The most common anxiety medications, explained

by Sue Benzuly, RN 

Endless worry, irritability and insomnia are all symptoms of a possible anxiety disorder.

Luckily, there are numerous anxiety medications that can help ease the condition.

Joy Alonzo, a specialist in the pharmacotherapy of mental disorders at Texas A&M’s College of Pharmacy, said recently, “If you understand the different types of medication, then you can become a better advocate for your anxiety treatment. Anxiety is one of the most under-treated mental illnesses, and we need to talk more about it.”

So, what medications can bring relief from crippling anxiety?

According to the Anxiety & Depression Association of America (ADAA), the most common classes of drugs for the treatment of anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Benzodiazepines
• Tricyclic antidepressants

Here is a rundown on medications for anxiety.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs work by preventing the body from reabsorbing serotonin, which leaves more available for use. The ADAA describes serotonin as a neurotransmitter that plays a role in feelings of well-being and happiness.

SSRIs are considered the first-line treatment for all types of anxiety disorders. A higher dose may be required when treating obsessive-compulsive disorder (OCD).

Common side effects:

• Insomnia 
  
• Sleepiness
• Sexual dysfunction
• Weight gain
• Dry mouth

Common SSRIs:

• Citalopram (Celexa) 
  
• Escitalopram (Lexapro)
• Fluoxetine (Prozac, Sarafem)
• Paroxetine (Paxil, Paxil CR, Pexeva, Brisdelle)
• Sertraline (Zoloft)

What else you should know about SSRIs:

• SSRIs may make it easier to engage in psychotherapy and other wellness activities 
  
• They may help improve other symptoms of anxiety, including headaches and sleep disturbances
• Initial side effects typically disappear after four to eight weeks
• SSRIs are safe for long-term use
• Check with your provider before stopping their use or changing your dose

Serotonin-norepinephrine reuptake inhibitors (SNRIs) 

This class of medication is also a first-line treatment for anxiety disorders, except for OCD. It works by inhibiting the brain cells’ reabsorption of both serotonin and norepinephrine. Serotonin is the neurotransmitter that helps with a sense of well-being. According to Anxiety.org, norepinephrine is considered important for its role in the body’s stress response.

Common side effects:

Anxiety.org states that SNRIs may have more side effects because they affect serotonin and norepinephrine. These side effects may include:

• Dry mouth 
  
• Nausea
• Nervousness
• Insomnia
• Drowsiness
• Dizziness
• Headache
• Sexual dysfunction
• Loss of appetite
• Agitation

Common SNRIs:

• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)

What else you should know about SNRIs 

Anxiety.org reports that these medications promote neuroplasticity in the brain. This may make your brain more flexible. There is evidence that these medications work best in combination with psychotherapy.

But there is one important caveat.

“SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief,” Alonzo said. “They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.”

Benzodiazepines

Benzodiazepines are considered a second-line therapy for the treatment of generalized anxiety disorder. According to the ADAA, they work by strengthening the GABA neurotransmitter. This neurotransmitter plays a primary role in feeling calm, muscle relaxation, reduction in brain activity and sleep.

Most common side effects:

• Drowsiness 
  
• Confusion
• Dizziness
• Depression
• Impaired coordination
• Vision problems

Common benzodiazepines:

• Alprazolam (Xanax) 
  
• Lorazepam (Ativan)
• Diazepam (Valium)

What else you should know about benzodiazepines for the treatment of anxiety:

• They act quickly, but do not stay in the system for long 
  
• They are not safe for continuous use, and can be addictive
• May be initiated with a first-line treatment, and then tapered off
• Do not operate heavy equipment while taking
• Do not mix with alcohol
• Not recommended for people with suicidal or addictive tendencies

Tricyclic antidepressants

According to the Mayo Clinic, tricyclic antidepressants are among the earliest antidepressants. They are often recommended when newer drugs have not been effective. They are not typically used for social anxiety disorder or OCD. They also work by blocking the reabsorption of serotonin and norepinephrine, but their mechanism of action is different and they typically cause more side effects than newer treatments.

Common tricyclic antidepressants:

• Imipramine (Tofranil) 
  
• Nortriptyline (Pamelor)
• Desipramine (Norpramin)
• Clomipramine (Anafranil)

Common side effects:

• Drowsiness 
  
• Blurred vision
• Constipation
• Dry mouth
• Drop in blood pressure when going from sitting to standing
• Urine retention
• Weight loss/weight gain
• Excessive sweating
• Tremor
• Sexual dysfunction

What else you should know about tricyclic antidepressants:

• You should not stop taking these medications abruptly 
  
• You may need to have blood work done to determine the correct dose
• Disorientation can occur in older people at higher doses
• May cause a rapid or irregular heart rate
• Can increase seizure activity if prone to seizures

When to seek treatment for anxiety

The National Institute of Mental Health lists these as common symptoms of anxiety:

• Feeling restless, wound up or on edge
• Being easily fatigued
• Having difficulty concentrating
• Being irritable
• Having headaches, muscle aches, stomach aches or unexplained pains
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep

The ADAA recommends seeking medication for anxiety when you are having physical symptoms, are unable to do what you want because of how you feel or are unable to make life choices because of fear. It is never too early to start treatment.

Anxiety treatment can be more effective when used with therapy. It is essential to keep all your appointments with your provider. Do not stop your medication or change the dose without discussing it with your provider. If the side effects affect your daily activities, inform your provider immediately.

If, at any time, you feel as though you may be suicidal, reach out to your provider or go to the nearest emergency room. You can also call or text the national suicide prevention hotline at 988.