Medication for anxiety can relieve anxious feelings, reduce the frequency and severity of panic attacks, and produce a sense of calm where there was agitation.
Millions of Americans use these medications on a daily basis to deal with general anxiety, panic attacks, various phobias, PTSD, obsessive-compulsive disorder, and more.
If you believe anxiety is interfering with your day-to-day life, consult your doctor or mental health professional to find out if anxiety medication is right for you.
Below are the best medications for anxiety of 2020.
Prozac (fluoxetine) has been overtaken sales-wise by some other anxiety medications in recent years. Yet that does not diminish the high marks it still earns for its effectiveness in treating panic attacks, OCD, and more.
What we like: Prozac has a proven track record for treating anxiety disorders. It has helped millions purge unwanted thoughts, reduce fear, and mitigate the urges behind compulsive behavior.
Flaws: Prozac should not be used by those with a history of bipolar disorder or those with liver problems or diabetes.
Zoloft (sertraline) is used by countless individuals to treat their OCD, panic attacks, PTSD, social anxiety, and more. It does a generally reliable job relieving anxiety, reducing the number and severity of panic attacks, and fending off OCD episodes.
What we like: Zoloft has a well-deserved record for addressing the worst aspects of general anxiety disorder and for preventing panic attacks. It is well tolerated by most people, with serious side effects being rare.
Flaws: While extremely rare, sertraline has been known to produce a heart rhythm anomaly called QT prolongation.
Xanax (alprazolam) is mostly used to treat general anxiety disorder and panic disorders. Although, on occasion, it might be deemed appropriate for other types of anxiety. Xanax is a benzodiazepine and is available in liquid or tablet form.
What we like: The fact that it is available in multiple forms is a plus. Xanax has a nearly 40-year record of providing effective relief for general anxiety disorder. In some cases, it may be used to treat patients with both anxiety and depression.
Flaws: Xanax has been known to produce dizziness in some patients. Also, cannabis use may exacerbate side effects.
Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat everything from general anxiety disorders to various phobias. It works by increasing serotonin in the brain, which improves mood and reduces anxiety.
What we like: Paxil is a generally effective, low-impact SSRI medication with a strong track record. It is particularly effective against panic attacks. Any side effects individuals experience from Paxil are usually mild.
Flaws: You should not smoke marijuana while taking this medication. Also, it may cause some drowsiness, so no operating heavy machinery either.
Lexapro (escitalopram) is used primarily to treat general anxiety disorders that have persisted for at least six months. Like several others on this list, it is an SSRI and works by tricking the brain into producing more serotonin.
What we like: Lexapro does a good job alleviating moderate to severe anxiety, and reducing intensity and frequency of panic attacks. Many have noted that it also does a good job reducing feelings of anger, while promoting deep, restful sleep.
Flaws: It has been known to negatively impact sex drive. And it may produce dizziness in some.
Klonopin (clonazepam) is widely used to control seizures. But it also reduces the severity and frequency of panic attacks, and is effective in treating social anxiety disorder. As a benzodiazepine, it goes to work fast.
What we like: As is the case with all benzodiazepines, you will not have to wait long to feel the effects of Klonopin. It is one of the most effective anxiety medications for panic attacks and quickly produces a feeling of calm.
Flaws: Dizziness is a fairly common side effect. As such, it may not be appropriate for older individuals.
Valium (diazepam) has a history that goes back nearly 60 years. A product of Swiss drugmaker Roache, Valium was the first drug to reach $1 billion in sales. Today it is used for everything from general anxiety to alcohol withdrawal.
What we like: Valium works fast to alleviate anxiety, reduce the severity of panic attacks, and produce feelings of emotional tranquility. Valium is a benzodiazepine and has proven itself useful in promoting a good night’s sleep.
Flaws: There have been rare instances where patients have claimed Valium has produced hallucinations. It is also potentially addictive.
Ativan (lorazepam) is another benzodiazepine that works by calming the nerves. It produces euphoria by enhancing the effect of the neurotransmitter GABA. By doing so, it prevents anxiety from rising to troublesome levels.
What we like: Ativan does an admirable job reducing panic attacks. When taken as directed by otherwise healthy individuals, side effects are manageable and far outweighed by the benefits.
Flaws: Ativan may cause drowsiness. As such, you should not drive, drink alcohol, or smoke marijuana while taking it.
