Understanding Which SSRIs Are Effective For Anxiety
Anxiety disorders are among the most common mental illnesses worldwide. There are various treatments on the market for anxiety conditions, including medications. Understanding the medications that are most often used for anxiety may help you and your doctor come to a decision about which treatment options to use. However, consult your doctor before starting, changing, or stopping any medication or medical treatment for anxiety.
What are SSRIs for anxiety?
Anxiety is the body's automated alarm system, the fight-or-flight response to a perceived threat. Anxiety can be a normal temporary reaction to uncontrolled or traumatic life circumstances. However, some anxiety can be long-term or severe anxiety that limits daily functioning. In these cases, people may find that taking antidepressants or other medications helps them manage their emotions and find calm.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment method for depression—and are frequently used to manage anxiety as well. SSRIs block serotonin reabsorption so your brain can better control mood. They have also been found to boost levels of brain-derived neurotrophic factor, an important protein that may be impaired in people with anxiety. In addition to reducing anxiety and depression, SSRIs can help individuals manage post-traumatic stress disorder, obsessive-compulsive disorders, and eating disorders.
SSRIs are often considered safe and have fewer side effects than other many other antidepressants. However, these medications can also result in adverse side effects and discontinuation syndrome when treatment ends.
The first step should be to diagnose an anxiety disorder before trying SSRIs or other medications. Taking antidepressants or SSRIs for anxiety may not always be the first-line treatment unless your doctor believes it is necessary. However, each individual situation is different.
Your doctor can help you decide what SSRIs are best to treat your anxiety if you’re interested in trying one of them. Refrain from taking old or expired SSRIs or someone else's SSRIs, as they could be ineffective or dangerous. Different medications affect people differently, so do not use other people's medications to treat depression or anxiety.
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants with an indication for the long-term treatment of anxiety disorders. SSRIs may be one of the first treatments to be prescribed if your doctor suspects an anxiety disorder.
When a doctor considers an SSRI for a prescription, they may consider the clinically significant differences between various SSRIs, including these:
- Efficacy across their recommended dose range
- Efficacy in metabolism across their dose range (kinetics)
- The speed of elimination from the body (half-life)
- How the client's age affects the elimination of the medication from the body
- How the medication affects the metabolism of other medications
These considerations can impact these decisions:
- SSRI dosing and administration
- Possible side effects
- Safety alongside other treatments
- Potential withdrawal effects
- Safety in the case of intraclass switching or switching to another class of antidepressant
What to know about SSRIs before getting a prescription
Here are a few cautions to consider before taking a medication like an SSRI.
Consider the side effects
According to the Journal of Clinical Psychiatry, some people will experience side effects when taking SSRIs. Common adverse effects may include libido changes, sexual performance challenges, weight changes, and sleep disturbances. Additionally, research suggests that there may be a link between SSRIs and increased suicide risk (especially in adolescents and young adults), though there is also evidence that they can decrease suicidal thoughts and behaviors.
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The possible side effects of these medications may be more severe if you take other medications or have other health conditions. According to the same study, people who experience mild side effects often see them disappear after the first few weeks. However, consult your doctor to understand your unique case, as side effects can vary between individuals.
Understand withdrawal
If you decide to stop taking an SSRI for anxiety, you may experience withdrawal-like symptoms. Withdrawal occurs if a person might have developed a physical dependence on SSRIs and the body is adjusting to not having them. To avoid withdrawal-like symptoms when taking SSRIs or other antidepressant medications, work with a doctor when tapering the dose, and do so gradually. Stopping a medication without consultation and without tapering off of it can have serious consequences in some cases.
Learn about discontinuation syndrome
You may experience discontinuation syndrome if you stop taking SSRIs after an extended course of treatment. Discontinuation syndrome occurs when people take themselves off SSRIs or other antidepressant medications too fast. Discontinuation syndrome symptoms include nausea, vertigo, difficulty sleeping, sensory overload, anxiety, and headaches.
Know that SSRIs may not treat other symptoms
If you are living with co-occurring anxiety and depression, know that some SSRIs treat both conditions, while others are only FDA-approved to treat one. Therefore, if you want to treat symptoms of depression and anxiety simultaneously, talk to your doctor about the options available. Therapy may also be a helpful resource for treating multiple mental health conditions, and therapy plus medication simultaneously may be more effective for some people.
