by Peter Roy-Byrne, MD

Peter Roy-Byrne, MDMedication treatment of anxiety is generally safe and effective. But it often takes time and patience to find the drug that works best for you.

The first line of treatment for an anxiety disorder is often cognitive-behavioral therapy, or CBT. This is a well-established, highly effective, and lasting treatment. Some people find that excessively high levels of anxiety make them unable to get the most out of such treatment, however. In this case, medication may allow full participation in CBT. Those without access to CBT or those who have not had a satisfactory response to it may benefit from medication treatment, too.Four major classes of medications are used to treat anxiety disorders.

Things to Consider

Have a discussion with your doctor about medication if you are suffering from significant insomnia, which is frequently associated with generalized anxiety disorder, or GAD. Distressed by repetitive and excessive worry, people with GAD usually focus on the day’s activities, such as what was left undone, what went wrong, what needs to be done tomorrow, and the like. People with this condition describe it as a difficulty turning their mind off, and they often have difficulty falling asleep. Improving sleep has been shown to reduce anxiety and depressive symptoms, and it can often be achieved with medication treatment.

Depression often complicates chronic anxiety. Don’t ignore a sad mood, bouts of tearfulness, low self-esteem, feelings of guilt or hopelessness, and other depressive symptoms. Medication is often helpful in reducing symptoms of anxiety and alleviating those of depression. Most drugs used to treat anxiety come from the antidepressant class of medication, so they can be used to treat both conditions effectively.

Listen to Dr. Roy-Byrne's podcast on medications.

Variety of Medications

Medication class Generic names How it works
SSRI (selective serotonin reuptake inhibitor)  citalopram, escitalopram, fluoxetine, paroxetine, sertraline  Relieves symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which enhances neurotransmission—the sending of nerve impulses—and improves mood. SSRIs are “selective” because they affect only serotonin and not other neurotransmitters.
SNRI (serotonin-norepinephrine reuptake inhibitor)  venlafaxine, duloxetine  Increases the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain.
Tricyclic antidepressant  amitriptyline, imipramine, nortriptyline  Inhibits the reabsorption of the neurotransmitters serotonin and norepinephrine. (Has been increasingly replaced by SSRIs.)
Benzodiazepine  alprazolam, clonazepam, diazepam, lorazepam  Promotes relaxation and reducing muscular tension and other physical symptoms of anxiety. Frequently used for short-term management of anxiety, such as for minor medical procedures.

Other medications may also be used to treat anxiety disorders, including MAOI's (monoamine oxidase inhibitors), anticonvulsants, beta blockers, and atypical antipsychotics (also known as second-generation antipsychotics).

If you experience a side effect of any medication, contact your physician. Do not stop taking a medication abruptly because it may create other health risks.

Making a Decision

If you and your doctor have decided on medication as a treatment option, you have many choices. Work with your doctor to find the medication that’s right for you. With patience and persistence, you will find a treatment that will help alleviate your anxiety symptoms.


Peter Roy-Byrne, MD, is Chief of Psychiatry, Harborview Medical Center; Professor and Vice Chair, Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center; and Director, Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP)


Anxiety my father age 86 can not sleep really bad to the point where he feels suffocation any body w/ suggestions is appreciated

Ask his doctor about taking Mirtazapine - I have been taking it for anxiety a few weeks - it has helped a bit with the anxiety but it has really helped me sleep well.

I have major attacks but other than that I can't sleep either but whe I need to I usually drink melethion tea can try that might help

Hey, I want to let you know that I'm praying for you and your father's anxiety he shouldn't be feeling that suffocation or shortness of breath that is a spirit like a snake or python

I'm am so sorry to hear all of you talk about your anxiety problems... I myself have anxiety and it really sucks. I get the feeling I'm dying and cant breath. I sometimes wake up from a sleep and start to panic :-( I take ativan and sometimes it helps, sometimes it doesn't. Anxiety has to be one of the worst disorders in the world. Like I said sometimes I feel like I'm going to die, but sometimes its so bad I wish I would. The only thing I can say is the only thing that has helped is STAYING POSITIVE. I try to think positive and I also PRAY when I have the attacks and the good LORD must have heard my prayers because the attacks have lessened... Thank God!

