26 Xanax alternatives for anxiety relief

Xanax (alprazolam) is one of the most prescribed anti-anxiety medications available. But, it’s not the best fit for everyone. Fortunately, there are many alternatives to Xanax. There are other medications, therapies, and even natural Xanax alternatives. 

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Why Xanax for anxiety?

Xanax (alprazolam) is an oral medication. It’s approved by the U.S. Food and Drug Administration (FDA) to treat generalized anxiety disorder and panic disorder. 

Xanax is a benzodiazepine, a type of central nervous system (CNS) depressant. Benzos as they’re called, boost a brain chemical called gamma-aminobutyric acid (GABA). When you take Xanax, it slows down your nervous system. It also relaxes your muscles, creating a calming effect in your mind and body. Xanax kicks in fast — in 1 to 2 hours — making it an effective treatment for relieving intense anxiety or panic attacks.

Why Xanax alternatives?

When used as directed, Xanax relieves anxiety for many people. But, it is a controlled substance, so it has a potential for misuse and dependence if not used as directed. Some people develop a tolerance to Xanax and start feeling like they need to take more to get the same effects. And if you stop Xanax suddenly, serious withdrawal symptoms can occur. Due to these risks, Xanax has a boxed warning from the FDA, its most serious warning for medications.

Xanax also causes side effects, which some people find intolerable. Common side effects of Xanax for anxiety include: 

• Drowsiness
• Light-headedness
• Dry mouth
• Increased salivation
• Low blood pressure
• Rash 

Some people shouldn’t take Xanax too, including women who are pregnant or breastfeeding. 

Xanax also shouldn’t be used with some medications, including:

• Opioids, such as fentanyl, oxycodone, codeine, and morphine
• Other CNS depressants, 
• Digoxin, a medication to treat heart failure
• CYP3A inducers, such as phenobarbital, St. John’s Wort, and Rifampin
• CYP3A inhibitors (except ritonavir), including clarithromycin, nefazodone, atazanavir, and grapefruit juice

15 prescription alternatives to Xanax

There are several prescription drugs that are Xanax alternatives, including other benzodiazepines, antidepressants, and more.

Ativan or Xanax

Ativan (lorazepam) is a benzodiazepine like Xanax. It has the same warnings for abuse and dependence as Xanax. Oral Ativan takes a little longer than Xanax to kick in, up to 2 hours. Xanax lasts a bit longer too, up to 11 hours compared to Ativan’s 6 to 8. Ativan is available as an oral tablet or injection. The oral tablet is usually taken over 2 to 3 doses a day for anxiety.

Clonazepam as a Xanax alternative

Clonazepam (brand name Klonopin) is another oral benzodiazepine used to treat panic disorder. It has the same warnings for abuse, misuse, and dependence as Xanax. Unlike Xanax, it’s also FDA-approved to treat certain seizure disorders. It’s not FDA-approved to treat anxiety disorders, but is approved to treat panic disorder. Clonazepam shouldn’t be used by people with certain eye or liver issues. Clonazepam typically starts working in 30 to 60 minutes and lasts 8 to 12 hours. In comparison, Xanax starts working in 1 to 2 hours and can last up to 40 hours.

Valium as an alternative to Xanax

Like Xanax, Valium (diazepam) is an oral benzodiazepine. It also has a boxed warning for abuse and dependence. Valium treats anxiety, as well as alcohol withdrawal, seizures, and muscle spasms. Valium shouldn’t be used by people with severe breathing or liver problems, sleep apnea, or myasthenia gravis (an autoimmune condition that causes muscle weakness). While Xanax can be taken with or without food, taking Valium after a high-fat meal can delay its effects.

Buspirone instead of Xanax

Buspirone also treats anxiety, but it works differently than Xanax. It’s not a benzodiazepine, so it doesn’t have the same warnings for abuse and dependence. And, it doesn’t relax your muscles like Xanax, so it’s less likely to cause sedation or tiredness. Instead, buspirone relieves anxiety by targeting serotonin and dopamine receptors in your brain. Common side effects of buspirone for anxiety include dizziness, drowsiness, nervousness, nausea, and headache. 

Gabapentin as a Xanax alternative

Gabapentin is an oral medication that treats seizures and shingles-related nerve pain. It’s prescribed off-label for anxiety. Like Xanax, sleepiness is a common side effect of gabapentin for anxiety. Gabapentin isn’t a federally controlled substance. But some states consider it a Schedule IV controlled substance and regulate its use at the state level.

Propranolol vs Xanax

Propranolol is an oral medication for high blood pressure, angina, migraine, and more. It’s also prescribed off-label to treat generalized anxiety,  social phobias, post-traumatic stress disorder (PTSD), pre-operative or pre-dental treatment anxiety, stage fright, and agoraphobia. As a beta-blocker, propranolol isn’t addictive like some anxiety meds, including Xanax. But, it can cause various gastrointestinal, cardiovascular, and nervous system-related side effects. People with breathing disorders, including asthma, shouldn’t take propranolol for anxiety.

