs haven’t worked. They also have a calming effect, similar to benzodiazepine medications.
TCA side effects tend to be worse than those of newer anti-anxiety medications and include:
The risk of overdose is higher in TCAs and can even be fatal. These medications carry a boxed warning from the FDA, as they can also cause suicidal thoughts in young people. Seek immediate medical care if this happens.
Patients should not take TCAs within 14 days of having taken an MAOI. People with coronary artery disease and seizure disorders also may not be able to take certain TCAs.
While benzodiazepines, SSRIs, SNRIs, and TCAs are the most common medications prescribed to treat anxiety, others may be able to help with symptoms, as well. Some of these medications are FDA-approved to treat anxiety, but some are prescribed off-label.
MAOIs are the oldest class of antidepressants, but they may also work on severe or treatment-resistant anxiety. Nardil (phenelzine) is the only MAOI FDA-approved for anxiety. Healthcare providers may choose to prescribe other MAOIs for anxiety at their discretion if they feel they’re medically necessary for a patient.
MAOIs work by increasing levels of neurotransmitters serotonin, norepinephrine, and dopamine to improve mood. People taking MAOIs must avoid foods high in tyramine. MAOIs can also cause side effects. And they can interact with many other drugs, which tends to make them a last option for anxiety.
Beta-blockers are FDA-approved to treat cardiovascular conditions. Common beta-blockers include carvedilol (Coreg), metoprolol (Lopressor), and propranolol (Inderal). They don’t directly affect mood, but they can reduce the physical symptoms of anxiety by slowing down your heart rate. Beta-blockers can be helpful for performance anxiety, such as public speaking.
Note that using a beta-blocker for anxiety is an off-label use. Providers can choose to prescribe a beta-blocker for anxiety if they feel it’s medically necessary for your condition.
Antihistamines, such as Benadryl (diphenhydramine), are used to alleviate allergy symptoms. One type — sedating antihistamines — are sometimes used off-label for anxiety because of their sedative effect, but they don’t have a direct impact on mood.
Hydroxyzine (Vistaril, Atarax) is FDA-approved to treat anxiety.
Anticonvulsants are used to control seizures. They’re sometimes prescribed off-label for anxiety because of their calming, stabilizing effect on the brain.
Klonopin (clonazepam) is FDA-approved for short-term anxiety relief and to treat panic disorders. Lyrica (pregabalin) is used only off-label for anxiety, but healthcare providers can choose to prescribe it to treat anxiety if they feel it’s medically necessary for your condition.
Some herbs may have a calming effect, which can help decrease symptoms of anxiety. These include chamomile, lavender, ashwagandha, and valerian. Aromatherapy may offer particular benefits. Herbal remedies haven’t been researched as extensively as medications, and their effectiveness varies.
Other alternative therapies for anxiety include mindfulness meditation, yoga, breathing practices, and acupuncture may also reduce symptoms of anxiety. Learn more about how to calm anxiety.
Anxiety is manageable with treatment — and the right treatment is within reach. Book an online appointment on Klarity Health today to speak to a qualified medical professional about an anxiety treatment plan tailored to your needs and that may include medication if your provider recommends it. Find a provider now.
*Appointments are generally available within 24 hours. Free initial consultations are available only with select providers. Prescriptions, particularly for controlled substances, may require an in-person evaluation depending on the state of residence and current federal regulations.
The information provided in this article is for educational purposes only and should not be construed as medical advice. Controlled substances, like Valium, Xanax, Ativan, Librium, Konopin, Lyrica, Marplan, and Nardil, may not be appropriate for all patients and any mention of these medications is for educational purposes only, not for marketing or encouraging self-diagnosis. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with clinical autonomy. Nothing in this article is intended to diagnose or treat any condition, including guaranteeing prescription medication of any kind or dosage. Not all providers on Klarity Health prescribe all medications, particularly medications that are controlled substances.
If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.
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