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Psychiatrists, family doctors or other doctors can prescribe medications for anxiety disorders. These doctors often work closely with psychologists, social workers or therapists. Although medications won't cure an anxiety disorder, they can help control symptoms and help you lead a normal, fulfilling life.
Often, anxiety disorders can occur with depression. Sometimes, anxiety disorders may appear with eating disorders or substance abuse problems. All these disorders must be treated.
| Class of Medication |
Most Common Medications Used |
How They Are Used |
Precautions |
Common Side Effects |
| Benzo- diazepines |
lorazepam (Ativan®)
diazepam (Valium®)
clonazepam (Klonopin®)
alprazolam(Xanax®) |
High-potency benzodiazepines relieve symptoms quickly and have few side effects, although drowsiness can be a problem. These medications may be used for six months to a year. Klonopin is used to treat social phobia and generalized anxiety disorder (GAD). Xanax is used to treat panic disorder and GAD. Ativan is used to treat panic disorder. |
May make it dangerous to drive or operate some machinery. Do not drink alcohol when taking benzodiazepines, because the interaction can cause serious problems and even death. May have withdrawal symptoms when stopping. Sometimes can rebound. |
Few side effects. But may cause drowsiness, loss of coordination, tiredness, and mental slowing or confusion. |
| Beta-blockers |
propranolol (Inderal® and Inderide®) |
Your doctor may prescribe a beta-blocker if you are anticipating an attack. The beta-blocker helps keep your heart from pounding, your hands from shaking and other physical symptoms from developing. |
If propranolol is stopped suddenly, it may cause chest pain or heart attack in some people. |
Side effects not common. But if they are severe or do not go away, call your doctor. Side efffects: dizziness or lightheadedness, trouble sleeping, feeling very tired, stomachache, vomiting, rash, diarrhea or constipation. |
| Anxiolytic |
buspirone (Buspar®) |
Must be taken consistently for at least two weeks before getting better. Cannot be used as an as-needed basis. May keep heart from pounding, hands from shaking and other physical symptoms from developing. Is used to treat GAD. |
Certain medications such as anticonvulsants, antihistamines, sleeping pills, vitamins, sedatives and painkillers may interact. |
Side effects are uncommon, Tell your doctor if any of these symptoms are severe or do not go away: Tiredness, stomachache, vomiting, constipation, diarrhea, headache, dry mouth, depression, excitement, trouble sleeping and lightheadedness. |
| SSRIs (selective serotonin reuptake inhibitors) |
fluoxetine (Prozac®)
paroxetine (Paxil®)
sertraline (Zoloft®)
citalopram (Celexa®)
fluvoxamine (Luvox®)
escitalopram (Lexapro®) |
These are usually medications that doctors may use first in treating depression because of low rate of side effects. Is used to treat panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress syndrome and social phobia |
Do not take with MAOIs, an older antidepressant class. Must be used carefully if given to people with bipolar disorder.
 See the alerts below. |
Side effects may include sexual problems, which might not go away unless the medication is stopped. Side effects that usually go away may include headache, nausea, trouble sleeping and agitation. |
| SNRIs (serotonin norepinephrine reuptake inhibitors) |
venlafaxine XR (Effexor®) |
Affects the uptake of the brain chemicals serotonin and norepinephrine. It's less likely to cause seizures or harm the heart. Can treat generalized anxiety disorder. Has relatively few side effects. Is used to treat generalized anxiety disorder and social phobia. |
A small number of people may see blood pressure rise. Higher doses may increase the risk of side effects. Cholesterol may increase.
See the alert below. |
Side effects increase as dose increases. Short-term nausea, sleepiness, dry mouth, dizziness, constipation, nervousness, sweating, abnormal ejaculation, confusion, sight problems, nausea, tremor and loss of appetite. A small number of people may see blood pressure rise. May increase cholesterol. |
| Tricyclics |
imipramine (Tofranil®)
nortriptyline (Pamelor®)
clomipramine (Anafranil®) |
Older than SSRIs and may work just as well as the SSRIs, but many doctors prefer newer drugs because the tricyclics sometimes cause more side effects. Is used to treat OCD and co-occurring anxiety disorders and depression. Anafranil is used to treat OCD and Tofranil is used to treat panic disorder and GAD. |
Talk to your doctor about using this during pregnancy. May interact with other drugs. Be sure to tell your doctor everything you take. Can cause cardiac arrhythmias, or irregular heartbeats.
