Anti-Anxiety Medication

What is anti-anxiety medication?

Anti-anxiety medications are often used to treat mental health disorders in which symptoms of anxiety occur, such as generalized anxiety disorder, social anxiety disorder, and panic disorder ^[1].

Symptoms of anxiety disorders may include ^[2]:

• Rapid heart rate
• Sweating
• Shaking
• Stomachache
• Feeling unable to stop worrying
• Trouble concentrating
• Sleep disturbances
• Intense or excessive fear of specific stimuli
• Avoidance of situations that induce anxiety

Obsessive compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are no longer listed as anxiety disorders in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ^[3][4] but share several symptoms with anxiety disorders and are thus able to be treated with similar medications ^[5][6].

There are several different types of anti-anxiety medication, each of which works in a slightly different way in the brain. Many medications used to treat anxiety disorders are also used to treat other mental health conditions, as they can impact a variety of symptoms, along with producing varying side effects ^[1].

Medications often work differently for different people, so what is effective for one person may not be effective for another. As such, many people need to try more than one medication, or a combination of medications, to find the most effective treatment ^[5].

Types of anti-anxiety medication

There are various types of medication used as anti-anxiety treatments, all of which work by impacting the action and transmission of various neurotransmitters in the brain. Each type of medication has a slightly different action, so impact varying symptoms and produce different side effects ^[1]. 

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are an antidepressant medication that has also been found to be effective in treating symptoms of anxiety. They are generally considered to be a safe medication, as they produce few side effects and have a low risk of drug interaction ^[7][8].

SSRIs work by reducing the reuptake of serotonin, thereby increasing the concentration of serotonin in the brain. Research indicates that low serotonin levels negatively impact mood, anxiety, and sleep, so an increase of serotonin can help to improve these symptoms ^[9].

Also, many people with an anxiety disorder also experience symptoms of depression, so SSRIs are a useful treatment for those who experience symptoms of both conditions ^[1].

Commonly prescribed SSRIs include ^[5]:

• Sertraline
• Fluoxetine
• Citalopram
• Escitalopram
• Paroxetine

SNRIs

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also a type of antidepressant medication that are commonly used to treat anxiety disorders, and generally considered to be effective and produce few side effects ^[8].

Similar to SSRIs, SNRIs impact serotonin levels, but also have a similar action on norepinephrine, increasing the concentration of this neurotransmitter in the brain ^[10].

Research shows that norepinephrine regulates stress and arousal responses, indicating that low levels can increase symptoms of anxiety ^[11]. As such, the combination of effects on serotonin and norepinephrine allows for effective treatment of anxiety disorders.

Commonly prescribed SNRIs include ^[8]:

• Duloxetine
• Venlafaxine

Benzodiazepines

Benzodiazepines are often prescribed to treat symptoms of anxiety disorders, as they are fast-acting and effective. However, they also are commonly abused and can lead to addiction and dependence, as well as producing potentially serious side effects. As such, benzodiazepines are recommended only for short-term use ^[1][8].

Benzodiazepines work by increasing the action of the neurotransmitter, gamma-aminobutyric acid (GABA), which inhibits activity in the central nervous system ^[12]. By enhancing GABAergic activity, benzodiazepines can very quickly reduce symptoms of anxiety, hence their popularity ^[5].

Commonly prescribed benzodiazepines include ^[8]:

• Lorazepam
• Diazepam
• Alprazolam
• Clonazepam

TCAs

Tricyclic antidepressants (TCAs) increase the concentration of serotonin and norepinephrine in the brain, like several other antidepressant medications, so can help to reduce symptoms of anxiety. However, they are also known to cause several intolerable side effects, as well as a high risk of overdose with low doses, so are not commonly prescribed ^[1].

Clomipramine is a TCA that is often prescribed to treat obsessive-compulsive disorder (OCD) ^[5].

Antihistamines

Antihistamines are typically prescribed to treat allergies but can also reduce symptoms of anxiety. As a neurotransmitter, histamine is believed to regulate levels of norepinephrine and serotonin, thus improving mood and reducing anxiety. Antihistamines can also have a sedating effect, which can help to reduce sleep disturbances common with anxiety disorders ^[5][8].

Hydroxyzine is an antihistamine medication that is prescribed as an anti-anxiety medication ^[8].

Azapirones

Azapirones are a class of medication that can be used to treat depression and anxiety. They work by increasing levels of serotonin, thus improving mood and symptoms of anxiety ^[1][8].

Buspirone is an azapirone that is prescribed as an anti-anxiety medication ^[8].

Side effects of anti-anxiety medication

When starting a new medication, it is common to experience side effects, but they will usually reduce as your body adjusts to the new medication. If any side effects persist or become problematic, it is important to contact your doctor, as you may need a reduced dose or a change of medication ^[1].

