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Alternatives to Xanax: What are some safer options for anxiety?

Alternatives to Xanax: What are some safer options for anxiety?

Alternatives to Xanax include SSRIs, SNRIS, and propranolol, which don't have the same potential for misuse. Natural Xanax alternatives aren't always clinically proven to work as a substitute.

Reviewed by:
Brenda Camacho, MD
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April 30, 2024
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Key takeaways

Are you tired of feeling tethered to anxiety, but concerned about the potential pitfalls of relying on Xanax? You’re not alone. Many people seek alternatives to Xanax, because they’re worried about its habit-forming nature, which can be a real concern for some people. Xanax is a commonly prescribed psychiatric medication that can be safe and effective when used as directed by a doctor. But does come with a risk of misuse and serious drawbacks that can put your health at risk, which is why some prefer not to prescribe it.  

Fortunately, many alternative treatments that offer relief from anxiety do exist, ranging from other medications to proven non-medical strategies. In this article we’ll detail the dangers of Xanax and other ways you can treat your anxiety.


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Risks and negative effects of Xanax

Xanax is a common brand name for alprazolam, a medication prescribed to help treat panic and anxiety disorders. It belongs to a class of drugs called benzodiazepines.

In your brain, there are communication centers called neurons that send messages to each other using chemicals called neurotransmitters. One of these neurotransmitters is called gamma-aminobutyric acid (GABA). GABA is like a brake pedal for your brain. It helps calm down the activity of neurons, which can prevent feelings of anxiety.

Xanax works by binding to specific receptors in the brain that are sensitive to GABA and enhancing GABA’s effect on them. In other words, it boosts the power of that brake pedal, making it even more effective at calming down the activity of neurons. As a result, Xanax helps reduce feelings of anxiety, panic, or tension.

Xanax has some common—and strong—side effects, including:

  • Changes in sex drive
  • Sexual dysfunction
  • Dizziness
  • Drowsiness (you should not drive a car if you’ve taken it)
  • Nausea

Besides these side effects, one of the main downsides of Xanax is that it can be habit-forming. Not everyone who takes Xanax will not become dependent on it. If you take it as directed, the chance of becoming addicted is very low. However, another concern with Xanax or any benzodiazepines is the chance of increased risk for dementia, the higher your dose and the longer you use it. For this reason, some psychiatrists are now reluctant to prescribe it.

Other benzodiazepines  

  • Klonopin (clonazepam)
  • Ativan (lorazepam)
  • Valium (diazepam)

These medications work similarly to Xanax (by enhancing the effects of GABA in the brain, leading to a reduction in anxiety symptoms) but still carry the same risks of dependence, misuse, and increased risk of dementia. That means that other types of medication are better choices when it comes to treating anxiety.

Prescription alternatives to Xanax

If you’re looking for medical alternatives to Xanax, you might consider, beta blockers, antidepressants, or other anxiety medications like BusPar.

Beta-blockers like propranolol

Beta-blockers are primarily used to treat conditions such as high blood pressure, heart failure, and certain heart-rhythm disorders, but one of them, propranolol, is also sometimes prescribed off-label for the treatment of anxiety, particularly performance anxiety or social anxiety disorder. (Being prescribed off-label means that they haven’t been approved by the FDA for these specific uses, but it’s still safe to take them if a doctor has prescribed them to you.)

Beta-blockers work by stunting the effects of a hormone called adrenaline (epinephrine) on your body. Adrenaline is what causes your body’s “flight-or-fight” response: It makes your heart beat faster, your breathing quicken, and your muscles tense. A beta-blocker will calm down these physical symptoms of anxiety.

It's important to note that while beta-blockers can be effective for reducing physical symptoms of anxiety, they do not address the underlying psychological aspects of anxiety disorders (neither do benzodiazepines). They are typically prescribed for short-term use or for specific anxiety-causing situations, such as a big meeting or performance. But unlike benzodiazepines, they are not considered habit-forming.