Zoloft as a Xanax alternative

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI). These medications work by boosting serotonin levels. SSRIs treat various mental health conditions, including depression, anxiety, and obsessive-compulsive disorder (OCD). SSRIs take longer to work than Xanax and are considered a long-term treatment for anxiety. 

Zoloft is indicated for panic disorder, PTSD, and social anxiety disorder. It’s not FDA-approved for generalized anxiety but is used off-label for it. Side effects from Zoloft include nausea, diarrhea, dry mouth, fatigue, and changes in appetite or libido. It has a boxed warning for suicidal thoughts and behaviors.

Prozac instead of Xanax

Prozac (fluoxetine) is another SSRI alternative to Xanax. It’s used to treat depression, OCD, panic disorder, and bulimia nervosa. It’s used off-label for generalized anxiety as well. Prozac isn’t habit-forming like Xanax. But, it does have a boxed warning for suicidal thoughts and behaviors. Typical side effects of Prozac for anxiety include sleepiness, nausea, diarrhea, and changes in libido or appetite.

Paxil vs Xanax

Paxil (paroxetine) is an SSRI FDA-approved to treat social anxiety disorder, depression, OCD, panic disorder, and PTSD.  It’s also used off-label for generalized anxiety disorder. Common side effects include nausea, trouble sleeping, and changes in libido. Paxil shouldn’t be combined with some medications, including monoamine oxidase inhibitors (MAOIs, a class of antidepressants), thioridazine (an antipsychotic), or pimozide (an antipsychotic). Like other SSRIs, it has a boxed warning for suicidal thoughts and behaviors. 

Lexapro as an alternative to Xanax

Lexapro (escitalopram) is another SSRI that treats anxiety and depression. Like other SSRIs, it can take weeks for the drug to build up in your system and be fully effective. It’s considered a long-term treatment for anxiety, as opposed to Xanax. Common side effects include nausea, diarrhea, trouble sleeping, dry mouth, and delayed ejaculation.

Effexor or Xanax

Effexor is an SNRI (serotonin and norepinephrine reuptake inhibitor). SNRIs target 2 neurotransmitters — serotonin and norepinephrine — as opposed to just one, like the SSRIs on this list. It’s available in an immediate-release and extended-release (XR) form. Immediate-release Effexor is used to treat generalized anxiety (an off-label use), social anxiety disorder, panic disorder, depression, and OCD. Effexor XR is FDA-approved for GAD. 

Effexor isn’t a controlled substance like Xanax, so there’s no risk of dependence. But, it does have a boxed warning for suicidal thoughts and behaviors. Sleepiness is a much less common side effect of Effexor vs Xanax. But, nausea is more common.

Cymbalta as a Xanax alternative

Cymbalta (duloxetine) is FDA-approved to treat depression, anxiety, and chronic pain conditions. It’s another SNRI, so it works by boosting your brain’s levels of serotonin and norepinephrine. Like Xanax, Cymbalta can cause sleepiness. But, nausea and headache are more common side effects. Cymbalta shouldn’t be used by people taking MAOIs. It carries a boxed warning for suicidal thoughts and behavior.

Pristiq instead of Xanax

Pristiq (desvenlafaxine) is an SNRI that treats depression. It’s prescribed off-label for anxiety. Pristiq shares some side effects with Xanax, including dry mouth and sleepiness. Nausea, constipation, and decreased appetite are more common with Pristiq. Pristiq may have fewer side effects overall. Pristiq has a boxed warning for suicidal thoughts and behavior. It shouldn’t be used by people taking MAOIs.

Wellbutrin vs Xanax

Wellbutrin (bupropion) is an oral antidepressant that can be prescribed off-label for anxiety. Wellbutrin treats anxiety by increasing norepinephrine and dopamine levels. Common side effects include headache, dry mouth, nausea, difficulty sleeping, and dizziness. Wellbutrin carries a boxed warning for suicidal thoughts and behaviors. It shouldn’t be used by people taking MAOIs or those who experience seizures or eating disorders. 

Spravato instead of Xanax

Unlike the other Xanax alternatives on our list, Spravato (esketamine) is a nasal spray. It treats treatment-resistant depression and suicidal symptoms in adults and is used off-label for anxiety. Spravato works by targeting N-methyl-D-aspartate (NMDA) receptors in the brain. Both Spravato and Xanax can make you feel sleepy. Side effects unique to Spravato include vertigo, feeling drunk, and changes in taste. Spravato and Xanax have similar boxed warnings for substance abuse and misuse. Spravato also carries warnings for sedation and suicidal thoughts and behavior.

