Medications for Anxiety: The Main Groups and How They Differ

Why there is more than one group

Anxiety disorders are not all the same, and neither are the medicines used for them. The National Institute of Mental Health (NIMH) says medications can play an important role in treatment and are often combined with other treatments, such as psychotherapy.

NIMH also says medicines affect people differently and that it may take several tries to find the one that works well with the fewest side effects. That is a normal part of care, and it does not mean you did anything wrong. The sections below describe the groups in general terms. They are not a ranking, and no group is presented here as the right one for you.

SSRIs and SNRIs

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants. NIMH says many of the medications used for depression, including these two groups, may also be used for anxiety. It adds that providers typically begin with SSRIs or other antidepressants for panic disorder and social anxiety disorder because they have fewer side effects than other medications.

FDA approval depends on the specific medicine and condition. For example, the label for escitalopram (Lexapro) lists generalized anxiety disorder, and the label for extended-release venlafaxine (Effexor XR) lists generalized anxiety disorder, social anxiety disorder and panic disorder. Medicine pages list each one's labeled uses.

These medicines take time. NIMH says antidepressants usually take 4 to 8 weeks to work. Their labels carry a boxed warning: antidepressants increased the risk of suicidal thoughts and behavior in children, teens and young adults in short-term studies, and everyone taking them should be watched for worsening or for suicidal thoughts. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.

Benzodiazepines

NIMH describes benzodiazepines as a common type of anti-anxiety medication used for some short-term anxiety symptoms, and sometimes for generalized anxiety disorder. Alprazolam (Xanax) is one example: its label lists acute treatment of generalized anxiety disorder and treatment of panic disorder in adults.

NIMH says that taking benzodiazepines over long periods may lead to tolerance or dependence, so providers usually prescribe them for short periods and taper them slowly. The alprazolam boxed warning covers serious risks when combined with opioids, risks of abuse, misuse and addiction, and dependence and withdrawal reactions that can be life-threatening if the medicine is stopped suddenly after continued use. Alprazolam is a Schedule IV controlled substance. Read more in our guide to benzodiazepines for anxiety.

Buspirone and hydroxyzine

Buspirone is a different type of anti-anxiety medication. NIMH says it can be used over longer periods, must be taken every day for 3 to 4 weeks to reach its full effect, and does not work on an as-needed basis.

Hydroxyzine is an older medicine whose label lists symptomatic relief of anxiety and tension. The same label says its effectiveness as an anti-anxiety medicine for long-term use, meaning more than 4 months, has not been assessed by systematic clinical studies. It also says hydroxyzine should not be used by people with a prolonged QT interval, a heart rhythm finding, and that drowsiness may occur.

Off-label options

Off-label means a clinician prescribes a medicine for a use that is not on its FDA label, so that use has not gone through FDA approval.

• Beta-blockers: NIMH says these are prescribed off-label for short-term anxiety symptoms, and can help manage physical symptoms such as rapid heart rate, sweating and tremors. It says they generally are not recommended for people with asthma or diabetes.
• Gabapentin: a 2020 review says it has been prescribed off-label for anxiety despite a lack of research evidence supporting that use.
• Pregabalin: the same review says it is approved for generalized anxiety disorder in the European Union but not by the FDA in the United States. It is a Schedule V medication.

Talking this through with a psychiatrist

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, treats anxiety by secure video for people physically located in Pennsylvania or New York during each visit. Whether a given medicine is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help.

See online anxiety treatment for how care works, or contact us about medication care. Therapy is often part of the picture too. Our therapists offer anxiety therapy in Pennsylvania, West Virginia, Arizona, Colorado and Florida, but not in New York. Therapists do not prescribe.