Sounds to me Beon, like your having severe PANIC ATTACKS , along with the anxiety 🙄 I committed myself to the psych ward because I , for a straight month straight, seriously could not stop that horrible feeling like you said feeling like you're going to die , and it feels so bad you feel like only death will stop it.
I Also of course have anxiety ,panic disorder, insomnia, bipolar depression,ADD, and PTSD. Ana I have fibromyalgia and back problems.
The psych ward was actually horrific. They never actually treated me or tried to figure out why such pure panick!! I'm disappointed in the health care system for sure after that!

Try not to worry Beon, you're in good company. I've had panic attacks, anxiety and depression for years. Medications have helped enormously. Recently Lorazepam and Sertraline..... earlier remedies were Citalopram, Alprazolam, Paxil and Lexapro. They've worked wonders for me. And I haven't even been including counseling at all in the past few years. Hang in there friend.

Insomnia is serious and without sleep for about 3to4 days, you can really start to think you're might loose your mind! I think you may even start to hallucinate after a certain number of days ( I'm no doctor. Obviously!)
He may be experiencing panic or anxiety, due to the lack of sleep , and panic attacks can make you feel like you can't breathe.
I would say call his doctor right away or go to the ER to make sure he doesn't have a physical condition that's making him feel suffocated. And definitely he needs a good sleep aid! Insomnia is serious!
Hope all is well and a solution to the problem has been put in place. 🙏

I suffer from something very much like your father. I think I have pinpointed my situation to panic attacks (for lack of a better term). I can't get the help I need. My Doc is afraid to prescribe. I, however have gotten some relief with benadryl. You just need to be careful with it. Good luck.

My advice is to insist on going to a Sleep specialist. Sleep specialist are a specialist in a specialist field of medicine. A Psychiatrist can specialize in sleep and so can a neurologist. Make sure your specialist is also a specialist in Sleep.

They should schedule you for an overnight sleep study with timed naps the morning after.

Always ask why you are being prescribed a prescription. You need to know clearly what your doctor is trying to do to help you and what he is expecting from the medication he prescribed. Be sure to ask if the medication is addictive.

I been anxiety and panic attacks for the last two weeks. I been prescribe sertraline and vistaril as antidepressants. But they haven't work out. They just trigger my anxiety more. I want to see any other antidepressants could work for me.

If you are having trouble with your meds then try this test called genolab ..... it is a test based on your dna and they test it against it to see what works and what doesn’t

I have had this my entire life. I have been told I get up just to worry. I get to where I hyperventilate where is I can’t at h my breath. Please help with a medication that can actually help me.

Suffered for over 17yrs with PTSD-Anxiety-Panic Attacks and insomnia. After countless drugs prescribed for depression (SSRIs etc), being a zombie, the only medication combination that worked for me was Xanax and Lexapro combined together. My quality of life was impressive. However, doctors are worried about addiction. When someone has what I do, I do not think being prescribed four to five medications that make you not feel “normal”, being able to not “deal” with daily problems and not being able to function is absurd! It took being hospitalized and seeing a 35yr State certified Psychiatrist to give me two medications that changed my life. The Lexapro helped with my depression but made my anxiety worse, and the Xanax to to help to offset the Lexapro yet helped with my anxiety, insomnia, panic attacks, startle response and muscles spasms. Now I live a great life, function as I should, and sleep. Also meditation, walking in nature, breathing methods and journaling helped tremendously. So doctors should never eliminate benzodiazepines and as 2nd line of defense against these mental conditions. Ever!

