What You Need to Know About Your Anxiety Medication

While the primary treatment for anxiety is typically therapy, medication is often prescribed alongside therapy to help reduce and control symptoms.

If you have an anxiety disorder, you may be considering asking your doctor about whether you should take medication and how it works. You may also be worried about the side effects of anxiety medication, and whether it will impact your productivity and life.

What kinds of anxiety medication are there?

There are a variety of types of medication¹ that can be prescribed to help treat anxiety. Not all medications work for everyone, and you may have to try more than one medication to find the one that is right for you.

The different types of medication include:

Selective serotonin reuptake inhibitors (SSRIs)

Although generally given as antidepressants to help treat depression, SSRIs can also relieve anxiety symptoms. They can also assist when you have both anxiety and depression, which is fairly common, as constant worry can lead to feeling depressed. You may have to take SSRIs for two to six weeks before seeing improvements in your symptoms of anxiety.

Selective norepinephrine reuptake inhibitors

These work in a similar way to SSRIs and can sometimes benefit patients who don't respond to SSRIs.

Pregabalin

Pregabalin is a medication that is more often prescribed for chronic pain and epilepsy. However, it has shown to be effective in clinical trials for generalised anxiety disorder (GAD). While not yet approved by the FDA for this purpose, it may be prescribed off-label.

Benzodiazepines

Benzodiazepines² include diazepam (Valium)  and alprazolam ( Xanax). These drugs are not recommended for long-term use as they can become addictive and eventually lose their effectiveness over time. However, they are very fast-acting, which makes them useful for immediate relief if you experience a panic attack or face a specific anxiety-inducing situation, such as a trip to the dentist.

Buspirone

This is an anxiolytic that works well for GAD. As long as a patient does not rely on this medication and becomes addicted, it can often be prescribed to those who have a history of substance abuse.

Beta blockers

Beta blockers work by blocking the effects of norepinephrine and epinephrine. They are most commonly used to treat high blood pressure and heart problems. However, they are also known to reduce the symptoms of the fight-or-flight response a person experiences when facing a stressful situation. Because of this, they are often prescribed off-label for anxiety. For example, many people with performance anxiety may take a single dose of a beta blocker before a show to calm their nerves.

A doctor may also prescribe medication to treat specific physical symptoms caused by anxiety. For example, if your insomnia is particularly severe, they might prescribe a sleeping drug such as zolpidem (Ambien) or suggest you try melatonin.

Many anxiety medications are prescribed off-label³ by experienced clinicians. Beta blockers, for example, are approved for high blood pressure and heart problems, as well as being used off-label for anxiety.  Your prescribing doctor will be able to discuss with you their reasons for recommending a particular medication off-label, and help you make an informed and evidence-based decision about taking it.

Different medications are prescribed to help with different situations. You might be prescribed SSRIs if you have long-term, chronic anxiety in combination with depression. However, if you have a less severe case of anxiety, such as being terrified about giving a presentation at work, your doctor might simply give you a beta blocker to take before the presentation.

Can medication cure anxiety?

No. There is no magic pill you can take to cure your anxiety forever. What medication can do is reduce the extent to which your symptoms interfere with your daily life.

Anxiety disorders cannot be cured, whether through therapy or medication, but they can be sent into remission, meaning you no longer experience routine symptoms of anxiety. A common approach to managing anxiety is with both psychotherapy and medication, but some prefer to use either therapy or medication alone. There is no right way as each approach depends on your individual needs. What is most important is that you are able to control your symptoms and lead a life you enjoy.

Side effects of medication

It's understandable to be concerned about the side effects you may experience from taking anxiety medications (or any kind of medication). It's worth remembering that many side effects are rare or mild, but your doctor will still be required to advise you of them. Doctors typically only prescribe medication when they assess that the benefits outweigh the risk of side effects.  With some types of medication, any side effects go away as your body gets used to the medication.

The most common side effects for each type of anxiety medication are:

SSRI and SNRI antidepressants

SSRIs and SNRI antidepressants can cause fatigue, nausea, agitation, weight gain, digestive troubles, insomnia, headaches, dry mouth, increased sweating, and sexual dysfunction. SNRIs can also increase blood pressure. In some people, they can actually make anxiety or depression worse. Many side effects appear at their worst in the first week then lessen or go away entirely after a few weeks. However, some side effects can be long-term, including sexual dysfunction, weight changes, and emotional numbness.

It's important not to go cold turkey by immediately stopping taking antidepressants as this can cause withdrawal symptoms, including extreme depression, anxiety, insomnia, and flu-like symptoms.

Pregabalin

Pregbalin can cause drowsiness, dizziness, increased appetite, weight gain, lack of coordination, blurred vision, headaches, and dry mouth. However, it is less likely to interfere with your sex drive. Very rare but serious side effects are an increase in suicidal thoughts and hypersensitivity reactions.