See the alert below. |
More likely to cause side effects than SSRIs. Can cause dizziness, drowsiness, dry mouth and weight gain. |
| MAOIs (monoamine oxidase inhibitors) |
phenelzine (Nardil®)
tranylcypromine (Parnate®)
isocarboxazid(Marplan®)
selegine patch(EnSan®) |
MAOIs are the oldest class of antidepressants. Parnate is used to treat panic disorder and social phobia. |
Must follow a restrictive diet because MAOIs can interact with some foods and beverages, such as cheese and red wine. May also interact with medications, including SSRIs, which may cause dangerous elevations in blood pressure or other life-threatening reactions.
See the alert below. |
Signs of unusually high blood pressure: Chest pain, large pupils, change in heartbeat, headache, sensitivity to light, heavy sweating, vomiting and stiff or sore neck Common: Blurred vision, less urine, sexual problems, dizziness or lightheadedness, feeling tired, mild headache, increased hunger or weight gain; sweating, muscle twitching during sleep, nausea, restlessness, trembling, tiredness and trouble sleeping
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Antidepressants
A number of medications that were originally approved to treat depression can also help with anxiety disorders. You may not see results right away; it may take several weeks before symptoms start to fade. So don't get discouraged, and do not stop taking your medicines.
Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
Some newer antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These medications act in the brain on a chemical messenger called serotonin. SSRIs tend to have fewer side effects than older antidepressants. People sometimes report feeling slightly nauseated or jittery when they first start taking SSRIs, but those side effects usually go away. Some people also have sexual problems when taking some SSRIs, which may be ongoing. Tell your doctor about your side effects to see if you need to change medications or the dose.
Paxil, an SSRI, may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
Tricyclics have been around longer than SSRIs and have been more widely studied for treating anxiety disorders. They are just as effective as SSRIs, however, they are more likely to cause dizziness, drowsiness, dry mouth and weight gain. You may need a change in medication or dose if your side effects don't go away or are bothersome.
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressants. People who take MAOIs are put on a special diet because these medications can interact with some foods and beverages, including cheese and red wine. MAOIs also interact with some medications such as SSRIs. These interactions can cause dangerous increases in blood pressure or cause other potentially life-threatening reactions.
Anti-anxiety medications
Benzodiazepines are used to treat anxiety, but they can be addictive and are only prescribed only for short periods. One exception is panic disorder, for which they may be used for six months to a year.
Some people have withdrawal symptoms when they stop taking benzodiazepines, although reducing the dosage gradually can diminish bothersome symptoms. In certain instances, the symptoms of anxiety can rebound after these medications are stopped.
Other medications
If you have been diagnosed with an anxiety disorder, your doctor may give you a beta-blocker for going into a situation where an attack may happen. The beta-blocker can keep your heart from pounding, your hands from shaking and other physical symptoms from developing.
Before taking medication for an anxiety disorder:
- Ask your doctor to tell you about the effects and side effects.
- Tell your doctor about any alternative therapies or over-the-counter medications you are using.
- Ask your doctor when and how the medication will be stopped. Some drugs have to be tapered slowly under a doctor's care.
- Be aware some medications are effective in anxiety disorders only as long as they are taken regularly, and symptoms may come back if you stop the medication.
How to make medications work better
A counselor or therapist - along with medication - is probably your best bet for getting better. Many people with anxiety disorders find joining a self-help group helps because they can share their problems and achievements with others. Talking with friends or someone from your religious or spiritual community also can help, although not a substitute for mental health care. The family is very important in the recovery of an anxiety disorder. Your family should be supportive. If your family tends to trivialize the disorder or demands improvement without treatment, you may suffer.
Managing stress and practicing meditation may help calm you and enhance treatment. Early research says heart-pumping exercise such as brisk walking or running may help. Caffeine, illegal drugs and even some over-the-counter cold medications can worsen an anxiety disorder. Check with your doctor or pharmacist before taking additional medications.
Other treatments
Cognitive-behavioral therapy (CBT) helps in changing the behaviors and thought processes of people with anxiety disorders. It is considered effective in helping medications work better. The cognitive part of CBT involves changing the thinking patterns that keep the person from overcoming the fear. Someone with panic disorder can learn to understand that they are not having a heart attack when they are having heart palpitations.
The behavioral part is meant to change the person's behavior by exposing that person to very thing they fear. For instance, someone with obsessive compulsive disorder with a fear of germs may be encouraged by a therapist to go a certain amount of time without washing.
Doing this repeatedly along with getting counseling from the therapist eventually helps decrease the anxiety. Sometimes behavioral therapy is used without as strong of a cognitive therapy. This involves exposing the person to the object or situation that is feared.
For these approaches to work, you must be ready. A therapist can help you decide if you are.
This article was reviewed and updated June 2007.
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