Anxiety Medications: What They Are and How They Work

One anxiety definition is that anxiety is the anticipation of a future threat. As a result, some signs that someone is anxious or anticipating a threat are muscle tension, excessive caution, or avoidant behaviors. Antianxiety medications, or anxiolytics, help to control symptoms of anxiety disorders.

They work to affect the natural chemicals, neurotransmitters, in the body that are involved in stress processes.

Classes of Anxiety Medications

Anxiety medications are divided into classes based on how they work and the neurotransmitters they affect. The US Food and Drug Administration (FDA) has approved some medications in each class to treat anxiety. However, providers can prescribe other medications off-label to treat anxiety symptoms as well.

Serotonin/Norepinephrine Antidepressants

Serotonin and norepinephrine are neurotransmitters involved in the body’s stress response. The FDA has approved some selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) to treat panic disorder (PD), generalized anxiety disorder (GAD), and social anxiety disorder (SAD).

These medications work by increasing levels of serotonin and norepinephrine levels in the brain.

More commonly known FDA-approved SSRIs and SNRIs are fluoxetine, sertraline, citalopram, fluvoxamine, duloxetine, and venlafaxine. These medications are taken once per day and can be taken indefinitely to manage anxiety.

SSRIs and SNRIs are commonly prescribed because they are generally well-tolerated and have manageable and short-lived side effects like nausea, headache, and dry mouth.

Benzodiazepines

Benzodiazepines (benzos) work by releasing gamma aminobutyric acid (GABA). GABA slows down brain function and creates a calming effect, which counteracts anxiety.

Benzos are used in combination with SSRIs or SNRIs to treat PD, GAD, and SAD. Common benzos are alprazolam, oxazepam, chlordiazepoxide, clonazepam, clorazepate, diazepam, and lorazepam.

Caution is important when prescribing benzos for children, older adults, and those with medical conditions. Caution also needs to be taken for people with substance use disorders (SUDs), especially for those who use substances that have depressant-type effects the way benzos do like opioids or alcohol. Combining benzos with these substances increases the risk of overdose.

Given that benzos have a risk for tolerance and dependence, the recommendation is to take the lowest effective dose and limit use to 2 to 4 weeks at the most.

Antihistamines

While histamines are mostly known for causing allergic reactions, they are chemicals that have also been linked to the anxiety symptoms of agitation and sleep problems.

The antihistamine that is FDA approved for treating anxiety is hydroxyzine. It can be taken as an alternative to benzodiazepines for panic attacks and anxiety. Antihistamines may also be safer for children, adolescents and pregnant women. Hydroxyzine is typically prescribed daily for up to 4 months.

Antihistamines are generally well tolerated and have manageable side effects like dry mouth, sedation and constipation.

The main drawback of treating anxiety with antihistamines is that people develop a tolerance to them over time and experience lowered effectiveness. At that point providers consider other possible anxiolytics as an option.

Antipsychotics

Antipsychotics are a class of medications used to treat symptoms of psychosis, like hallucinations, delusions and disordered thinking. Buspirone is one antipsychotic that is FDA approved to treat anxiety. It’s usually used in conjunction with an SSRI or an SNRI to treat GAD.

Busiprone works by releasing more serotonin and dopamine in the body. Increased serotonin helps to reduce anxiety. Dopamine doesn’t affect anxiety directly but can help improve focus, which may be compromised by anxiety. Providers usually prescribe buspirone to be taken 2 or 3 times per day.

Buspirone tends to be less effective than benzos and antidepressants and is not as well-tolerated. Side effects include nausea and dizziness.

Beta-Blockers

Beta blockers are medications typically used to treat heart conditions like hypertension, angina, arrhythmias and atrial fibrillation. They inhibit beta receptors in the body that would otherwise increase blood pressure. As such, they affect the physiological symptoms of anxiety.

Propranolol is a beta blocker that is not FDA approved to treat anxiety but is used off label for performance anxiety and SAD. Depending on your needs, propranolol can be taken daily or only as needed, such as before an anxiety-provoking event.

Atenolol is another beta-blocker that lowers heart rate and blood pressure. It has fairly recently come to be used for anxiety symptoms, and initial research shows it to be effective.

Common potential side effects of beta-blockers include very low heart rate and blood pressure, fatigue, dizziness, nausea, and constipation.

Conditions Treated by Anxiety Medication

What is anxiety? It is a condition that involves excessive and uncontrollable fear or worry. What causes anxiety? Well, there can be a few different causes. One is that through childhood experiences, a person becomes conditioned to fear certain things or situations.