Antidepressants

If you’re more interested in addressing your anxiety with a long-term medication that focuses on the psychological rather than physical effects of the condition, antidepressants might be the right choice for you. As the name implies, antidepressants are designed to treat depression, but they can be effective against anxiety as well.

There are a few different types of antidepressants, and they all work by affecting the levels of brain chemicals that can influence mood. The most commonly prescribed types are selective serotonin reuptake inhibitors (SSRIS), which affect serotonin, and serotonin–norepinephrine reuptake inhibitors (SNRIs), which regulate both serotonin and norepinephrine. Some common examples of this class of medications are:

  • SSRIs: Zoloft (sertraline), Prozac (fluoxetine), and Lexapro (escitalopram)
  • SNRIs: Effexor (venlafaxine) and Cymbalta (duloxetine)

Unlike benzodiazepines and beta-blockers, which act quickly, SSRIs and SNRIs work by gradually increasing the levels of serotonin and/or norepinephrine in the brain. They do not produce immediate mood-altering effects, and users do not typically experience feelings of euphoria or intoxication, the way they might with benzodiazepines, for example.

It's important to note that although SSRIs are not habit-forming in the traditional sense, they do require careful management. It’s essential to take SSRIs exactly as prescribed by a health-care professional, like a psychiatrist, and to follow their guidance regarding dosage adjustments, tapering, and discontinuation.

If you want to explore trying antidepressants or another kind of medication to treat your anxiety symptoms, take Talkiatry’s quick online assessment. You will be matched with one of our psychiatrists, who can work with you to decide what treatment path makes sense for you.

5 non-medication alternatives to Xanax

Several herbal treatments and over-the-counter or holistic medicines are believed to help manage anxiety symptoms. Some of the commonly cited herbal options are chamomile, valerian root, lavender, and kava. Over-the-counter remedies like the amino acid L-Theanine, melatonin, and magnesium are also frequently recommended as alternative anxiety treatments.

However, doctors do not typically recommend these as natural alternatives as much more research is needed to definitively establish if they are effective for treating mental health conditions like anxiety.  Keep in mind that just because "natural" remedies or OTC options don't require a prescription, it doesn't mean they are completely safe.  

They’re not regulated in the same way as prescription medications, so their potency, purity, and safety of herbal supplements especially can vary significantly between brands and products. Additionally, these treatments may interact with other medications or health conditions and could be harmful to you. It’s crucial to consult with a health-care professional before starting any holistic treatment.

However, there are non-medication strategies for treating anxiety that actually have sufficient scientific research backing up their effectiveness.

Regular exercise

Exercise is a highly effective non-medical solution to preventing and treating anxiety. This is especially true for cardiovascular exercise, but don’t worry if you’re not a runner. You can reap the benefits of exercise for your mental health with just committing to a brisk walk a few days a week, a bike ride, or even a dance class (or a dance party in your living room).

Sleep hygiene

Getting adequate sleep is extremely important for mental health, but sometimes anxiety makes it hard to fall or stay asleep. This can create a vicious cycle, because anxiety itself can be exacerbated by poor sleep quality. One way to approach getting better sleep is taking steps to prepare yourself to get the best sleep possible. This might include things like maintaining a regular bedtime, avoiding screens for one to two hours before bedtime, and making sure your bedroom is suited to good sleep, with blackout curtains or maybe a white-noise machine.

Breathing exercises

Breathwork has been proven to improve anxiety symptoms, both on a day-to-day basis and in acute episodes of anxiety, like panic attacks. Some strategies are as simple as extending your exhale while visualizing your stress leaving your body, or box breathing, where you inhale for four counts, hold for four counts, then exhale for four counts, and hold for four counts again.

Here are more coping strategies and grounding techniques for anxiety.