I was just told today that they want to put me on depression medications. And will not give me anything for the anxiety I went in for. I have had my sisters Xanax before and lorazepam. And they both calm me. So I went to try and get my own without having to ask my sister. And was told I could not be prescribed that. At this point I don’t care what it is. But the other one they proscribed was Hydroxyzine. And the side affects are disgusting. I can’t be walking around like a zombie and not be able to drive to work. Or be at work not all there. That’s in sane the pills I took from my sister I took a half a one maybe 3 times a week when my anxiety was really bad. Never got hooked nothing. And now I feel like there is nothing for me. Cuz everything else that they proscribed me has all these shitty side affects. I’d rather just take a shot. I just loved your comment lol

It sounds like you may need to try a different class of medication or a higher dose. I found switching from SSRI to SNRI made a big improvement. SSRI didn't work for me after trying a couple different ones at a different dose. I am now on veneflaxine and have been for two years. Issue with SSRI is they have an uplifting effect which can be bad when trying to treat anxiety although good for depression.

I would say your Dr should give u a pill like clonzapam a quick acting antianxiety drug to make u relax before your antidepressants kick in

My medical physician put me on xanax and my pain doctor took me off of it. I dont understand why they won't let me stay on it if its helping me. I am on the edge all the time and feel like I'm going to go off on someone.. Can you help me??

Xanax and Pain meds are a deadly combination. It would kill you, That's why he took you off

My anxiety had been controlled for years with Xanax. I had two unsuccessful neck surgeries in 2007 and 2008. I also have Psoriatic Arthritis and my Pain Dr started 4 Norco and 4 Soma a day. I also had neck and shoulder injections several times a year. Never had a problem of any kind. Once the government declared the opioid problem over the last year I have been reduced to only 3 Norco a day. Did not have a problem stopping the xanax or soma. We have tried several anxiety meds none have worked. When my family doctor of 30 years started me on the lowest dose of clozapine with gave me relief, my pain doctor was going to cut my Norco if I didn't stop the clozapine. So I back to square one.
Yes some people abuse, some use illegal drugs, but for those of us that have had years of problem free relief we are now the criminal with no voice to share our story. The American public only hears about the over doses and not the chronic pain patients that suffer daily because the government is now the American doctors.

My mother was cut down to 3 times a day on lortab and made to go to pain management. She has done this for several months. Pain doctor hasnt increased her back to 4. Why bother going? She has MRI and scans showing why she needs the pain med. They took mine away cold turkey after 13 years of taking. People are still overdosing. It will drive more abusers to heroin. Those on the news are overdosing on it.

I truly feel sorry for you. I am in health care and have been so disgusted with this change with these drugs. In the 70's, 80's and even the 90's, these drugs were used all f the time (valium, and various pain meds) The difference is pt's back then didn't abuse this meds! Now, these people are mixing many different meds. to achive a high.So, people like you who NEED these drugs are suffering. Doctors are afraid to prescribe, so they refer to pain MD's. Even pain doc's are having a tough time. No change anytime soon!.

i would like to know how u quit xanax without a issue

Our government is sticking its nose in where it doesnt belong. I was prescribed oxycodone for 4 hetniated discs. I was only taking them as prescribed. Even had some left over at the end of each month. Now ive been limited to 12 a month. I have had to take early retirement because i cant sit or stand due to the pain.

I do not think it’s the combination of opiates with benzodiazepines. I believe it’s the stronger Morphine based drugs like Oxycotin. It’s also very dangerous with just Norco, Vicodin, and Percocet because you do have people that abuse them and take too much of both, or with one of the other too much. I think the ones who really need them should not be stigmatized for taking them as prescribed by their Doctor. The ones that do not need them don’t care what they take of them because their not in pain. Along with mixing them with alcohol and other drugs, they also get them off the streets that can sometimes have other medications mixed in them. Then you have the people whom are prescribed opiates and they sale them, not take them, thus giving an outlet to those who do not need them and hence making the epidemic and addiction worse. So the government cannot keep tabs on who has what so everybody suffers except the drug dealers and their clients.