A woman anxiously clutches her knees while lying on the couch

There can also be genetic causes of anxiety; having close family members with an anxiety disorder can mean that you are more likely to have an anxiety disorder. Yet another cause could be a medical condition. Anxiety can also occur as a result of substance misuse.

What a person fears depends on the type of anxiety disorder they are dealing with. As such, there are different anxiety ICD 10 codes for the different anxiety conditions.

ICD stands for International Classification of Diseases, a system to code medical and mental health conditions. Providers use these codes to record their diagnoses and send them to insurance companies.

There are a few types of anxiety disorders that can be treated with antianxiety medication:

Generalized Anxiety Disorder (GAD). GAD is characterized by constant, uncontrollable worry over different things.
Social Anxiety. Social anxiety refers to unrealistically feeling scrutinized by other people and fearing that, while with others, you will act in a way that will be judged.
Separation Anxiety. Separation anxiety involves excessive fear or distress at the anticipation or experience of being away from someone to whom you feel closely attached.
Panic Disorder. Panic disorder involves fearing potential panic attacks, sometimes called anxiety attacks. Examples of anxiety attack symptoms include pounding heart, shaking, feelings of choking, feeling faint, fear of losing control, or fear of dying.
Phobias. Phobias are fears of specific things or events, like spiders or going to the dentist.

Signs of anxiety can vary from person to person. For instance, with GAD, one person may experience muscle tension, trouble sleeping, and irritability, while another may experience restlessness, fatigue, and concentration problems.

GAD and Panic Disorder involve persistent anxiety; therefore, medication to treat them is prescribed daily. On the other hand, conditions like phobias or separation anxiety can be treated with medication on an as-needed basis.

FAQs

Can Anxiety Medications Cure Anxiety?

Medications cannot cure anxiety, but rather, they help to manage anxiety symptoms.

How Long Soes it Take for Anxiety Medication to Work?

This can depend on the individual and the specific medication. Generally, you would notice some benefit in 2 weeks and the full effects in 4 weeks.

Are Anxiety Medications Safe for Long-Term Use?

Some anxiety medications, like SSRIs, are safe for long-term use whereas it is recommended that benzodiazepines are taken short-term.

Can Children Take Anxiety Medications?

Yes, children can take anxiety medications, and the ones that tend to be best suited for children are SSRIs.

Do I Need Therapy if I’m Taking Medication?

This would depend on your specific circumstances. While medication can help with physiological causes of anxiety, therapy can help to provide coping skills, enhance interpersonal communication, and address maladaptive thinking.

Benefits and Risks of Taking Anxiety Medications

Benefits of anxiety medication can include:

Improved sleep
Reduction in anxiety symptoms
Improved quality of life
Improved daily functioning

Risks associated with anxiety medications, depending on the medication, can include:

Dependency on the medication
Side effects
Withdrawal symptoms upon stopping the medication
Interactions with other medications

As with any type of medication, antianxiety medications do come with side effects and some downsides. However, they can also effectively manage anxiety symptoms.

Whether or not it is best to take anxiety medication, and which one, varies from person to person. Your provider can help you weigh the pros and cons to help develop the best anxiety treatment plan for you.

Medication and Therapy: A Powerful Combination

Treatment for anxiety disorders often involves a combination of medication and evidence-based therapy like cognitive-behavioral therapy (CBT). CBT can help to reduce anxiety by exploring unhelpful beliefs learned in childhood and how they affect emotions and behavior.

A doctor speaks with an anxious patient during a consultation

By changing those maladaptive beliefs, you can start to experience more positive emotions and engage in healthier behaviors.

Exposure therapy is a type of CBT that can help someone get over a phobia. By gradually exposing someone to increasing levels of stimuli that cause them distress, they start to learn that what they fear about that stimulus is not likely to occur.

Therapy can also provide training and instruction in mindfulness, a practice that helps you to be present in the current moment. Engaging more and more in mindfulness can help train you to take your mind away from worrying thoughts and instead focus on the present.

Antianxiety medication is sometimes viewed as a quick fix or a lazy option compared to therapy. However, this is far from true. Medication is a valid and sometimes needed treatment to manage anxiety. After all, the brain is also an organ that may at times need medication to function better, just as in conditions like cancer or diabetes.

Furthermore, medication combined with individual or group therapy can be very powerful in helping you manage anxiety and experience a better quality of life in the long term.

It is never too late to seek help, no matter the type of anxiety disorder you are dealing with. A mental health professional can help you develop a treatment plan tailored to you so that you can get the most benefit.