Effexor (venlafaxine) is an SNRI that works by increasing the amounts of serotonin and norepinephrine in the brain. Effexor is typically used to treat general anxiety disorder, social anxiety disorder, and certain phobias.
What we like: Effexor is a long term treatment for less immediate needs. It generally produces an easy feeling and effectively takes the edge off of angry feelings, impatience, and restlessness.
Flaws: You should avoid aspirin when taking Effexor. And it may produce a severe interaction with MAO inhibitors.
Celexa (citalopram), has quietly become one of the most prescribed anxiety medications on the market. It is an SSRI that works by restoring serotonin balance in the brain. It needs to be taken on a regular basis to be truly effective.
What we like: Once Celexa reaches critical mass in your bloodstream, it does an outstanding job of helping you maintain an even compass. Side effects are also typically quite manageable.
Flaws: Although not common, this medication may cause an irregular heartbeat, dizziness, and fainting.
Who Needs Medication for Anxiety?
Feeling anxious now and then is part of life. It is a component of the body’s natural self-defense system and linked closely with the fight or flight response. But there is a difference between feeling anxious prior to performing in front of a crowd, and being afraid to leave your house because you might encounter people outside. Just as there is a difference between jiggling the doorknob once as you leave your home to make sure it is locked, and checking the doorknob two dozen times.
Essentially, anyone who suffers from an anxiety disorder is a potential candidate for anxiety medication. But, just because someone might benefit from anxiety medication, it does not mean they necessarily should take one. They may be served just as effectively by a combination of psychotherapy and exercise. The most important thing is that the decision to use an anxiety medication is arrived at only after careful consultation with your doctor.
How We Ranked
Ranking anxiety medications is an inexact science due to the range of divergent opinions regarding their efficacy and applicability. The fact is, many therapists are extremely reluctant to prescribe anxiety medications, preferring, instead, to try and unmask and treat the root cause. While in other instances, some doctors and psychotherapists will prescribe first and ask questions later. That approach stresses bringing the problem under control before trying to treat any underlying causes.
So who is right? At this point, it is nearly impossible to say. All that can be said with any certainty is that it is best to use a multi-pronged approach when treating anxiety disorders. That typically means therapy, exercise, and, perhaps, medication. Otherwise, at the end of the medication cycle, the underlying causes will still be there.
All that said, the general consensus as of this writing is that SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors) represent the current cream of the crop. SSRIs include Prozac, Zoloft, Celexa, and others. SNRIs include Effexor and Savella. Both are commonly prescribed for those suffering from general anxiety disorder (GAD), panic disorders, and obsessive-compulsive disorder, or OCD.
Finally, benzodiazepines are often used to treat social anxiety disorder and panic disorders. Benzodiazepines include Valium and Xanax. For the most part, these no longer enjoy the favored status they once did. That is mainly due to the elevated risk of addiction they present, compared to SSRIs and SNRIs. They are still in common use, however.
At the end of the day, we let the results of our research into the current thinking of mental health professionals guide our rankings.
Medication for anxiety can provide effective short term relief. Anxiety medication provides temporary relief from the worst symptoms of anxiety. In some cases, that relief will arrive within a half-hour or so and last most of the day. In the case of SSRIs like Prozac, you will need to wait a few weeks before enough accumulates in your system to provide relief. Then, it is a matter of maintaining the proper level. If you do not, the symptoms will slowly return.
Medication for anxiety can reduce the physical symptoms of anxiety. Oftentimes, anxiety is accompanied by distressing physical symptoms, including sweating and shaking, shortness of breath, muscle tension, dizziness, and more (1). The right anxiety medication can bring an end to these physical manifestations and allow you to feel more like your normal self.
Most medication for anxiety is non-addictive. With a few exceptions, most of today’s best anxiety medications are safe and non-addictive. They are a far cry from anxiety treatments of the past that often included morphine (2) and other opioids. Still, safety is not a green light for abuse. Virtually any medication can become a problem if not taken as directed. And anxiety medications are no different.
Medication for anxiety does not pose a threat to other bodily functions. The notion that anxiety medications can harm various organs is just not true. When taken as directed, anxiety medications do not pose a direct threat to vital organs. Nor do they compromise essential bodily functions. In fact, antibiotics pose a greater danger to your liver and kidneys than anxiety medications (3). So do NSAIDs like Advil and Motrin.