4 therapy complements or alternatives to Xanax 

Therapy helps with anxiety, and can be an effective alternative to Xanax or a complement to Xanax or another medication. 

Cognitive behavioral therapy 

Cognitive behavioral therapy (CBT) is considered the first-line therapeutic treatment for anxiety. In CBT, your therapist works with you to identify the intrusive thoughts and behaviors contributing to your anxiety. Then, they give you tools to replace them with healthier coping strategies.

Exposure therapy for anxiety

Exposure therapy works by exposing you to things that trigger your anxiety. For example, if you’re undergoing exposure therapy for social anxiety, your therapist might walk through an anxiety-inducing scenario with you, such as a birthday party. Then, they’ll give you guidance for facing it in real life. 

Psychodynamic therapy

Psychodynamic therapy aims to uncover the repressed thoughts and feelings behind your anxiety. Sessions focus on digging into your past experiences, so you can identify unresolved conflicts and work through them. 

Transcranial magnetic stimulation (TMS)

TMS uses magnetic pulses to stimulate parts of your brain that regulate your mood. The pulses are delivered via a magnetic coil placed over your scalp. The procedure is non-invasive. Therapists may use TMS to treat generalized anxiety disorder or social anxiety disorder.

Many licensed healthcare professionals offer anxiety therapy online. Find a provider on Klarity Health today, and you begin anxiety treatment online with medication and/or therapy. 

7 natural alternatives to Xanax

Natural alternative treatments to Xanax for anxiety include natural remedies, over-the-counter supplements, acupuncture, and mindfulness techniques.

Natural supplements for anxiety

Several herbs and medicinal plants can have a mild anxiety-relieving effect. According to research, these include:

• Lavender
• Lemon balm
• Valerian root
• Passionflower
• Chamomile
• Saffron
• Black cohosh
• Chasteberry

You can find these in over-the-counter supplements and teas.

Mindfulness for anxiety

Mindfulness exercises focus on tuning into the present moment, without judgment. When other thoughts come up, you accept them without judgment and turn back to what you are focusing on. For example, a visual meditation can help you focus on a peaceful place you imagine, such as a shady spot by a beach. Yoga also incorporates mindfulness and has shown to be effective at relieving anxiety. 

Breathing exercises for anxiety relief

Focusing on your breathing can be another form of mindfulness. Deep breathing exercises can calm you during an intense bout of anxiety. You can also use them to clear your mind and relax before falling asleep. 

Grounding techniques 

Grounding relies on the idea that touching the ground, and connecting with the earth’s natural energetic current, can be healing. Grounding helps you slow down and reconnect with something stable (in this case, the earth), which may help with anxiety and panic attacks. The 333 rule is another grounding technique for anxiety. You stop and count 3 things you can see, 3 you can hear and 3 you can touch.

Acupuncture for anxiety

Studies show that acupuncture can help with situational anxiety, such as undergoing an operation. However, recent research suggests it can also reduce general anxiety, making it a potential option for people interested in natural alternatives to Xanax.

Exercise and diet

Certain forms of exercise, such as yoga and tai chi, relieve anxiety by incorporating body movement, breath, and mindfulness. Other forms, such as running, can be a helpful addition as part of a holistic therapy for mental health. Improving your diet may also relieve anxiety, thanks to the gut-brain connection. Specifically, researchers recommend avoiding sugar, artificial sweeteners, and gluten. Instead, they recommend plenty of vitamin D, omega-3 fatty acids, and turmeric. High-fat, low-carb diets, such as the ketogenic diet, may also be helpful. 

Good sleep for anxiety

Poor sleep and anxiety go hand in hand. If you’re having trouble sleeping, you might start feeling anxious. And if you’re anxious, you’re going to have a tough time sleeping. Thankfully, research shows that improving either one can also relieve the other. Try improving your sleep. Make time to get a full 7 to 9 hours per night and follow the same sleep schedule every day. To fall asleep, practice anxiety-relieving breathing and mindfulness techniques. And if needed, consider getting treatment for insomnia.

Key takeaway

• Xanax is one of the most prescribed medications for anxiety, but it’s not a good fit for everyone.
• Pharmaceutical alternatives to Xanax include other benzodiazepines, SSRIs, SNRIs, and other antidepressants.
• Natural alternatives to Xanax include herbal supplements, mindfulness exercises, and exercises like yoga.
• Talk therapy and acupuncture have also shown promise in treating anxiety.

Affordable, caring anxiety treatment is a click away

Anxiety is treatable. The key is to find a treatment plan that works for you. You’ve already taken the first step towards relief by reading this article. Now, it’s time to connect with a therapist or psychiatrist on Klarity Health. Find a provider today.