Anti-Anxiety Medications List
Types & Classes of Anxiety Medications
- Selective Serotonin Reuptake Inhibitors
- Serotonin and Noradrenaline Reuptake Inhibitors
- Tricyclic antidepressants
- Benzodiazepines
- Azapirones
- Antiepileptics
- Antihistamines
- Beta-Blockers
- Antipsychotic drugs
Based on "Essential Psychopharmacology"
written by Stephen M. Stahl, MD, PhD
Up-to-date comprehensive listing of medications used to treat anxiety disorders.
List of main types of Anxiety disorders
- Generalized anxiety disorder (GAD)
- Panic disorder (PD) with or without agoraphobia
- Social anxiety disorder (social phobia) (SAD)
- Post-traumatic stress disorder (PTSD)
- Obsessive–compulsive disorder (OCD)
Selective Serotonin Reuptake Inhibitors
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Escitalopram | Lexapro® | • GAD |
| Fluoxetine | Prozac® | • OCD • PD |
| Paroxetine | Paxil® Paxil CR® |
• GAD • PTSD • SAD • OCD • PD |
| Sertraline | Zoloft® | • PTSD • SAD • OCD • PD |
| Citalopram | Celexa® | • "Off label" for social phobia, PD |
Currently, antidepressants are recommended as medications of first choice for anxiety disorders if pharmacological treatment is necessary (pharmacotherapy indicated).
Selective serotonin reuptake inhibitors are effective in all anxiety disorders. SSRIs relieve anxiety symptoms and are especially helpful for anxiety disorders that often accompany depression.
Advantages of antidepressants over benzodiazepines:
- Antidepressants don't potentiate alcohol.
- No cross tolerance between different SSRIs.
- No risk of drug abuse.
Main limitations and problems:
- Side effects: sexual side effects, weight gain.
- Discontinuation syndrome.
- Delayed anti-anxiety effect.
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Duloxetine | Cymbalta® | • GAD |
| Venlafaxine | Effexor® Effexor XR® |
• GAD • SAD • PD |
Selective serotonin and norepinephrine reuptake inhibitors duloxetine and venlafaxine work similarly to SSRIs. However, there is no sufficient evidence for their efficacy in the treatment of Obsessive-compulsive disorder.
Main limitations and problems:
- Side effects: sexual side effects, weight gain, elevated blood pressure.
- Discontinuation syndrome
- Delayed anti-anxiety effect
Tricyclic antidepressants (TCA)
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Clomipramine | Anafranil® | • OCD |
| Doxepin | Adapin® Sinequan® |
• Psychoneurotic patients with anxiety • Anxiety associated with alcoholism or organic disease |
| Imipramine | Tofranil® | • "Off-label" for PD |
| Nortriptyline | Pamelor® | • "Off-label" for PD |
| Protriptyline | Vivactil® | • "Off-label" for PD |
| See complete list of tricyclic antidepressants | ||
Despite not all tricyclic antidepressants are officially approved for anxiety, most are efficacious in the treatment of wide variety of anxiety disorders. TCAs are useful for comorbid anxiety and depression.
Main limitations and problems:
- Side effects: sedation, dry mouth, constipation, weight gain.
- Potential lethality in overdose due to cardiac adverse effects and CNS toxicity.
Benzodiazepines
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Alprazolam | Xanax® Xanax XR® |
• GAD • PD |
| Chlordiazepoxide | Limbitrol® Librium® Librax® |
• Preoperative anxiety • Anxiety disorders • Short-term relief of anxiety symptoms |
| Clonazepam | Klonopin® | • PD |
| Diazepam | Valium® | • Anxiety disorders • Relief of symptoms of anxiety |
| Lorazepam | Ativan® | • Anxiety disorders • Short-term relief of anxiety symptoms • Anxiety associated with depression |
| Oxazepam | Serax® | • Anxiety disorders • Anxiety associated with depression • Anxiety, agitation, and irritability in elderly patients |
Benzodiazepines produce a very fast anxiolytic effect. They start to relieve anxiety symptoms within minutes after dosing. Benzodiazepines may also be used in combination with serotonergic medications during the first weeks of treatment to suppress increased anxiety.
Despite being potent anti-anxiety drugs, benzodiazepines have a number of disadvantages that preclude their use as first-line treatments.
Main limitations and problems:
- All benzodiazepines are schedule IV controlled substances.
- Development of dependence and tolerance.
- All of the benzodiazepines are classified as either Category D or Category X.
- Side effects: sedation, dizziness, prolonged reaction time, impairment of cognitive functions and driving skills, psychomotor slowing.
Azapirones, Serotonin 1A Partial Agonists
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Buspirone | Buspar® | • Anxiety disorders • Short-term treatment of anxiety symptoms |
Buspirone differs from benzodiazepine anxiolytics in that it is not addictive, not sedative, and does not impair cognitive or motor performance.
Main limitations and problems:
- Slow onset of action
- Limited efficacy
Antiepileptics
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Pregabalin | Lyrica® | • GAD (approved by European Commission in EU, in U.S. off-label use) |
| Gabapentin | Neurontin® | • "Off-label" |
Pregabalin, a calcium channel modulator, is effective for effective generalized anxiety disorder. Pregabalin is indicated for GAD in Europe, but in U.S. this drug is used for anxiety disorders "off-label". Gabapentin, another calcium channel modulator, is also used "off-label" to treat anxiety.
Important advantage of pregabalin over antidepressants is quick onset of anti-anxiety effect – it works within several first days of treatment.
Antihistamines
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Hydroxyzine | Atarax® Vistaril® |
• Anxiety and tension associated with psychoneurosis • Anxiety withdrawal symptoms in alcoholics • Organic disorders in which anxiety is manifested |
| Diphenhydramine | Benadryl® | • "Off-label" |
Antihistamines relatively inexpensive and are sold over-the-counter.
Main limitations and problems:
- Side effects include sedation, anticholinergic effects at high doses, blurred vision, confusion, delirium and others.
- Not suitable for severe anxiety.
Beta-Blockers
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Atenolol | Tenormin® | • "Off-label" for situational/performance anxiety |
| Nadolol | Corgard® | • "Off-label" for situational/performance anxiety |
| Propranolol | Inderal® | • "Off-label" for PD, PTSD, SAD, situational/performance anxiety |
Beta-blockers are antihypertensive medications primary used to lower blood pressure. Beta-blockers are useful for anxiety accompanied by physical symptoms, especially cardiovascular complaints (e.g. palpitations and tachycardia).
Antipsychotic Drugs (Neuroleptics)
| Generic Name | Brand Name | Licensed indications |
|---|---|---|
| Molindone | Moban® | • "Off-label" |
| Olanzapine | Zyprexa® | • "Off-label" |
| Quetiapine | Seroquel® | • "Off-label" for GAD |
| Risperidone | Risperda® | • "Off-label" for OCD, PTSD |
There is quite strong evidence that atypical antipsychotic drugs have anti-anxiety properties and can be used as adjunctive treatment for refractory anxiety disorders 1.
Main limitations and problems:
- Weight gain
- Glycemic and lipid abnormalities
- Extrapyramidal side effects
- Tardive dyskinesia
Resources
- 1. Pies R. Should psychiatrists use atypical antipsychotics to treat nonpsychotic anxiety? Psychiatry . 2009 Jun;6(6):29-37. PubMed
- 2. Bandelow B, Sher L, Bunevicius R, et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry ClinPract. 2012 Jun;16(2):77-84.
Published: March 24, 2018
Last reviewed: March 24, 2018
