Common Medications Used To Manage Anxiety
Medically reviewed by Arianna Williams, LPC, CCTP
Updated April 16, 2024by BetterHelp Editorial Team
Anxiety disorders are among the most common mental illnesses worldwide. There are various treatments on the market for these conditions, including medication. Understanding the medications most used for anxiety can help you and your doctor come to a decision about the treatments you may be interested in. However, consult your doctor before starting, changing, or stopping any medication or medical treatment for anxiety.
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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 reaction to uncontrolled or traumatic life circumstances and is often temporary. However, several anxiety disorders can cause long-term and severe anxiety that limits daily functioning. In these cases, some people find that taking antidepressants or other medications helps them manage their emotions and find calm.
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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 absorption so your brain can better control mood. They have also been found to boost levels of brain-derived neurotrophic factor, an important protein that is thought to be impaired in people with anxiety. In addition to anxiety and depression, SSRIs can help manage post-traumatic stress disorder, obsessive-compulsive disorders, and eating disorders.
SSRIs are often considered safe and have fewer side effects than other antidepressants. However, SSRIs are not perfect and may result in adverse side effects and discontinuation syndrome when treatment ends.
Taking antidepressants or SSRIs for anxiety is often not considered a first-line treatment unless your doctor believes it is the best option. Doctors often require that clients be diagnosed with or exhibit evidence of an anxiety disorder before being approved for SSRIs or other medications.
Your doctor can help you decide what SSRIs are best to treat your anxiety. Refrain from taking old or expired SSRIs or someone else's SSRIs, as they could prove dangerous. Different medications affect people differently, so do not use other people's medications to treat depression or anxiety.
How do selective serotonin reuptake inhibitors (SSRIs) work?
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants with an indication for the long-term treatment of numerous 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 consider the clinically significant differences between the SSRIs, including:
- 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 affect:
- SSRI dosing and administration
- Side effects
- Safety alongside other treatments
- 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
There are a few cautions to consider before taking a medication like an SSRI, including the following.
Consider the side effects
According to the Journal of Clinical Psychiatry, some people will experience side effects when taking SSRIs. Common adverse events may include libido changes, sexual performance challenges, weight gain, and sleep disturbances. Weight loss may also occur during early usage of some SSRIs. Additionally, research suggests that there may be a link between SSRIs and an increased suicide risk, though there is also evidence that they can decrease suicidal thoughts and behaviors.
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The possible side effects may worsen 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.
Understand withdrawal
If you decide to stop taking SSRI for anxiety, you may experience withdrawal-like symptoms. Withdrawal occurs because you may have developed a physical dependence on SSRIs, and your body is adjusting to life without them. To avoid withdrawal-like symptoms when taking SSRIs or other antidepressant medications, work with a doctor when withdrawing and do it slowly. Stopping a medication without consultation and without tapering off can have serious consequences in some cases.
Learn about discontinuation syndrome
You may experience discontinuation syndrome if you stop taking SSRIs after an extended period. 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.
Be patient
Some people may not know that SSRIs take a few weeks to start working. For those first few weeks, you may not experience any changes in your anxiety or depression or 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. High doses can cause severe problems, including seizures and death. Therefore, take what is prescribed and start with a low dose. Even if your anxiety or depression is not subsiding, do not give in to the temptation to take several doses. A low 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. In a broad-based study of the therapeutic efficacy of several different medications for anxiety, researchers found that the SSRI escitalopram was one of the two most effective drugs, exhibiting a comparable efficacy to the SNRI duloxetine. However, each person reacts differently to different medications, and what works for one person might not work for another. For this reason, finding the best SSRI for anxiety depends 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.
What are anxiety disorders?
It can be normal to experience occasional anxiety. However, someone with an anxiety disorder experiences anxiety chronically and more severely. Below is a chart to explain the differences between anxiety and anxiety disorders.
If you recognize the above 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
The following physical symptoms of anxiety are common. However, if you have an anxiety disorder, you may frequently, chronically, or excessively experience two or more of the following:
- 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
Generalized anxiety disorder
Generalized anxiety disorder (GAD) involves persistent, excessive worry and fear that arise in various situations and are difficult to manage. GAD can significantly impact an individual’s social, professional, and personal life. Various SSRIs can reduce symptoms of generalized anxiety disorder effectively. For example, in one placebo-controlled study, researchers concluded that vortioxetine was an effective method of treatment for GAD.