Be patient
Some people may not know that SSRIs often take a few weeks to start working. For those first few weeks, you may not experience any changes in your anxiety or depression, and you may experience odd symptoms. Allow several weeks to pass before assessing if your SSRI is helping. In addition, talk to your doctor if you are experiencing any adverse effects.
Consider the dosage
According to the Journal of Clinical Psychiatry, the adverse effects of SSRIs are amplified by the dosage. Higher doses can cause severe side effects for some people, including seizures and death. Take what is prescribed, usually starting with a low dose. Even if your anxiety and depression are not subsiding, do not give in to the temptation to take several doses. A lower dose can result in fewer side effects. You may try high doses or several doses if you get approval from your doctor and have been prescribed this amount.
What are the best SSRIs for anxiety?
There are many SSRIs on the market for anxiety disorders. What works for one person may not work for others, so there is no one “best” SSRI. However, studies have found a few may be more effective in studies of populations. When looking at research on SSRI effectiveness, take what you see at face value and consult your doctor for personalized care and advice.
Finding the best SSRI for anxiety can depend on your unique symptoms, diagnoses, and needs. Your doctor can explain your options and help you find a medication and dosage that reduces your symptoms.
It can be normal to experience occasional anxiety. However, someone with an anxiety disorder experiences anxiety regularly and more severely than occasional anxiety. Below is a chart to explain the differences between anxiety and anxiety disorders.
If you recognize anxiety symptoms in yourself, it may be helpful to consider professional treatment. Other troubling emotional symptoms of an anxiety disorder may include the following:
- Extreme irritability
- A sense of a "blank" mind
- Difficulty concentrating
Physical symptoms of anxiety
People living with anxiety may experience some of these physical symptoms of anxiety. However, if you have an anxiety disorder, you may frequently, chronically, or excessively experience two or more of the following symptoms:
- A pounding heart
- Sweating
- Tension headaches
- Stomach upset and diarrhea
- Dizziness
- Frequent urination
- Shortness of breath
- Involuntary muscle twitches
- Excessive muscle tension
- Shaking or trembling
- Insomnia
List of anxiety disorders
Below are some of the anxiety disorders that can be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These conditions may sometimes be treated with SSRIs, but therapy is also an effective approach for individuals seeking care.
Generalized anxiety disorder
Generalized anxiety disorder (GAD) involves persistent, excessive worry and fear that arises in various situations and is difficult to manage. GAD can significantly impact an individual’s social, professional, and personal life. Various SSRIs may reduce symptoms of generalized anxiety disorder effectively.
Panic disorder
Individuals who live with panic disorder experience frequent panic attacks—periods of severe anxiety marked by symptoms like a racing heart, rapid breathing, sweating, dizziness, gastrointestinal distress, and a sense of losing control. Panic disorder can lead to an intense fear of experiencing another attack. In a placebo-controlled trial, researchers found that certain SSRIs may reduce symptoms of panic disorder. However, discuss these options with your doctor if you’re considering taking medication for panic disorder.
Social anxiety disorder
Social anxiety disorder is characterized by elevated apprehension and nervousness surrounding social situations. This condition can be separated into two categories: generalized social anxiety disorder and non-generalized social anxiety disorder. Generalized social anxiety disorder can arise in various situations, while non-generalized social anxiety disorder typically occurs during specific events or scenarios. Research suggests that multiple SSRIs can alleviate social anxiety symptoms.
Medication categories often used to treat anxiety
Doctors may prescribe the following medication types to treat anxiety. You may discuss these options with your provider if interested in trying medication.
Beta blockers
Typically used to control blood pressure, beta blockers can also be used to reduce anxiety symptoms, especially the physical symptoms of anxiety. Some beta blockers have been associated with worsened depression symptoms, so they might not be utilized for people with a history of depressive disorders.
Benzodiazepines
Benzodiazepines enhance the activity of gamma aminobutyric acid (GABA), an inhibitory neurotransmitter, resulting in slowed activity in the central nervous system. According to experts, benzodiazepines can be used if individuals are still experiencing significant symptoms of anxiety after multiple trials of SSRIs. However, these medications can cause dependency, so discuss the risks with your doctor before starting benzodiazepines.
Tricyclic antidepressants
Considered particularly effective for people with severe depression, tricyclic antidepressants (TCAs) can also be used to alleviate anxiety. In an analysis of three placebo-controlled trials, researchers found that a few types of these medications could lead to significant improvements in symptoms of both anxiety and depression in participants. TCAs may also reduce symptoms of chronic pain, a common comorbidity with anxiety disorders.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) are a type of antidepressants that prevent monoamine oxidase from breaking down an amino acid called tyramine. MAOIs are often considered a later treatment for anxiety because of their significant adverse effects, which can include insomnia, significant weight gain, sexual dysfunction, low blood pressure, and the increased risk of serotonin syndrome.
