The 4 Major Classes of Anxiety Medications

Female doctor counseling patient on anti-anxiety medications
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Anxiety disorders are more than just a case of nerves. They are illnesses, often related to a person's biological makeup and life experiences, and your symptoms can keep you from coping and may even make it hard to maintain your daily activities. Fortunately, there are a number of medications available to treat the symptoms of anxiety disorders.

Medications Used to Treat Anxiety Disorders

Although a variety of categories of medications are used in the treatment of anxiety, here are four major classes of medications that mental health professionals use to treat anxiety disorders.

Each class of medication attempts to reduce anxiety in a different way and has its own benefits and risks. While some may be considered preferred options, the drug selection can vary based on the type of anxiety you have and your symptoms.

Using medications for anxiety disorder is considered safe and effective. It can take several weeks (usually four to six weeks) for most anxiety medications to start working, and can be particularly helpful when used along with psychotherapy.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are currently considered the first-line medication for most forms of anxiety. They work by causing more serotonin to be available in the brain, which can improve both mood and anxiety.

If you have been diagnosed with an anxiety disorder, your doctor may recommend one of the following SSRIs:

Although SSRIs have fewer side effects than some other antidepressants, they may still cause gastrointestinal distress, sleep difficulties, and sexual dysfunction. Many side effects go away within a couple weeks of beginning the medication, however, so give your body time to adjust.

SSRIs are considered a first-line treatment for all anxiety disorders. The treatment of OCD typically requires a higher dose.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are an option for people who don't respond to SSRIs. They are called SNRIs because they increase levels of both serotonin and norepinephrine, another neurotransmitter in the brain.

The most commonly prescribed SNRIs for anxiety include:

SNRIs are considered just as effective as SSRIs, but they tend to have more side effects. These may include headaches, sexual dysfunction, insomnia, upset stomach, and increased blood pressure.

SNRIs are considered as effective as SSRIs. They are therefore considered a first-line treatment for all anxiety disorders except obsessive compulsive disorder (OCD).

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) were some of the first antidepressants developed. Like SNRIs, TCAs block the reuptake of serotonin and norepinephrine.

The TCAs most commonly prescribed today include:

  • Elavil (amitriptyline)
  • Pamelor (nortriptyline)
  • Tofranil (imipramine)

Although they are just as effective as SSRIs in treating anxiety disorders, TCAs tend to cause significant side effects, including dry mouth, constipation, blurry vision, trouble urinating, and hypotension (low blood pressure on standing). For these reasons, TCAs are usually only prescribed when other drugs are unable to provide relief.

Benzodiazepines

Benzodiazepines (sometimes called "benzos") are the most widely used group of sedative drugs. They are usually prescribed for short-term management of severe or treatment-resistant anxiety.

Benzodiazepines are also prescribed on an as-needed basis to help you relax and reduce muscle tension. Because they are fast-acting, they are very helpful in treating panic attacks. They can also be useful for social anxiety disorder (SAD) and phobias if they are only taken occasionally.

Common benzodiazepines include:

When used on occasion or daily for a few weeks, benzos have a low risk of addiction. This risk increases when benzodiazepines are taken regularly for more than a few weeks. Benzodiazepines are not considered safe for continuous use, as this can increase risk for dependence and tolerance. 

You should abstain from alcohol when taking benzodiazepines because the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. Be sure to tell your doctor about other medications you are taking.

Risks

Anxiety medications have some important risks you should be aware of. These risks differ a bit between the drug classes, with suicidal thoughts a bigger risk with antidepressants and dependence and withdrawal a concern with benzodiazepines.

Suicidal Thoughts

In 2005, the Food and Drug Administration (FDA) required all antidepressants carry a black-box warning relating to the increased risk of suicidal thinking and behavior in children and young adults up to age 25.

Those younger than 25 should be carefully watched for increased depression, agitation, irritability, suicidality, and unusual changes in behavior, especially at the beginning of treatment or when doses are changed.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Tolerance and Dependence

Long-term use of benzodiazepines is generally not recommended because you can develop tolerance and/or dependence. 

Tolerance means you need to take more of the medication in order to make it work. Dependence means that you develop withdrawal symptoms if you stop taking the medication. Some people abuse these medications in order to get high.

Withdrawal

Many people who take a medication over a long period of time can become dependent. When they go off the drug, they need to do so gradually, to avoid experiencing withdrawal symptoms.

Withdrawal symptoms usually appear within three days of stopping a medication and last one to two weeks. Ironically, many withdrawal symptoms are similar to the anxiety symptoms that you may have initially sought treatment for:

  • Anxiety
  • Difficulty concentrating
  • Headache
  • Insomnia
  • Sweating

Some drugs cause more severe withdrawal symptoms than others. For instance, discontinuing benzodiazepines can lead to severe or life-threatening withdrawal symptoms, such as seizures.

Be sure to talk with the doctor before discontinuing any medication. To avoid these symptoms your doctor will probably taper your medication dose gradually.

A Word From Verywell

Be sure to take your medications exactly as prescribed by your doctor. If you are having serious side effects, consult your doctor, but do not stop your medication without your doctor's approval as this can cause serious health issues.

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  1. U.S. Food and Drug Administration. Suicidality in children and adolescents being treated with antidepressant medications. Published February 5, 2018.

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