Which anxiety medication is best for me?

Which anxiety medication is best for me?

Reviewed by:
Michael Roman, MD
Staff Psychiatrist
at Talkiatry
February 13, 2024
In this article

Feeling stressed or nervous from time to time is a normal part of life. But if symptoms of anxiety, like a racing heart, or a constant on-edge feeling, are getting in the way of daily life, it might be time to ask for help.  

Mental health professionals, like psychiatrists, have a lot of tools to help people living with anxiety disorders. One of those tools is medication. And there are a lot of different kinds out there—SSRIs, benzodiazepines, and beta blockers, just to name a few. If you're living with anxiety and want to know if any of these are right for you, the best thing to do is talk to a psychiatrist who can address your specific needs and concerns. In the meantime, here's an overview of the most common medications doctors use to treat anxiety.


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The role of medication in anxiety  

Anti-anxiety medications are a safe and effective way to help minimize your symptoms. They can calm your fear signals and fight-or-flight responses to help you feel less nervous and more in control. They’re not a cure all though. When they’re taken in combination with other techniques and therapy, these medications can be effective for a lot of people.  

Most anxiety medications are prescription drugs, so you’ll need a doctor or psychiatrist to prescribe them to you. Here’s more on who can prescribe anxiety medication.

5 types of anxiety medications  

Anxiety medications are a broad class of drugs that can include antidepressants, benzodiazepines, beta blockers, antihistamines, and buspirone. Here’s a look at what’s commonly prescribed.

Antidepressants  

Antidepressants help treat depressive disorders, but they’re also often used for all types of anxiety disorders, too. Antidepressants work by regulating the levels of certain chemicals in the brain—or neurotransmitters—like serotonin and norepinephrine. When these chemicals are imbalanced, it can lead to mood changes, behavior shifts, and increased symptoms of anxiety.    

There are different classes of antidepressant medications, and not all of them are a doctor’s first choice when it comes to anxiety treatment.  

SSRIS (selective serotonin reuptake inhibitors), like Zoloft (sertraline), Prozac (fluoxetine), and Lexapro (escitalopram), and SNRIs (serotonin and norepinephrine reuptake inhibitors), such as Effexor (venlafaxine) and Cymbalta (duloxetine), are widely prescribed for both anxiety and depression. They are considered the “first-line treatment” or the initial, go-to choice by mental health professionals, because they’re effective and have relatively fewer side effects compared to other types of medication. SSRIs and SNRIs work by increasing the availability of serotonin and norepinephrine in the brain, helping to regulate mood and alleviate anxiety symptoms.  

Learn more about SSRIs vs SNRIs, including a more detailed explanation of how they work and the differences between them.

Tricyclic antidepressants (TCAs) are an older class of antidepressants. Psychiatrists sometimes prescribe them when SSRIs or SNRIs are not effective or tolerated well by your body. TCAs, like impramine, work similarly to SSRIs and SNRIs, but they may have more side effects and require careful monitoring.

Likewise, monoamine oxidase inhibitors (MAOIs) are another class of antidepressants that are usually reserved for cases when other medications haven’t worked. MAOIs slow down the activity of an enzyme called monoamine oxidase, which results in an increase in the levels of serotonin, norepinephrine, and dopamine in your brain. MAOIs come with dietary restrictions and you may need to monitor potential drug interactions more carefully because of the potential side effects—some of them can even be life threatening so it’s always important to discuss your treatment optionswith your doctor.  

Finally, there's atypical antidepressants, like Wellbutrin, Trintellix, and Viibryd which work in a few different ways and don't fit into any neat category listed above.  

When it comes to treating anxiety, antidepressants can be helpful and there’s no one-size-fits all choice. To find out which one will work for you, you’ll have to talk to a doctor. You can take our short online assessment to get matched with a licensed psychiatrist to get diagnosis and treatment.