Medication for anxiety can reduce negative thoughts. Many of those who suffer from anxiety are also beset by bouts of negative thinking (4). These unwanted negative thoughts often seem to come out of nowhere. They can be very disturbing both in nature and in the degree to which they disrupt normal thought patterns. Many of today’s best anxiety medications reduce or eliminate these negative thoughts.
Medication for anxiety is often covered by Medicare. Many individuals, especially older ones, worry about how they will pay for anxiety medication. The good news is that if you have a Medicare Advantage Plan, as well as a prescription for the anxiety medication, it will likely be covered by Medicare Part D (5).
Medication for anxiety can help you recover. Not everyone will completely recover from their anxiety disorder, but in many cases, it is possible. It usually takes a multi-pronged approach that includes medication, therapy, and exercise. And, of course, it will take time. As long as you are patient and persistent, there is a decent chance you can emerge on the other side of an anxiety disorder.
Medication for anxiety can open up possibilities in your life. Anxiety often causes people to circle the wagons and withdraw from life (6). They begin to make excuses for avoiding get-togethers such as; “I never liked going there” or “I just don’t feel like going out”. When in reality, they are giving in to their anxiety. The right anxiety medication can remove the walls of fear and open up new horizons.
Medication for anxiety can also relieve some symptoms of depression. SSRIs (selective serotonin reuptake inhibitors) have shown quite a bit of promise in the treatment of depression symptoms, as well as symptoms of anxiety. So much so that they are often prescribed as the sole medication for patients who suffer from both conditions (7).
Medication for anxiety can make you a better worker. Anxiety can be a major obstacle to workplace productivity (8). Among other things, it can cause procrastination. It can interfere with a person’s ability to make a clear and informative presentation. And it can cause people to avoid or cancel important meetings. The right anxiety medication can remove anxiety-driven obstacles and let you get back to the business of business.
Medication for anxiety is covered by most insurance plans. As long as your health insurance has a prescription drug coverage component, it will likely cover the cost of anxiety medication (9). But even if you do not have insurance, the cost of many anxiety medications is very reasonable.
Medication for anxiety can help prevent migraines. The relationship between migraines and anxiety is complex. In some cases, it is very much a matter of which came first, the chicken (anxiety) or the egg (migraine). But regardless of whether your anxiety is triggering migraines or your migraines are triggering anxiety, there are anxiety medications that can help put an end to the cycle.
Medication for anxiety can help improve your relationships. Anxiety disorders can be disruptive to normal relationships (10), especially when they are left untreated. Those with anxiety may become defensive or decline to participate in family events. Trust suffers. They may even snap at loved ones for no apparent reason. Anxiety medications can help turn things around and restore healthy family interactions.
Medication for anxiety can let you sleep easier. Insomnia and anxiety have an unfortunate tendency to go hand in hand (11). Whether a person suffers from a General Anxiety Disorder or something more specific, sleep is often one of the first and more persistent casualties. The right anxiety medication can help reverse this disturbing trend and allow you to get the restful sleep you need.
Medication for anxiety can get you through trying times. To say things have been ‘trying’ as of late would be an understatement. As a result, just about everyone’s anxiety levels have risen (12). But recent events aside, life in general has a way of trying our patience and fraying our nerves. For some people, it can be overwhelming. The right anxiety medication can help you get through trying times so that when the good times return, you can enjoy them.
Medication for anxiety can prevent panic attacks. Benzodiazepines such as Klonopin are effective at preventing panic attacks (13) in many individuals. Panic attacks can be frightening, overwhelming experiences that take hold of a person’s consciousness for 10 or 15 minutes. Being free of them can be a very liberating experience. Keep in mind, however, that medication alone will not help you get to the root cause of your panic attacks.
Medication for anxiety can treat phobias too. Many people think phobias are a world unto themselves. But they are actually classified as a type of anxiety disorder and will often respond well to the right kind of anxiety medication. Whether you suffer ophidiophobia (fear of snakes), monophobia (fear of being alone), acrophobia (fear of heights), or aerophobia (fear of flying), there is likely an anxiety medication that can provide some measure of relief.
Q: What causes anxiety disorders?
