Antianxiety Medications Explained

Antianxiety medications are used to help reduce the intensity and frequency of anxiety-related symptoms. There are many different classes of medications used to treat anxiety symptoms, ranging from SSRIs to benzodiazepines.

Next, let’s look at the common antianxiety medications used to help treat anxiety disorders, along with common side effects and indications for use.

Benzodiazepines

Antianxiety medications include a class of drugs called benzodiazepines, which can provide more immediate relief of acute anxiety.

The FDA approves certain benzodiazepines for the treatment of insomnia, generalized anxiety disorder, panic disorder, social anxiety disorder, as well as seizure disorders. These medications have also been used to treat alcohol withdrawal (Nordqvist, 2020).

Commonly used benzodiazepines include:

• Clonazepam (Klonopin^®)
• Alprazolam (Xanax^®)
• Diazepam (Valium^®)
• Lorazepam (Ativan^®)

Benzodiazepine Precautions

Benzodiazepines can make people drowsy, slow motor coordination, or cause confusion and fatigue. These medications “slow down” the central nervous system.

Taking these medications along with other central nervous system depressants, such as alcohol, can lead to dangerous additive effects, which can be life-threatening. For example, combining benzodiazepines and opioids (e.g., fentanyl) can cause extreme sedation and slowing of breathing.

Benzodiazepines are less likely to be used for long-term treatment because they can be habit-forming (due to rewarding effects), with both tolerance and withdrawal symptoms potentially occurring.

Long-term use of benzodiazepines has been associated with memory loss, personality change, aggression, and paranoia (Alcohol and Drug Foundation [ADF], 2021).

Withdrawal

Prolonged use of benzodiazepines can result in decreased sensitivity (i.e., tolerance) and dependency on the medication. Prescribers will often limit the use of these medications to treat acute anxiety symptoms over a short period (e.g., panic attacks).

The individuals you work with who are taking benzodiazepines may experience withdrawal symptoms if they stop taking the medication suddenly. Withdrawal from the medication may cause seizures, so a cautious and gradual plan to titrate off of this medication is required (ADF, 2021). 

Antidepressants for Anxiety and Related Disorders

Given the side effects and potential for misuse of benzodiazepines, prescribers will often treat anxiety disorders with antidepressant medications instead.

The SSRIs and other antidepressant medications (i.e., SNRIs, tricyclics, and atypical antidepressants) have a direct effect on anxiety symptoms, are not habit-forming, and tend to have more favorable side effects and risk profiles than benzodiazepines (Westphalen, 2020).

If the provider prescribes an antidepressant, the client will generally need to take it for several weeks before anxiety symptoms start to improve. It may be helpful to inform clients of this, particularly if they have previously taken medications with an immediate onset of effects, such as benzodiazepines.

Other Medications for Anxiety

There are several additional categories of medications commonly used to treat anxiety symptoms.

Buspirone

Buspirone is an anxiolytic and is indicated for the treatment of anxiety disorders. Buspirone is not fast-acting like the benzodiazepines; rather, individuals must take it consistently for at least two weeks to achieve an antianxiety effect. Consequently, it cannot be used on an “as-needed” basis (MedlinePlus, 2022a).

Beta Blockers

Beta blockers are medications that were initially designed to treat high blood pressure and some heart conditions. However, they are effective in assisting individuals who experience anxiety in performance situations, such as public speaking.

Thus, these medications are known to reduce anxiety symptoms quickly. One that is commonly prescribed for such cases is propranolol (Inderal®, Inderide®; Bettino, 2021). These medications are immediately effective and may be used ‘as needed.’

Gabapentin

Gabapentin (Neurontin^®) is an anticonvulsant that is used to treat seizures and nerve pain, and to reduce feelings of restlessness. In addition, this medication may be used to treat anxiety symptoms. It is not typically prescribed for the treatment of anxiety as a monotherapy (Cagliostro, 2021).

Antihistamines

Finally, you may occasionally see some antihistamine medications such as hydroxyzine (Vistaril^®) and diphenhydramine (Benadryl^®) used for anxiety, primarily on an as-needed basis. They are commonly used for individuals instead of benzodiazepines because they do not have the same addiction and physical dependence potential (NAMI, 2021b).

There are several different categories of antidepressant and antianxiety medications. The most common forms of antidepressants used are SSRIs and SNRIs. This is due to their effectiveness and fewer side effects associated with their use. Antidepressants are also used for several mental health conditions (and some physical conditions) outside of depression.

Benzodiazepines provide rapid relief for anxiety, though due to these medications being habit-forming and risks associated with tolerance and withdrawal, these are not prescribed as often as they once were. Anxiety is also sometimes treated with SSRIs, buspirone, beta-blockers, gabapentin, and antihistamine agents.