Benzodiazepines  

Benzodiazepines, such as Klonopin (clonazepam), Xanax (alprazolam), and Valium (diazepam), are fast-acting medications that can provide immediate relief for anxiety. Benzodiazepines work by targeting gamma-aminobutyric acid (GABA), a neurotransmitter that has a sedative effect, which helps slow down your brain when it feels overexcited and promote a sense of calm. They are typically prescribed for conditions such as generalized anxiety disorder, panic disorder, and social anxiety disorder.  
When used correctly these medications are safe and effective. However, there is a higher risk of becoming dependent on these medications, which can potentially lead to a substance abuse disorder. As a result, they’re better for short-term use during anxiety flare-ups rather than for long-term treatment.

BusPar (buspirone)

Buspirone is a medication used to treat generalized anxiety disorder, usually as a second-line treatment when the initially prescribed medication doesn’t work. Unlike benzodiazepines, it does not cause drowsiness or cognitive impairment, and has a lower risk of dependence. Buspirone falls under the class of anxiolytics, and it works by interacting with serotonin and dopamine receptors in the brain, gradually alleviating anxiety symptoms over time. Buspirone may be prescribed alone or in combination with other medications, depending on your needs and response.  


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Hydroxyzine

Antihistamines are primarily used for allergies, but some of them, like Vistaril (hydroxyzine), have been proven effective in the treatment of anxiety. Hydroxyzine works by blocking certain histamine receptors in the brain, which helps to reduce excessive activity in the central nervous system, leading to a calming effect on the body.  

Even though hydroxyzine wasn’t originally developed to treat anxiety, it can still work —and has even been approved by the FDA for short-term use. One advantage of hydroxyzine is that it kicks in quickly, within 30 minutes, and is not a controlled substance. There is no risk of addiction, making this an effective alternative to benzodiazepines.

Beta-blockers  

Beta-blockers are usually prescribed for cardiovascular diseases and heart conditions, like high blood pressure and chest pain. Since they can lessen physical symptoms like sweating, trembling, and a racing heart, beta blockers have an off-label use as an anxiety medication. Off-label use means a doctor prescribes a medication for a condition that it wasn’t originally intended for. (They usually do this based on evidence and professional judgment.)

The way beta blockers work is by blocking adrenaline, the hormone that gets released when you feel anxious or nervous. They can even be taken in advance to reduce tremors and anxiety ahead of situations or events that trigger nervousness like public speaking or performances.  Another example: if you have a fear of flying, you can take a beta-blocker before going on a plane to help calm your nerves.  

Examples of beta blockers are

  • Inderal LA, InnoPran X (propranolol)
  • Lopresor (metoprolol)
  • Nebilet (nebivolol)
  • Tenormin (atenolol).  

When should you take medication for anxiety?

Deciding whether your anxiety should be treated with medication should be discussed with a professional health care provider. If you've ever thought about talking to someone you should. If you feel like your anxiety is affecting your life or getting in the way of things you'd like to do, talk to a psychiatrist. They're trained to help. Anxiety medications require a valid prescription, and starting a new anxiety medication should always be done under the supervision of your doctor.  

Curious to learn more about your symptoms or not ready to see a psychiatrist quite yet? Answer a few questions about your anxious feelings so we can help you understand more.

Managing your anxiety medication  

If your mental health provider prescribes an anxiety medication for you, it’s important to follow their instructions for it to work effectively. For instance, this usually requires consistent use at the same time of day for antidepressants and avoiding missed doses. If you regularly skip doses or stop your medication altogether without proper medical guidance, it can cause your anxiety symptoms to come back and get worse. In the case of certain medications it can lead to serotonin withdrawal, which can be dangerous.  

Regular appointments and follow-ups can help your doctor monitor any potential side effects and make necessary treatment modifications. They’ll make adjustments over time to ensure your needs are met while trying to minimize any potential side effects you may feel.  

How do I choose an anxiety medication?  

There are a lot of options out there, but there are also people trained to help you navigate the options and find which one works best for you. Psychiatrists have extensive training in medication management. When you work with one they'll keep in mind your diagnosis, medical history, preferences and put together a treatment plan that fits you.  

