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

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.

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.

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 understand your question quite well. They probably took you off of it because its meant to be used as a short term medication and if used for a long period of time can cause addiction.

If you need to take a drug that enables you to function normally in society and without it you have no life what does the term addiction really mean. It means you have to have it to function. I'm addicted to my Diabetes meds because without them I would die.

My fiance is currently serving 25 yrs on a 35 yr sentence. He was a heroin addict for a long time. At 8 yrs old he was taken into state custody because his parents couldn't control him. Other drugs began at this age. Many tramatic things happened to him as a child and continued on to adulthood. He turned to heroin and then accidently took a life. I believe he has devoloped PTSD from many places in his life; prison itself being one. He had succeeded in taking himself off of Klonopin, but he slowly returned to almost a hermit and is not taking care of himself and has no energy or drive. He used to lift weights all the time, but he was taking 4 mg of Klonopin. He is now contemplating going back on his Klonopin. He says the other class of meds (mentioned above) do not help. Is there a reason that these meds would not work for him? Does it have anything to do with the kind of drugs he used before? Can someone need to be on Klonopin for their whole adult life? Is that safe? Thank you for your time! -D.