A: The exact cause of anxiety disorders will often vary from person to person. Genetics may play a role. Or it may be a result of learned behavior or personal experience. Military personnel often suffer from PTSD as a result of wartime trauma. Anxiety disorders may also appear as a symptom of other mental health issues. In some instances, however, there may be no apparent cause.
Q: Isn’t anxiety normal?
A: Anxiety and fear are indeed considered normal responses in some situations (14). For instance, few are the people who do not feel some butterflies before speaking to a crowd. And, if there is a legitimate threat at hand (say, someone pointing a gun at you), fear is a completely normal response. Anxiety only becomes a problem when it interferes with a person’s ability to live their life, do their job, or maintain relationships.
Q: Is medication the answer for anxiety?
A: Medication may be part of the answer for anxiety. But it is often recommended that a person also engages in psychotherapy and exercise (15). In fact, many doctors recommend a person try exercising before they will prescribe medication. Exercise releases muscle tension that can contribute to anxiety. It gets oxygen flowing to the brain that can elevate mood, and it releases the feel-good hormone serotonin (16).
Q: Do all anxiety medications treat all types of anxiety?
A: No. Anxiety medications are not one-size-fits-all drugs. Just because a certain medication works to relieve PTSD symptoms, it does not mean it will also alleviate anxiety related to fear of heights. Or that you can use it to treat obsessive-compulsive disorder (17). It is vital that you work with your doctor to find the right anxiety medication for your particular situation. And that you avoid ‘sharing’ anxiety medications with others.
Q: Are there different kinds of medication for anxiety?
A: There are several different kinds of anxiety medication. They include SSRIs, SNRIs, beta-blockers, and some antidepressants. Each of these medications work in different ways. SSRIs block reabsorption of serotonin in the brain, which increases the amount of serotonin available. SNRIs do the same but also block norepinephrine. Beta-blockers work by stunting the effects of adrenaline, while antidepressants work in much the same way as SSRIs.
Q: Are medications for anxiety addictive?
A: In the past, when opioids (18) were often prescribed for anxiety disorders, addiction was an all too common outcome. Today, opioids are reserved for only the most severe cases. And even then, their use is strictly controlled. That said, anxiety medications need to be dispensed carefully because some are capable of creating a euphoric feeling that may prove problematic for some individuals.
Q: Do anxiety medications produce the same results for everyone?
A: Unfortunately, a particular anxiety medication may produce very different results in different people. A medication that works fine for Person A may not work for Person B else. Or, Person B may need to combine it with another medication to enjoy the benefits. The fact is, mental health professionals do not know why a particular drug will work for one person but will not work for another.
Q: Will Medicare pay for my anxiety medication?
A: As long as you are 65 and enrolled in Medicare, and you have opted for Medicare Advantage plan (19), Medicare should cover the cost of your anxiety medication. That is, as long as you have a prescription from a qualified doctor. For the record, most private health insurance plans will also cover anxiety medication, as long as it is prescribed by a qualified mental health professional.
Q: Should people with a history of substance abuse use medication for anxiety?
A: While today’s anxiety medications typically present a low risk of addiction, the possibility is nonetheless there. As such, those with a history of drug or alcohol addiction should discuss the matter thoroughly with a mental health professional before deciding whether to take anxiety medications. Remember, there are other non-medical options for treating anxiety, including psychotherapy (20) and exercise.
Q: What are SSRIs?
A: SSRI stands for Selective Serotonin Reuptake Inhibitors. This class of medications works to prevent the hormone serotonin from being reabsorbed by the brain. By denying reabsorption, the brain is forced to produce more serotonin that, in turn, helps reduce anxiety. Prozac and Celexa are popular SSRIs. While SSRIs are considered non-addictive, they can produce drowsiness, sexual dysfunction, and other side effects in some people.
Q: Are anxiety and phobia the same thing?
A: While they may share some similarities in the way they physically manifest, anxiety and phobia are not the same. Anxiety is a feeling of intense apprehension that may be all-encompassing or may arise when a person is faced with a stressful or awkward situation. Phobias, by comparison, produce an overwhelming fear of a specific thing or event, such as heights, spiders, elevators, large gatherings, and airplanes.
Q: Can anxiety disorders be cured?
