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 recognized mental health conditions that can make it more difficult to cope with life's ups and downs—even sometimes making it harder to enjoy or even participate in daily activities.

Fortunately, there are a number of medications available to treat anxiety disorder symptoms. Learn what these medicines are, how they work, their benefits, and their potential risks.

It can take up to six weeks for anxiety medications to start working. They can be particularly helpful when used along with psychotherapy.

Medications Used to Treat Anxiety Disorders

There are four major classes of medications used in the treatment of anxiety. Each class attempts to reduce anxiety in a different way and has its own benefits and risks.

While some may be considered preferred options, drug selection can vary based on the type of anxiety you have and your symptoms. The amount of time you are on the drug can vary as well.

For instance, if you take antidepressant medications, your healthcare provider may recommend that you continue to use them for four to nine months after symptoms have resolved. But if you take benzodiazepines, you should only use them short-term.

Overall, using medications for anxiety disorders is considered safe and effective.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line medication for many forms of anxiety. They work by causing more serotonin to be available in the brain, which can improve both anxiety and mood. Due to these effects, SSRIs are also often used to treat depression and other mood disorders.

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

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

Recap

SSRIs are considered the first-line treatment for anxiety disorders and often have fewer adverse effects than other medications.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another first-line option for treating anxiety. This class of medicines increases levels of both serotonin and norepinephrine. Like serotonin, norepinephrine is a neurotransmitter in the brain that plays a role in mood regulation.

Some of the SNRIs prescribed for anxiety include:

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

Recap

SNRIs are another first-line anxiety medication and are considered as effective as SSRIs, although they can have more side effects.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) were some of the first medications used to treat anxiety disorders. Like SNRIs, TCAs block the reuptake of serotonin and norepinephrine. And they've been found effective for treating various anxiety disorders.

The TCAs prescribed for anxiety 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 don't provide relief.

Recap

TCAs are effective for treating anxiety but often come with more significant side effects, so they are often only prescribed when other anti-anxiety medications aren't working.

Benzodiazepines

Benzodiazepines (sometimes called "benzos") are a class of sedative drugs. They work by strengthening the effect of the GABA neurotransmitter, which plays a role in relaxation and reduces brain activity.

Benzodiazepines can be taken on an as-needed basis to help you relax and reduce muscle tension when facing a stressful situation. Because they are fast-acting, they can be 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:

Possible side effects include drowsiness, dizziness, impaired coordination, and vision issues. When used on occasion or short term, benzos have a low risk of addiction. However, they are not considered safe for long-term use as this can increase the risk of dependence and tolerance. 

Recap

Benzodiazepines can help treat anxiety short-term, on an as-needed basis, but aren't recommended for long-term use due to an increased risk of dependence.

Risks of Anxiety Medications

Anxiety medications have some important risks you should be aware of. These risks can differ a bit between the drug classes.

Suicidal Thoughts

Suicidal thoughts are a risk with antidepressants, particularly for younger patients. A review of 24 different studies found that 4% of child or adolescent antidepressant users had a higher risk of suicidality within the first few months of starting these drugs—double the amount of those receiving a placebo.

As a result, in 2004, the Food and Drug Administration (FDA) began to require that all antidepressants carry a black-box warning relating to the increased risk of suicidal thinking and behavior in children and adolescents.

Those younger than 25 should be carefully watched for signs of suicidal thinking, especially at the beginning of treatment or when dosages are changed. This includes experiencing increased depression, agitation, irritability, suicidality, and unusual changes in behavior.

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

Dependence is a greater concern with benzodiazepines than some of the other anti-anxiety medication classes. Long-term benzodiazepine use (more than 12 weeks) is generally not recommended because you can develop tolerance and/or dependence. 

Tolerance means that 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.

Potential for Misuse or Abuse

There is also a risk that some anti-anxiety medications will be misused or abused. This risk is greater with benzodiazepines, especially alprazolam (which is commonly known by its brand name Xanax).

Research published in 2020 found that benzodiazepine misuse occurs in 17% of users, with a majority of these individuals misusing these drugs in an attempt to control distress symptoms and the remainder attempting to get high.

A 2014 study involving 2,700 students in high school and middle school found that the risk of benzodiazepine abuse was 12 times higher in teens who had been prescribed these drugs.

Withdrawal

Many people who take 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.

Antidepressant drug withdrawal can occur within days of stopping the medication and symptoms generally resolve within a couple of weeks. Ironically, many withdrawal symptoms are similar to anxiety symptoms, including:

  • Anxiety
  • Concentration issues
  • Headache
  • Insomnia
  • Sweating

Some drugs can cause more severe withdrawal symptoms than others. For instance, discontinuing benzodiazepines after long-term use can lead to severe or life-threatening withdrawal symptoms, such as seizures, delirium, and even death.

Talk with your healthcare provider before discontinuing any medication. To avoid withdrawal symptoms, they may taper your medication dose, reducing it gradually.

Interactions

Some anti-anxiety medications negatively interact with other drugs. For example, if benzodiazepines are taken in combination with an opioid medication, it can result in difficult or slowed breathing and death.

Tell your healthcare provider if you are taking any other medications. Abstaining from alcohol when taking benzodiazepines is also important because the interaction between these drugs and alcohol can lead to serious, possibly life-threatening complications.

A Word From Verywell

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

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