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 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

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!

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.

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!?

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.

You really need to write an article, David. I hear you. Druggies have ruined it for normal people. Druggies don't GO to doctors! They buy street drugs. So, all our doctors who are too scared to prescribe something that can really help someone with this disorder won't help you or me. They lump everyone together. If you saw how doctors are trained, you'd realize how little training they get. I would say that with all the literature you have probably read on this subject would be more than the one semester of Pharmacy med students get in school. It's true. I'm in a different field and our Pharmacy professor told us just how little training they receive and how much more people in my field received. But we cannot prescribe... I'm very angry about the accusations that anyone who takes some of these medications are now drug addicts. If doctors were properly trained, they wouldn't be afraid to give people the medication they need. But in America doctors, ironically, are the ones prescribing, when in the old days it was the pharmacist who actually knows the chemical composition of all these drugs, and can diagram the molecular structure and how it changes with an addition of another drug. Pharmacists, unfortunately, are not prescribing, but I think doctors should be ordered to work with a pharmacist who knows the molecular structures and can easily tell you what a drug would then turn into if added to a different drug. Doctors don't know HOW to do that. Always check with your pharmacist/chemist. I rely on them. Unfortunately, they can't help you other than the information. I had a Pharmacist friend who worked in a large famous hospital in the U.S. and he ended up quitting because he'd tell the doctors what each drug would do to the patient and if they combined another drug he could tell if it would then turn into a different drug that could kill. After too many deaths, and doctors not listening to him, he quit and opened his own pharmacy. My friend had a Ph.D. in Pharmacology, so he obviously had loads more information about drugs and how they change when combined. But an M.D. will look down on someone if they don't have that coveted degree.
I also worked in a large hospital in the Chemistry Lab and I had a good friend who was head of the lab who quit because he couldn't take the stress anymore when he'd call a doctor on a ward and say that a patient's blood showed that they were getting intravenous drugs or chemicals and that the patient would die because and he'd explain it. But they are an MD and think they are God, so they ignored him. In the chemistry lab we could track what happened to each patient and how their blood work changed. They eventually killed the man because they would not listen to the chemist.
Doctors really do think they are Gods. They think they know it all. But they don't. And they are not even humble enough to admit it.
Good luck to you, David. I am sorry you are going through this.

Nice response to that!!! My husband is addicted to Keppra because without it he wouldn’t have no life because of seizures. Good statement. It’s always about the quality of a patients life. Not a addiction. People also have addictive personalities that Doctors can suspect. Like marijuana use and alcohol use are two known things that prove addictive personalities even with either being addictive.

No the pain Dr's said any of that class. I can take antidepressants. Not depressed.
My reg Dr said go off the librium slowly and start the new one as I quit the old. It's not the "will be addicted" problem. It's a class, even my pain Dr said he had no issue with it. The other Dr's out ranked him. He's had his own practice for years and just didn't want me on calonipin. He joined a group of Dr's. So he's low on the totem pole so to speak!
Now I'm struggling to live with severe pain for yrs, and waking up going to bed hurting like hell. In bed mostly. Then the anxiety from it I've struggled with, along with social anxiety, ocd, and panic attacks! I'm Being punished for the Abuse of drugs that others are doing! And the drug enforcement isn't helping hurting the good Dr's along with the bad! They are afraid to prescribe!

Trust me when I say Xanax are horrible for you! They are extremely addictive. The withdrawl can range fro rashes, to hair loss, to even more severe symptoms. I KNOW this because my husband was on both pain management and xanax. He wnded up in the hospital and has not been the same since. Mentally, emotionally, or physically. It is not worth the risk! There are other medications that work just as well. Yes, some of thoae are addictive as well, but the withdrawl is not as complicated or severe. Please consult your physician for better options!

Exactly the same thing, I was at a happy medium ,then my pain dr. Took me off xanax, now I can't sleep and I'm a nervous wreck don't even want to leave my house

i have been on xanax for years treating anxiety its works dont understand doctors either look for someone else to talk to about it. Its a different world out there now

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.