Benzodiazepines

Benzodiazepines can cause drowsiness, difficulty concentrating, headaches, vertigo, tremor, low sex drive, impaired memory, and concentration. You should not drink alcohol, drive, or operate machinery while taking benzodiazepines. Benzodiazepines are generally prescribed for short-term or acute use. If you are prescribed a dose to deal with a medical procedure or a similar event, you will need somebody to drive you to and from the appointment.

Benzodiazepines should be used carefully according to your doctor’s advice, due to the risk of developing a physical dependency on them. If you have been taking them daily for a significant amount of time, you should be careful about stopping suddenly, as this can result in life-threatening withdrawal.

Buspirone

Buspirone can cause drowsiness, nausea, sleep problems, weight gain, headaches, upset stomach, constipation, nervousness, diarrhea, and dry mouth.

Beta blockers

Beta blockers can cause dizziness, fatigue, weakness, nausea, headache, constipation, and diarrhea. They can also affect blood pressure, heart rate, and the cardiovascular system, as they were originally developed as a heart medication.

While side effects may seem scary, not everyone who takes these drugs experiences them, they often go away, and your doctor will work with you to find a medication that works best for your body and/or has side effects you can tolerate. Drowsiness or fatigue are particularly common side effects of anxiety medication, so many people need to avoid driving while on a new medication.

Whenever starting a new medication, it’s always a good idea to ask your doctor or pharmacist about any side effects to watch out for, as some people may be more prone to side effects than others, depending on age and medical history. It’s also helpful to read the Medication Guide that comes with your medications.

When should you ask your doctor about anxiety medication?

You may want to consider asking your doctor about anxiety medication if you experience any of the following:

• Your anxiety is associated with depression.

• Anxiety is affecting your ability to function at work, school, or in your social life and relationships.

• You have specific things you want or need to be able to do that your anxiety is preventing you from doing, such as going to the dentist, speaking at a work meeting, or taking a flight to visit a distant family.

• You are unable to attend therapy. This might be because you cannot afford to see a therapist, are unable to find one in your area, or because your anxiety is so severe that it makes it hard to participate in psychotherapy

• You experience acute anxiety attacks or panic attacks which can end up putting you in the ER.

Remember, medication is not a cure, but it can provide relief for your symptoms and improve your quality of life day-to-day while you are working on your anxiety through other methods such as therapy.

Anxiety medication can be prescribed by both your family doctor and by a psychiatrist. Treatment for acute anxiety, such as benzodiazepines, may also be prescribed by dentists to people suffering from severe dental anxiety, but this is situationally specific. If you are having trouble finding the right medication, or it seems that you will need to be on medication long-term, getting a specialist opinion from a psychiatrist may be helpful.

Natural remedies and lifestyle changes for anxiety

Some people prefer to seek out alternative medication and natural remedies to manage the symptoms of anxiety and other conditions. A number of herbal remedies⁴ have been studied as a treatment for anxiety, but none are yet approved.

Talk to your doctor if you are trying herbal remedies for anxiety, especially valerian or kava. Herbal and natural medications can come with their own side effects and can interact with prescribed medication so it is important that you make your doctor aware of what you are taking.

There are also various lifestyle changes you can make that help with anxiety, such as exercise, diet, meditation, and relaxation techniques. You should talk to your doctor or therapist about whether these would be useful to manage your symptoms.

Combining medication and psychotherapy

Although medication can offer benefits, psychotherapy (usually cognitive behavioral therapy) remains the go-to treatment for anxiety. However, just because you are in therapy does not mean you don’t need medication and vice versa.

Typically, medication is used to help you function and control symptoms while you are working on the causes and longer-term management of your anxiety through therapy. As there is no quick fix, medication can help the process along by supporting your functioning day-to-day in the interim.

You could also receive therapy for your anxiety disorder, but have as-needed medication to deal with acute symptoms such as panic attacks.

Your therapist or counselor will work with your doctor or psychiatrist to help determine when it is appropriate to start weaning you off of long-term anxiety medication, such as SSRIs. They will also help you work through withdrawal symptoms and the rebound anxiety that can sometimes happen when you reduce or stop taking medication.

The lowdown

Anxiety medication can help with both chronic and acute symptoms of anxiety. There is a range of types of medication that may be prescribed depending on your individual needs. Medication should be regarded as a tool to help your day-to-day functioning while you learn the skills you need to manage your anxiety in the longer term, as it is not a magic pill that will cure you. Many people with anxiety disorders go into remission with effective therapy and gain the ability to handle anxiety without needing medication.

You should ask your doctor about anxiety medication if your anxiety is seriously affecting your life.