Panic disorder
Individuals who live with panic disorder experience frequent panic attacks—periods of severe anxiety marked by symptoms like racing heart, rapid breathing, sweating, dizziness, gastrointestinal distress, and a feeling of losing control. Panic disorder can lead to an intense fear of experiencing another attack. In a placebo-controlled trial, researchers found that the SSRI escitalopram significantly reduced symptoms of panic disorder. The results of other placebo-controlled trials suggest that fluvoxamine, paroxetine, citalopram, and several other SSRIs can also be effective for panic disorder.
Social anxiety disorder
Social anxiety disorder is characterized by elevated apprehension and nervousness surrounding social situations. It 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—including paroxetine, fluvoxamine, sertraline, and escitalopram—can alleviate social anxiety symptoms.
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Other medications for anxiety
Buspirone
An anxiolytic medication, buspirone is often used as an adjunctive therapy, alongside SSRIs, when treating anxiety. Buspirone is thought to produce fewer adverse effects than many anxiety medications and reduce certain side effects of SSRIs.
Beta-blockers
Typically used to control blood pressure, beta blockers can also be used to reduce anxiety symptoms. Beta blockers are primarily prescribed to alleviate the physical symptoms of anxiety. Some beta blockers have been associated with worsening depression symptoms, so they may not be utilized for people with a history of depressive disorders.
Benzodiazepines
Benzodiazepines are depressant medications that slow activity in the central nervous system. According to experts, benzodiazepines should be used if individuals are still experiencing significant symptoms of anxiety after multiple trials of SSRIs and buspirone.
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 nortriptyline, a type of TCA, led to significant improvements in symptoms of both anxiety and depression in participants. TCAs can also reduce symptoms of chronic pain, a common comorbidity with anxiety disorders.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors are a type of antidepressant that work by preventing monoamine oxidase from breaking down an amino acid called tyramine. MAOIs are often considered a last-line treatment for anxiety because of their significant adverse effects, which can include insomnia, significant weight gain, sexual dysfunction, low blood pressure, and 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 upon signing up. 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.
Takeaway
SSRIs are a typical class of medication that doctors prescribe to treat anxiety. While they are effective for some people, there are a few considerations to keep in mind before you start, change, or stop a medication. You can also reach out to a therapist at any time for non-medical support.
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Frequently asked questions
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. For example, the symptoms of generalized anxiety disorder (GAD) tend to respond well to a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRIs), but panic disorder might respond better to benzodiazepines. Similarly, choosing the best type of SSRI likely depends on the type of anxiety being treated. For instance, two randomized controlled trials found that the SSRI sertraline was the most effective medication to treat panic disorder, while another study found that fluoxetine was superior for the treatment of GAD.
What is the first drug of choice for anxiety?
Until recently, benzodiazepines (BZDs) were the first choice to manage anxiety symptoms due to their rapid onset and satisfactory results. BZDs diffuse through the blood-brain barrier and produce sedative effects by affecting the neurotransmitter GABA. While BZDs are 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 drugs were tested to determine if they had significant anxiety-reducing potential.
Current best practices indicate that selective serotonin reuptake inhibitors or a serotonin-norepinephrine reuptake inhibitor should be used as first-line treatment for anxiety. Both classes of drugs are antidepressants and have a long history of treating 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 have exacerbated anxiety to a greater degree. It may also be possible that those with multiple anxiety disorders experience the impact of the medication differently.
What anxiety medication has the highest success rate?
The success rate of anxiety medications likely 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, the treatment of panic disorders used to be done mainly through the use of benzodiazepines, a class of drugs 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 are addictive and come with other substantial risks. Because of this, the first-line treatment for panic disorders today is typically either an SSRI or SNRI, which have a much safer side-effect profile. However, they cannot be used to slow anxiety quickly, but they have utility as a maintenance treatment. Over time, they 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, social anxiety disorder, and 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, like social anxiety. Determining effectiveness is likely best done on an individual level because not all patients 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, it is important to be open to other types of medications as well. The medical provider treating your anxiety will work with you to decide on the best medication for your specific needs. If the first attempt is ineffective, your provider will likely try a different drug in the same class or switch to a different type of medication. While there are a few side effects associated with SSRIs, they are limited and relatively benign compared to some other medication options. Your medical provider will inform you of a certain medication's potential risks and benefits when prescribed.
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