SSRIs, SNRIs, TCAs

Common side effects of most antidepressant medications used to treat anxiety include ^[5][7]:

• Stomach upset, including constipation, diarrhea, nausea, and vomiting
• Headache
• Sleep disturbances
• Drowsiness
• Dry mouth
• Change in appetite and weight
• Sexual dysfunction, such as reduced libido and erectile dysfunction

Suicidal thoughts

It is common for antidepressant medications to cause suicidal thoughts, particularly at the start of treatment. This risk has been found to be higher in people under the age of 25 ^[7].

If you or your family members notice any concerning changes in your mental state, or you have any thoughts of harming yourself, contact your doctor or mental health professional immediately.

Benzodiazepines

Common side effects of benzodiazepines include ^[5]:

• Drowsiness and sedation
• Dizziness
• Potential for abuse and dependence (recommended only for short-term use)

Withdrawal symptoms

Benzodiazepines can cause withdrawal symptoms when the medication is stopped. This risk is increased with higher doses, prolonged treatment, and abruptly stopping treatment ^[1][13].

Withdrawal symptoms can worsen symptoms of anxiety disorders and may include ^[13]:

• Agitation
• Panic attacks
• Sleep disturbances
• Muscle aches and stiffness
• Irritability

Your doctor will likely gradually reduce your prescription to prevent withdrawal symptoms from occurring ^[1].

Other side effects

Other side effects of anti-anxiety medications can include ^[5][6]:

• Sedation
• Dizziness
• Nausea
• Headache
• Dry mouth
• Constipation

It is important that during your treatment you attend all arranged appointments with your doctor and to tell them about any side effects that you experience, so that they can monitor your physical and mental health and prevent or treat any serious effects that occur.

What disorders does anti-anxiety medication treat?

Some anti-anxiety medications are approved by the US Food and Drug Administration (FDA) for only one specific use, while others may be prescribed for several uses. Medications can also be prescribed for uses that are not approved by the FDA but have been deemed necessary for treatment by a medical professional, known as off-label use.

Some of the conditions that can be treated by the various types of anti-anxiety medications include ^{[1][5][8][14][15]}:

• Generalized anxiety disorder
• Panic disorder
• Social anxiety disorder
• Specific phobias
• Agoraphobia
• Obsessive-compulsive disorder (OCD)
• Posttraumatic stress disorder (PTSD)
• Insomnia
• Depression
• Eating disorders
• Alcohol withdrawal

Alternative treatments for anxiety disorders

Often the most effective treatment for anxiety disorders is a combination of medication and talking therapy. Your doctor can discuss with you the available treatment options for your condition ^[1].

Medications

People respond differently to different medications, so to treat anxiety or other disorders in which similar symptoms occur, you may need to try several medications or a combination of medications before you find the most effective treatment.

There are many medications that were designed to treat other mental and physical health conditions but have since been found to be useful in managing symptoms of anxiety as well. Your doctor may prescribe you one of these medications off-label to help you manage your condition. This may include ^[1][5][8]:

• Beta-blockers, such as propranolol
• Anticonvulsants, such as pregabalin or lamotrigine
• Antipsychotics, such as quetiapine, risperidone, or olanzapine
• Atypical antidepressants, such as mirtazapine

Therapies

Talking therapies can help to reduce emotional distress that can occur with certain mental health conditions, and it is recommended to engage in therapy alongside medication, for the most effective treatment. Various types of therapy are available, such as ^[1][2]:

• Talk therapy: Cognitive behavioral therapy (CBT) is one type of talk therapy that can be an effective treatment for anxiety disorders, by providing a better understanding of your condition, increasing tolerance to emotional distress, and teaching how to alter negative thoughts and behaviors.
• Family therapy: Family therapy can help you and your family better understand your condition and discuss any challenges that may be experienced, while providing your family members with support and education about how to help you manage your symptoms.
• Exposure therapy: Some anxiety disorders may benefit from exposure therapy, particularly phobias. Exposure therapy works by gradually increasing exposure to the feared stimulus, eventually resulting in desensitization and a reduction in symptoms of anxiety.

Self-help

Looking after your general well-being can help you to manage the symptoms of your condition, by improving and maintaining your physical and mental wellbeing with self-help techniques, such as ^[1][16]:

• Healthy eating
• Relaxation activities, such as meditation, breathing exercises, or yoga
• Forming and maintaining a regular sleep pattern
• Engaging in regular exercise
• Avoiding drugs and alcohol
• Attending all appointments with your doctor and mental health professionals
• Ensuring you follow advice and treatment plans