Once you start taking a medication, you'll have check-ins with them to measure your progress and talk about side effects, if you experience any. Treatment is a conversation, so being as open and honest with your clinician as possible will help build trust and move you toward your goals.

If you’re interested in getting help for your anxiety, you can reach out to a professional mental health provider, like Talkiatry. We’re a national psychiatry practice that provides in-network, virtual care, so you can see a psychiatrist from the comfort of your home, and our treatment strategies include a combination of therapy and medications.  

To get started, take our free online assessment; get matched with a psychiatrist and schedule your first appointment in a matter of days.

FAQs about anxiety medications  

Whether you’re struggling with on-going anxiety or have already been diagnosed with an anxiety disorder, it’s important to consult with your provider. Here are some common, related questions to keep in mind.

What is the most common type of anxiety medication?  

The most common type of medication prescribed for anxiety disorders are SSRIs, like Lexapro and Viibryd, as a first-line treatment and have relatively fewer side effects compared to other types of antidepressants, like MAOIs.

What are “first choice” anxiety medications?

"First choice" anxiety medications refer to the medications that are commonly prescribed as a first-line treatment for anxiety disorders. These medications are generally well-tolerated and have been extensively studied for their effectiveness in managing anxiety symptoms. When the first-choice medications don’t work, that’s when a doctor might prescribe another medication in place of or in addition to your main medication.

What is the best medication for anxiety with least side effects?  

The choice of medication for anxiety and the occurrence of side effects can vary from person to person. What works best with the fewest side effects depends on the person’s specific symptoms, medical history, and response to medication. It's essential to consult your prescribing doctor to determine the most suitable medication for your anxiety in your situation.  

What is the difference between benzodiazepines and antidepressants?

Benzodiazepines and antidepressants are two different types of medication. Benzodiazepines, like Ativan (lorazepam), work by enhancing a brain chemical called gamma-aminobutyric acid (GABA) to help you feel calm. They typically provide rapid relief, sometimes even within minutes to hours, but become addictive if used for a long time. Antidepressants, on the other hand, take longer to work and regulate your mood by balancing neurotransmitters like serotonin, norepinephrine, and dopamine.

What’s the best anxiety medication for me?

If your anxiety is disrupting your quality of life, medication may be a good option to help minimize symptoms, alongside lifestyle changes and therapy. While there’s no one-size-fits-all medication, by working with your mental health provider, you can determine the best one that can work for you to help. Some factors that may help determine which one that may be can include your diagnosis, medical history, goals, symptoms, and tolerance.  

The information in this article is for informational and educational 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.

Dr. Michael Roman is currently a Staff Psychiatrist at Talkiatry. He completed his adult psychiatry residency training at the University of Pennsylvania. Dr. Roman is a board-certified Adult Psychiatrist and a diplomate of the American Board of Psychiatry and Neurology (ABPN).

Dr. Roman’s clinical practice centers primarily around medication management and psychopharmacological treatment approaches. He also specializes in a variety of psychotherapeutic modalities which he utilizes in conjunction with medication management in order to provide patients with the best possible treatment outcomes.

Dr. Roman’s curiosity for the studies of the human mind began with pursuing a bachelor’s degree in psychobiology at the University of California, Los Angeles (UCLA). He was intrigued by the way our mind, body, emotions, and behavior were intertwined to comprise our everyday life experiences. His interest in the intricacy of the human mind was deepened in medical school, and he received his medical degree from the David Geffen School of Medicine at UCLA. He completed his adult psychiatry residency training at the University of Pennsylvania.

Dr. Roman treats a wide spectrum of patients, but his primary clinical focus is treating mood disorders, ADHD, anxiety disorders, and PTSD. Dr. Roman also specializes in treating substance use disorders and possesses clinical expertise in implementing high quality motivational interviewing and motivational enhancing therapy.

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