Mindfulness

A study published in 2022 compared meditation and the antidepressant Lexapro for anxiety and found that the two were equally effective at managing symptoms. The researchers say that meditation works because it combines breathwork with an emphasis on staying present—so you’re not dwelling in worries about the past or the future. In the study, the meditating participants took regular mindfulness classes, but if you’re interested in trying meditation, you can easily start on your own with meditation apps or other online resources.

Cognitive behavioral therapy (CBT)

One therapy modality that has been shown to be especially effective in treating anxiety disorders is cognitive behavioral therapy, or CBT. CBT works by helping you identify, understand, and stop negative thought cycles. If you’re interested in CBT and medication management, you can take Talkiatry’s online assessment to get matched with one of our doctors. We’re a national psychiatry practice that provides virtual in-network are.


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FAQs

Here are more questions about alternatives to Xanax.

What are drugs that calm you down?

If you’re having acute symptoms of anxiety, like a panic attack, prescription drugs like benzodiazepines or a beta-blocker like propranolol can help you manage the physical symptoms and calm you down since they work quickly—but benzodiazepines have adverse effects and negative consequences in the long term, including a potential for substance misuse and physical dependence that can outweigh any potential benefits.

What is the best benzodiazepine for anxiety?

When it comes to managing anxiety, it's important to note that benzodiazepines are not the only option. While they can be prescribed for anxiety, it's crucial to consider their negative effects that can occur in the long term. While Xanax, Klonopin, Ativan, and Valium are some examples benzodiazepines, your doctor may not prescribe any of them, preferring antidepressants medications instead. Antidepressants are effective, have lower risk of side effects, and the primary choice among psychiatrists to help treat anxiety.

Are there over-the-counter anxiety medications?

There are several over-the-counter (OTC) products, supplements that people use to help manage anxiety symptoms. Some of these include L-Theanine, melatonin, magnesium, chamomile, and kava. Research on the effectiveness of these medications is limited—and while these products are available without a prescription, it's essential to approach them with caution and consult with a doctor before starting any new treatment, especially if you are currently taking medication or have underlying health conditions.

Is trazodone similar to Xanax?

These drugs are central-nervous-system depressants that can both have calming effects. Trazodone, which might be sold under the brand name Desyrel, is an antidepressant classified as a serotonin antagonist and reuptake inhibitor (SARI). It is primarily used to treat depression but is also prescribed off-label to help with sleep because of its sedating effects lowering your heart rate.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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Frequently asked questions

Does Talkiatry take my insurance?

We're in network with major insurers, including:

  • Aetna
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Even if your insurer isn't on the list, we might still accept it. Use the insurance eligibility checker in our online assessment to learn more.

Can I get an estimate of my visit cost?

The best way to get a detailed estimate of your cost is to contact your insurance company directly, since your cost will depend on the details of your insurance.  

For some, it’s just a co-pay. If you have an unmet deductible it could be more.  

Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

About
Brenda Camacho, MD

Dr. Brenda Y. Camacho holds the position of Staff Psychiatrist at Talkiatry. She is board-certified in Adult Psychiatry. She has been practicing for over 25 years.

While having treated a wide range of adult patients, Dr. Camacho’s primary focus is treating adult outpatients with mood or psychotic disorders. Her practice focuses on medication management. Typically, she offers this in conjunction with supportive or insight-oriented therapy in 30-minute follow-up visits. On occasion, Dr. Camacho will believe additional therapy is also needed and asks that you bring a therapist into your care team to provide the best outcome.

Dr. Camacho completed her undergraduate studies at Tufts University. She received her medical degree from Temple University School of Medicine in Philadelphia, PA and then continued with Temple for her residency in adult psychiatry. After completing training, Dr. Camacho worked at Cooper Hospital in Camden NJ as Associate Director of Consultation/Liaison Service and Psychiatry Residency Training and Co-Director of the Neuropsychiatry Clinic. She then began working exclusively in outpatient settings, joined NewPoint Behavioral Health Care, and served as Medical Director before and after their merge with Acenda Integrated Health.

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