It is four years, I have been taking medicine, until now, I have used diffetent kinds of medicine, but still I am suffering...I really dont know what to do...
While walking, eating and being jobless, I think I will have brain attack, I mean somethi ng will happen with my brain...and I also sufffer phyically...this the big problem, it physically disturb me, while eating, walking, bathing...

I fell at work in 2013 an injured my ahoulder, I had 3 a surgeries on my damaged left one, and my right one is now damaged due to repetitive motion from scrubbing carpet with a trucm mounted equipment for 18 yrs and my boss rushing the insurance to send me back to work, I finally found a pain Dr who prescibed xanax and it helped me sleep, I got rest, I got relief from my pain with norcos, (even when they only give you 3 p/ day) after a few months while getting the last 2 sugeries done, going homeless for lack of responsalities owned up by employer and insurance and stress from being fired, now I'm fighting the system, Michael Jackson, Prince an others don't matter to my family, if they were stupid for killing themselves, why do we have to suffer, does anybody think it's fair to punish everybody for the mistakea of a few?
Jose Orona from Montclair Ca.

Severe Anxiety has destroyed my life- the obly relief i recieved was from xanax. I was put on other meds that never worked- and being homeless and unemployed- the state clinic would not prescribe what I need. I am dying from two different issues and my only family member left is also dying. The disability route for me was rejected. I am to the point of ....beyond anger

I definitely agree with you, I’ve been treated for the past 3 yrs for anxiety and bipolar disorders, around the end of last year I also started to have lower back pain; therefore, my general doctor prescribed norco and soma to control the pain, but the pharmacist made such a BIG deal about it, i completely understand the risks of taking the antidepressants along with the pain meds, but my dr had explained me very detailed as to how to take the meds for them not to hurt me, but that didn’t work at all the pharmacist refused to fill my prescription......unfortunately May 31, 2019 my dad passed away and it really hurts because I was so close to him, then on June 18 , 2019 I had a lower back surgery and this was considered a major surgery so I was given pain meds when I was discharged. I always have such a difficult time to get my refills, Walgreens or perhaps the pharmacist at Walgreens made a Humongous problem and made a note in the system that I was getting the meds from different doctors and even though I explain to her about the surgery, she just close her BIG EARS and she didn’t fill my prescription, I consider this even more danger than taking both the anxiety meds and the pain meds because per the instructions on the anxiety meds, patients should NOT stop taking the anxiety pills at once because this can cause patients to have suicidal thoughts and the pain meds I still need due to the surgery. Went to another Walgreens and the pharmacist there did fill up the RX, but now they are saying that I’m getting pain meds from different doctors and different Walgreens pharmacies so this was a red flag 🚩, I explained the pharmacist that MD(grant dr was not the one who surgeon that’s way he is not the one prescribing the pain meds, the neurosurgeon or sometimes his assistant are the ones prescribing the pain meds, but they are aware of the anxiety pills I take on a daily basis and now is when I need them the most because of my dad and even on bed rest way from the world is absolutely NO EASY, but it seems like the pharmacist don’t care.....well thanks to the pharmacist now I’m starting to have suicidal thoughts. I do believe in God and ask for strength daily, but can’t stop the crying 😢 because of the anxiety and stress and can’t stop the crying because of the pain I get, plus my dad’s death still so fresh in my heart. I will really appreciate it someone knows who can I talk above all this pharmacists in order to get the meds I needs because I never had a problem while taking the pain meds and anxity, but the suicidal thoughts are getting stronger every day, so who’s fault it will be if something was to happen to me for not taking the anxiety meds?

I feel anxious. Can't sleep without sleeping pills. And to make things worse I think I’m getting addicted to them. How can I make myself feel better and sleep better?

I have had anxiety for a while now. I stopped driving because of it. And have tried every antidepressant.
But my life took a terrible devastating turn on may 17 2019 when I lost my only son in a motorcycle accident. I have lost 50 lbs. Cry all the time. These horrible thoughts that I replay in my mind over And over. No sleep. I'm a mess. Can anyone recommend someone to help?