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)

 

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!

Debbie, I empathize with your situation, but I've used xanax for 10 years and stopped from time to time with no negative
effect. It allows me to sleep better and deal with anxiety and stomach issues.
There may be other factors at play with your husband vs one drug xanax.

Pharmaceutical drugs have different impacts on each person, hence the need to find the one that works the best for each patient.

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

What was the dosage on the Xanax my boyfriend had a stress and no sleep breakdown since then his mind has not been the same talking confused his short term memory is interrupted....The dr gave him 0.5 Xanax but it’s not helping sleep or his mind... HELP

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 took ativan for nearly 30 years for anxiety and it helped. I moved and my new psychiatrist took me off of it within 2 months of my primary care doctor's recommendation. There was no reason except my primary care doctor doesn't like to prescribe any medication for people over 65 except for things like tylenol, blood pressure medicine and cholesterol lowering medication. She evidently wants to keep the elderly alive but suffering.
I bet if there was a blood test for anxiety more doctors would see the needs of their patients and prescribe medication like ativan.
As it is my now previous primary care doctor has made the rest of my life full of anxiety. I have tried all the medications for anxiety prescribed by my previous psychiatrist and counseling and none of them worked. My previous primary care doctor and my previous psychiatrist have convinced my daughter that ativan is bad for me. Ativan never hurt me but some of the medications given by my previous psychiatrist such as zyprexia and seroquel gave me tartive dyskinesia for life.
Like I said if there were a blood test for anxiety I think these doctors would prescribe ativan and other medications like it.

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?

What would be the best anxiety medicine to use when having symptoms of consuming and that won’t cause addiction to them?

I found an interesting report on the web .I have taken xanax for anxiety and panic attacks for 25 years . got injured 14 years ago 2 herniated disks in neck the same in lower back been taking oxycodone 4x a day . Mya doc could not give me xanax anymore it worked fine took the edge off so I could function some what without attacks.Went to A mental health center for help what a mistake.It seemed there only interest was getting me off xanax not addressing my anxiety problems .They took a decent function person and made me a hateful being . I thought Docs were here to help and cure not torture I was wrong . Found good article on web for benzos read it you will learn alot its called the Ashton report good luck all hope to be around to see all Docs be held responsible for all our torture!!!!!!!

After living with this horrible mental issue for yrs, going to mental health for yrs, being prescribed multiple drugs at a time over a two yr period and no relief, along with being a zombie and not getting better was my last draw. I kept telling them over and over things weren’t helping and getting worse, “just keep taking the meds” is all I was told over and over. After I was put on SSRIs-Trycilics etc, I had a nervous breakdown and was institutionalized. After a week in a Mental institution I had a wonderful 35yr State Certified Psychiatrist diagnosing me with Ptsd-Mdd. I was given Lexapro along with Xanax and have live 12yrs with a great quality of life! The Lexapro was given for my depression, it worked! The side effects however increased my panic attacks-anxiety- insomnia and anxiety. The Psychiatrist gave me Xanax along with my Lexapro to counter my effects from Lexapro Because Lexapro was the only thing that helped my MDD. These two combined was a miracle for me! I was balanced at last, no 4-5 different pills a day and being out of it, no side effects hindering me from getting better, or feeling better. It’s been 15yrs now and since this diagnosis and these two drug combinations, my life has had quality, meaning and purpose. My family and I are both great full to this Doctor who seen me as a person and not a book. I meditate, go on walks, practice breathing, sleep better, no panic attacks, anxiety attacks either. My startle response is still on key though, but I look at that as a good thing sometimes. So to people who suffer with this horrible disorder there is hope for you. You just have to find what works for you! You are not a book, not everyone else suffering the same way. I want this to be known to the Mental Health doctors and Psychiatrist whom think that all people suffering from this is not treated the same! And NO Xanax is not addictive if taken for a reason giving a better quality of life to those who need it! To all those out there with this disorder, do not allow yourself to think because your doctors give you meds based on a book or others experiences cause you the suffering of what I went through! Be your own advocacy for your own body. Best Hope to you all and remember there is help in meditation. Just make sure you know what’s working and what’s not.

I have also been tested for bipolar. My daughter has it my son also has it. My dad was exceptional hot tempered.

I’m an occupational therapist trying to help a patient with specific anxiety about ill health in himself or members of his family, although he’s generally cheerful. What can he take during these periods of anxiety? He’s tried CBT. Could CBD help?

My son suffers from anxiety so bad. He is on lithium and Effexor. No good results. He can’t get good mental health help. His doctor just throws meds at him. No counseling. What can we do. He has not interest in anything

Feel worse on venlafaxine 225mg. Cant sleep anxiety high. Any help would be appreciated. Thank you.

My daughter is 24 and been struggling with anxiety and depression. She was on Lexapro and Abilify for about a year but stopped taking them because of the side effects such as excessive sweating, nightmares, and just felt like she wasn’t feeling any better. Her depression seems less now but she is always anxious. Some days are worse than others. We’ve tried natural teas and supplements but she is impatient and refuses to take them. She takes Xanax when it gets really bead. She’s hesitant to ask her primary for meds as she thinks she’ll get put on antidepressants again and not get better. She’s very stubborn. She does see a therapist every two weeks. I just don’t know what do do or how to help her. Do you have any suggestions for me to help her please? I feel so helpless and I’m worried about her.

MaryJane Becker

September 13, 2020

I’m having anxiety so I’m very afraid to fall down from (Steps, ups and downs ) I use my walker cane but it is not help much ! I’m afraid to walk alone ! I can walk on flat hard floors without cane ! I’m frustrating on my anxiety !

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