A: Permanent recovery from anxiety disorders is possible (21). But it is rarely as simple as taking a certain medication for a few months. It is also important to keep in mind that anxious feelings are a natural part of our natural defense system. As such, even if someone has recovered from a certain type of anxiety disorder, they will still be susceptible to anxious feelings from time to time.
Q: How do I know if I need medication for my anxiety?
A: You will need to see a qualified mental health professional and receive a proper diagnosis. Anxiety disorders are not like headaches. They cannot be self-diagnosed. If you believe anxiety is interfering with your ability to live a normal life, you should make an appointment and discuss the situation with a doctor. Even then, other therapeutic options should be discussed before the decision is made to use anxiety medications.
Q: What are SNRIs?
A: SNRI stands for Serotonin and Norepinephrine Reuptake Inhibitors (22). SNRIs are a class of medications that boost serotonin while also regulating the neurotransmitter norepinephrine (23). SNRIs are mostly used to treat depression. But they are also prescribed for generalized anxiety, and to a lesser extent, panic disorders. Side effects from SNRIs may include fatigue, constipation, and loss of appetite.
Q: Is there a downside to medications for anxiety?
A: Any downside to anxiety medication must be weighed against the potential benefits. Certainly, you cannot ignore the possibility (or reality) of side effects. But if you are experiencing genuine relief from your anxiety, the side effects (if any) will probably be worth it. Another potential downside has to do with expectations. If you expect the medication to cure you of your anxiety quickly, you are setting yourself up for disappointment.
Q: Are there alternatives to medication for anxiety?
A: It is rarely advisable to try and treat anxiety with medication alone. Most people should also consider engaging in cognitive behavioral therapy (24) as well. That is because anxiety often has complex mental and emotional roots. Medications, useful as they may be at treating symptoms, are not able to address those root causes. And if you hope to transcend your anxiety, you will need to address them.
Q: Are medication for anxiety safe?
A: Anxiety medications are generally safe and effective. They have little impact on vital organs or bodily functions. While side effects such as fatigue and trouble concentrating are possible, many people experience few or no adverse effects. That said, the longer you use some anxiety medications, the less effective they will become. And, to avoid withdrawal symptoms, you should not abruptly stop taking them.
Q: What is a beta blocker?
A: A beta-blocker is a type of medication commonly used to treat hypertension (25) and circulatory problems. On occasion, doctors may prescribe them to deal with certain symptoms of anxiety, such as rapid heart rate and shaking. That is because they can block the effects of adrenaline (26) and epinephrine (27). As a general rule, however, they are not considered to be true anxiety medications per se.
Q: Are there different kinds of anxiety disorders?
A: There are five generally recognized categories of anxiety disorders. They are Generalized Anxiety, phobias, panic disorders, Post Traumatic Stress Disorder (PTSD), and obsessive-compulsive disorders. In some cases, it can be difficult to discern exactly which category a person’s symptoms may belong to. As such, it is vital that you discuss the matter with your doctor to get a proper diagnosis and the proper medication.
Q: Will I need anxiety medication for the rest of my life?
A: It is typically not constructive to think about things in such a way. A better approach, according to mental health professionals, is to deal with the current situation, develop a treatment approach with your doctor, and see how things go. It is possible that you may transcend the anxiety disorder in time. Keeping a positive attitude (28) can go a long way toward ensuring that happens.
Q: Can anxiety cause a migraine headache?
A: Anxiety can and often does trigger a migraine in people who suffer them. It can sometimes go the other way too. That is, worrying about a migraine can trigger anxiety, which in turn triggers a migraine (29). If you suffer from migraines, it is highly recommended that you try and avoid situations that cause undue stress or anxiety. Also, if you suffer from some form of anxiety disorder, medication may help to relieve the anxiety and prevent it from becoming a trigger.
Anxiety disorders are vexing conditions that often evade simple treatment or quick resolution. Their potential causes are many and complex and may include personal trauma, learned behavior, genetics, or any of numerous other possibilities.
Anxiety medications have come a long way since the days when patients were routinely given morphine or other opioids. Today’s anxiety medications are largely non-addictive, target specific aspects of brain activity, and cause only mild or no side effects in many people.
The information above is presented for informational purposes only and should not be considered medical advice. If you feel that anxiety is interfering with your life in a substantive way, you should seek the help of a qualified mental health professional as soon as possible.
For cpoe.org’s #1 recommended anxiety medication, click here.