Non-medical support options
In some cases, those with anxiety respond better to non-medical treatment options, like therapy. If you experience barriers to in-person therapy, you can receive support online through an online platform like BetterHelp.
Online therapy matches you with a qualified therapist, often within 48 hours. You don't have to worry about being on a waiting list, and you can attend sessions from the comfort of your home or anywhere you have an internet connection. Attending sessions online, you can communicate with your therapist via phone, video, or live chat and send messages throughout the week.
Research shows that online therapy, specifically cognitive-behavioral therapy, may be more effective than medications for some people. Talk to your doctor to determine what treatment is best for you.
The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.
Takeaway
Read more below for answers to questions commonly asked about this topic.
Which SSRI works best for anxiety?
The best medication for anxiety depends on what type of anxiety is being treated and individual factors. For example, the symptoms of generalized anxiety disorder (GAD) tend to respond well to selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), but panic disorder might respond better to benzodiazepines. Talk to your doctor if you’re interested in trying anxiety medication, as each person can have different results with different medications.
What is the first medication of choice for anxiety?
Benzodiazepines (BZDs) may have been a popular choice for treating anxiety in the past due to their rapid onset and efficacy. BZDs diffuse through the blood-brain barrier and produce sedative effects by enhancing the effects of the neurotransmitter GABA. While BZDs may be powerful tools for controlling anxiety, they have a significant addictive potential and may produce withdrawal symptoms when discontinued. Because of the risks associated with BZDs, other medications may effectively treat anxiety without these higher risks.
Current best practices indicate that an SSRI may be the best first-line pharmacologic treatment for anxiety. SSRIs have a long history of treating anxiety disorders, major depressive disorder, and other mood disorders. In recent years, more antidepressants have gained FDA approval for the treatment of anxiety as greater numbers of randomized controlled trials support their use.
Does anxiety get worse when starting an SSRI?
There is some evidence to suggest the possibility of worsening anxiety when starting an SSRI. One study found that 15% of people with major depression experienced an increase in anxiety within the first two weeks of starting an SSRI. However, the same study found that around 50% of participants reported a decrease in anxiety, with the rest of the participants reporting no change. It is possible that older medications, such as tricyclic antidepressants, may exacerbate anxiety more than SSRIs. It may also be possible that those with multiple anxiety disorders experience the impacts of medications differently. Everyone is different, so discuss medication options with your doctor.
What anxiety medication has the highest success rate?
The success rate of anxiety medications often depends on which anxiety disorder they have been prescribed to treat, the medication’s side effect profile, and the unique neurobiology of the person taking it. For example, panic disorders has traditionally been treated with benzodiazepines, a class of medications that relieve anxiety rapidly and can be taken at the start of a panic episode to stop symptoms before they develop.
While they may seem like an ideal medication for anxiety, benzodiazepines can be addictive and come with other substantial risks. As a result, the first-line treatment for panic disorders may be an SSRI, which has a much safer side effect profile. However, SSRIs do not ease anxiety quickly and are usually more effective as a maintenance treatment. Over time, they may help patients reduce the number of panic episodes that they have. SSRIs are also first-line treatments for other anxiety disorders, such as generalized anxiety disorder and social anxiety disorder, as well as conditions like obsessive-compulsive disorder.
What is considered the most effective SSRI?
The effectiveness of SSRIs varies considerably based on the person being treated and their diagnosis. Some SSRIs work well for depression but show less efficacy when used to treat anxiety, while others show strong promise for treating general anxiety but are less effective when treating other anxiety disorders. Determining SSRI effectiveness depends on the individual, as not all people respond to medication in the same way.
Is it worth taking SSRIs for anxiety?
There is substantial evidence that SSRIs are an effective treatment for most types of anxiety. However, these results can vary between people. The medical provider treating your anxiety can work with you to decide on the best medication for your specific needs. If the first attempt is ineffective, your provider may try a different medication in the same class or switch to another class. While there are a few side effects associated with SSRIs, they are often limited and relatively benign compared to some other medication options. Your medical provider can inform you of a certain medication's potential risks and benefits when prescribed. Therapy is a non-medical option that may also be helpful in reducing symptoms of anxiety and can often be offered alongside medication management.
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