I've been taking clonazepam for over 8 years and now thy wanna take me off my health is good but nothing else is working can't sleep I can feel my heart beating and more I was doing ok were I was i had a normal life God just pls help me my life not the same it's not far why did thy give it to me in the first place

I have been on Clonazepam for 10yrs I started taking it when my husband passed away.Now my doctor said

she can't prescribe 1mg.3 times a day as needed.I seldom ever had to take 3 .. Now she has me taking.
5, twice a day and it's not the helping
All because other people abuse medicine p
And the ones who need it suffer 😢

I agree that people that actually suffer from chronic pain and anxiety are not taken into consideration when comes to opioids and benzodiazepines, I need both and luckily have drs that understand that , they are however conservative about dosages.although I really do need to increase my pain meds from 2x a day to 3x a day, my dr will not, the DEA have really cracked down on drs that prescribe them .. I have RA , psoriatic arthritis,osteo arthritis and a lumbar and c-spine spinal fusions and also suffer from PTSD and anxiety... since I’ve started taking biologics my RA isn’t as painful as it was but still have pain and increased with flare ups.. sorry to be so lengthy, bottom line is a lot people need these meds and not everyone abuses them

There is no drug addicted person who has ever killed themselves on purpose. However there has been countless doctors/pharmacists who have prescribed lethal combinations of narcotics and benzodiazepines. It is an epidemic in our country in all parts. Please educate yourself to help stop this rather then blame it on an addict.

"There is no drug addicted person who has ever killed themselves on purpose."
What kind of absurd statement is this? Are you aware that depression and suicide exists? I'm sure many of the people who killed themselves were deeply depressed and taking drugs to cope. Purposely overdosing has got to be one of the most painless ways to commit suicide.

you would think you were awful insomnia sometimes there are times when i sleep a few hours at night for days.going to see a psychiatrist soon to see if they can help yes i am on pain management but damn i take on a prescribed and the xanax i want for sleep at night 1mg at bed time. they won't even give me that don't think that will kill me.

I use to be on 4 vicoprofen 3 flexural 30mg diazepam and a 150mg fentanyl patch and I never had any problems except after being on pain medication for 9 years due to 13 herniated disc and 9 operations on my spine I had to have a pain pump put in because I built a tolerance to the fentanyl. They put dilaudid in it and that helped me. But the Dr. that put the pump in would not let me be on valium even though I was only taking 2.5 about 4 times a week for high anxiety. but my family Dr. told him I needed it because it was a lot safer then the 5 over the counter meds I was taking to try and calm me down. And if anyone has stomach problems DO NOT TAKE ZZZ QUILE or you will have stomach pain like you never had

I’m sorry you’re going thru this, I currently am too. I have taken pain meds and klonopin together for 15yrs and all because these druggies out here that take more than prescribed we either suffer with the pain or we give up our pain meds to take something for anxiety and panic attack’s. I don’t even leave my house anymore and have a really bad nervous disorder that what’s the sense of going to the DR for? They give you these meds that take 6 weeks to get into your system and if I doesn’t work you have to be switched and in mean time while coming off them you get terrible brain zaps and restlessness that you cannot even walk around and function. Verses taking one or two pills a day when you feel panicked or overwhelmed.

Thank you for your response. I am sorry that you have to deal with that every day. I think he has already made his mind up to go back onto them. I just hate the withdrawal he goes through when they run out of his medication and he suffers all weekend. I hope things get better for you my friend. Stay strong

I too just got informed the meds my reg Dr has me on I can't take with pain meds. Librium. I use oxygen at night just to please them. Taken this anxiety meds for yrs. Got off took clonazepan. Pain Dr said get off of those. Went back to librium.. He recently went in with other doctors. They voted says anyone taking poxides won't get pain meds. Two neck surgeries in 97 left me with upper back and neck pain. Injections etc now. Now lower back pain too another ruptered disk. Also nerve damage in extremities arms. One really bad. What can you take for panic attacks and anxiety with pain meds!?