The main anxiety medications are SSRIs and SNRIs (antidepressants that are usually tried first), buspirone, benzodiazepines and beta-blockers. SSRIs, SNRIs and buspirone are taken daily and need several weeks to work, while benzodiazepines act fast but carry risks of dependence and are generally meant for short-term use. The right choice depends on your symptoms, health history and substance use history, and many people do best with medication plus therapy.
This guide explains how each type of anxiety medication works, what to expect and what safety issues to talk through with your prescriber. It is for education only and is not a substitute for medical advice.
How Anxiety Medications Fit Into Treatment
Medication doesn’t cure an anxiety disorder, but it can ease symptoms enough for you to function and make progress in therapy. For generalized anxiety disorder, Mayo Clinic notes that cognitive behavioral therapy (CBT) is the most effective form of psychotherapy and that a combination of therapy and medication often works best. Your provider will consider how much anxiety is affecting your daily life, other health conditions and any past problems with alcohol or drugs.
SSRIs and SNRIs: Usually the First Choice
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants, but they are also widely used for anxiety. According to the National Institute of Mental Health (NIMH), providers typically start treatment for panic disorder and social anxiety disorder with these medications because their side effects are often easier to tolerate than older options.
Mayo Clinic lists escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva) as examples used for generalized anxiety disorder. For a deeper look at how these drug classes differ, see our guide to types of antidepressants.
What to Expect
- They take time. NIMH notes antidepressants usually take 4 to 8 weeks to work, and sleep, appetite and energy often improve before mood does.
- Side effects are usually mild. Common ones include upset stomach, headache and sexual side effects, which often ease over time.
- A boxed warning applies to young people. Children, teens and young adults under 25 may have an increase in suicidal thoughts or behaviors when starting antidepressants, especially in the first few weeks, so close monitoring is important.
- Watch for interactions. Combining antidepressants with certain medicines or supplements, such as triptans or St. John’s wort, can cause a rare but life-threatening reaction called serotonin syndrome.
If you or someone you love has thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline. In an emergency, call 911.
Buspirone: An Option for Ongoing Anxiety
Buspirone is an anti-anxiety medication (anxiolytic) that works differently from benzodiazepines. MedlinePlus explains that it treats anxiety by changing the amounts of certain natural substances in the brain. Doctors usually start at a low dose and increase it gradually, so it may take several weeks to find a dose that works.
NIMH notes that buspirone must be taken every day for 3 to 4 weeks to reach its full effect and does not work on an as-needed basis. Possible side effects include dizziness, nausea, headache, tiredness, nervousness, trouble sleeping and drowsiness. MedlinePlus advises not driving until you know how it affects you.
Benzodiazepines: Fast Relief With Serious Risks
Benzodiazepines, such as alprazolam (Xanax) and lorazepam, are commonly prescribed for panic disorder and calm anxiety quickly. NIMH’s panic disorder guide notes they can rapidly reduce symptoms but carry a risk of dependence. Because of this, providers usually prescribe them for short periods and taper the dose gradually when stopping.
What the FDA Boxed Warning Says
In 2020, the U.S. Food and Drug Administration (FDA) required an updated boxed warning for all benzodiazepines. It highlights:
- Risks of abuse, misuse, addiction, physical dependence and withdrawal reactions
- Risk of overdose and death, especially when combined with opioids, alcohol or other drugs
- That stopping suddenly or cutting the dose too fast can cause serious withdrawal reactions, including life-threatening seizures
- That dependence can develop within days to weeks, even when the medication is taken as prescribed
The FDA also noted there is no standard tapering schedule that fits everyone, so any plan to stop should be individualized and supervised. Benzodiazepine withdrawal can be life-threatening and needs medical supervision. Never stop or cut back on your own. Our benzodiazepine withdrawal timeline explains what that process involves.
Who Should Be Extra Cautious
Mayo Clinic notes that benzodiazepines can be habit-forming and aren’t a good choice if you have or have had problems with alcohol or drug use. If you notice you are taking more than prescribed, running out early or using benzos with alcohol, read about the signs of Xanax addiction and talk with a provider. Our benzodiazepine addiction hub covers treatment options.
Beta-Blockers for Physical Symptoms
Beta-blockers are heart and blood pressure medications that can ease the physical side of anxiety, like a racing heart, shaking or trembling. NIMH notes they may be prescribed off-label for short-term anxiety, such as before a known stressful event for someone with a phobia. They don’t treat worried thoughts, and NIMH says they are generally not recommended for people with asthma or diabetes because they may worsen those conditions.
Safety Tips for Any Anxiety Medication
- Don’t stop suddenly. NIMH advises never stopping a prescribed medication, even if you feel better, without your provider’s help. Stopping abruptly can cause unpleasant or harmful effects.
- Share your full history. Tell your prescriber about alcohol or drug use, other medicines and supplements.
- Be careful with herbal remedies. Mayo Clinic warns that some supplements, such as kava and valerian, may increase the risk of serious liver damage.
- Give it time and check in. If side effects bother you or you see no change after several weeks, ask about adjusting your plan rather than quitting.
Not sure who should manage your medication? Our guide to psychiatrist vs. therapist explains the difference.
Frequently Asked Questions
What is the most common medication for anxiety?
SSRIs and SNRIs are often tried first for many anxiety disorders, in part because their side effects are usually easier to tolerate than older options.
What anxiety medication works fastest?
Benzodiazepines work quickly, but they carry risks of dependence, withdrawal and overdose when mixed with opioids or alcohol, so they are usually limited to short-term use.
Are there alternatives to benzodiazepines for anxiety?
Yes. SSRIs, SNRIs and buspirone are taken daily for ongoing anxiety, and therapy such as CBT is highly effective. Ask your provider which option fits your history, and never stop any medication suddenly.
Do I have to take anxiety medications forever?
Not necessarily. Many people use medication alongside therapy, then work with their provider on a gradual plan to reduce or stop it when they are ready.
Get Help for Anxiety in Lancaster, PA
Medication works best as part of a full treatment plan. At The Ranch Pennsylvania Outpatient Services, our mental health treatment programs combine psychiatric evaluation and medication management with CBT, DBT and group therapy. Our intensive outpatient program lets you keep living at home, and our partial hospitalization program offers more structure. If benzodiazepine or other substance use is part of the picture, integrated dual diagnosis care is available. Verify your insurance to learn about coverage. Our admissions team is available 24/7, and calls are free and confidential.
