What Are the Top 10 Medications for Anxiety?

There is no single best medication for anxiety. The right one depends on the type of anxiety, other health conditions, other medications and how a person responds, and finding it can take some trial and error[2]. What does exist is a short list of medications clinicians reach for most often.

Below are ten of them, what each is used to treat, what to expect and which ones carry a risk of dependence. This is a guide for conversations with your prescriber, not a substitute for them.

What Are the Top 10 Medications for Anxiety?

Antidepressants from the SSRI and SNRI classes come first here for a reason: providers typically start with them because they have fewer side effects than other anxiety medications[1].

1. 1. Escitalopram (Lexapro)

   SSRI

   Depression and generalized anxiety disorder[3]

2. 2. Sertraline (Zoloft)

   SSRI

   Panic attacks, social anxiety disorder, PTSD, OCD and depression[4]

3. 3. Paroxetine (Paxil)

   SSRI

   Generalized anxiety, panic disorder, social anxiety disorder, PTSD, OCD and depression[5]

4. 4. Fluoxetine (Prozac)

   SSRI

   Panic attacks, OCD, depression and some eating disorders[6]

5. 5. Venlafaxine (Effexor XR)

   SNRI

   Generalized anxiety, social anxiety disorder, panic disorder and depression[7]

6. 6. Duloxetine (Cymbalta)

   SNRI

   Generalized anxiety and depression, plus some chronic pain conditions[8]

7. 7. Buspirone

   Anxiolytic

   Anxiety, usually over the longer term[9]

8. 8. Hydroxyzine

   Antihistamine

   Anxiety and tension, and itching from allergic skin reactions[10]

9. 9. Propranolol

   Beta blocker

   Heart and blood pressure conditions; sometimes used for anxiety[11]

10. 10. Benzodiazepines: alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin)

    Benzodiazepine

    Anxiety disorders and panic disorder, usually short term[12]

SSRIs for Anxiety: Escitalopram, Sertraline, Paroxetine and Fluoxetine

Selective serotonin reuptake inhibitors, or SSRIs, work by increasing the amount of serotonin available in the brain[4]. Many of them were developed for depression and are also used for anxiety[1].

Escitalopram (Lexapro)

Escitalopram is used to treat depression and generalized anxiety disorder, the kind of excessive worry and tension that disrupts daily life for six months or longer[3]. Common side effects include nausea, drowsiness, trouble sleeping, increased sweating and sexual side effects[3].

Sertraline (Zoloft)

Sertraline is used for depression, obsessive-compulsive disorder, panic attacks, posttraumatic stress disorder and social anxiety disorder[4]. It can take a few weeks or longer to feel the full benefit[4].

Paroxetine (Paxil)

Paroxetine covers a wide range of anxiety conditions: generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder and PTSD, as well as depression[5].

Fluoxetine (Prozac)

Fluoxetine is used for depression, obsessive-compulsive disorder, some eating disorders and panic attacks[6].

One warning applies to every antidepressant on this list. Children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior, especially in the first few weeks or after a dose change[1]. Anyone starting an antidepressant, and the people close to them, should know to watch for this.

SNRIs for Anxiety: Venlafaxine and Duloxetine

Serotonin and norepinephrine reuptake inhibitors, or SNRIs, act on two brain chemicals instead of one. Venlafaxine (Effexor XR) is used for generalized anxiety disorder, social anxiety disorder, panic disorder and depression[7]. Duloxetine (Cymbalta) is used for generalized anxiety disorder and depression, and also for diabetic nerve pain and fibromyalgia[8], which can make it a practical choice when anxiety and chronic pain show up together.

Both can cause withdrawal symptoms if stopped suddenly, such as dizziness, nausea, irritability, trouble sleeping and tingling or electric shock-like feelings[7][8].

Buspirone for Anxiety

Buspirone is an anxiolytic, an anti-anxiety medication that works differently from the others on this list[9]. It is not a sedative and has less potential to be addictive[2], and it can be used to treat anxiety over longer periods[1].

The tradeoff is time. Buspirone is started at a low dose and raised gradually, and it may take several weeks to reach a dose that works[9]. Side effects can include dizziness, nausea, headache, nervousness, lightheadedness and trouble sleeping[9].

Hydroxyzine for Anxiety

Hydroxyzine is an antihistamine used to relieve anxiety and tension, as well as itching from allergic skin reactions[10]. It can cause drowsiness, so do not drive until you know how it affects you. People with a prolonged QT interval, a rare heart rhythm problem, should not take it[10].

Propranolol and Beta Blockers for Anxiety

Propranolol is a beta blocker approved for heart and blood pressure conditions, certain types of tremor and migraine headaches, and it is also sometimes used for anxiety[11]. Beta blockers can help manage the physical symptoms of anxiety[1], rather than the worry itself. Stopping propranolol suddenly can cause serious heart problems[11].

Benzodiazepines for Anxiety: Alprazolam, Lorazepam and Clonazepam

Benzodiazepines can decrease anxiety quickly, which is why they are prescribed. Some people build up a tolerance[2], and taking them over long periods can lead to dependence, so providers usually prescribe them for short periods and taper them slowly[1].

• Alprazolam (Xanax) is used for anxiety disorders and panic disorder[12].
• Lorazepam (Ativan) is used for anxiety and insomnia[13].
• Clonazepam (Klonopin) is used for panic attacks and certain types of seizures[14].

Ativan Side Effects

Common side effects of lorazepam include drowsiness, dizziness, weakness and unsteadiness, and alcohol can make them worse[13]. The same caution applies to the whole class: combining benzodiazepines with opioid pain relievers, alcohol or other drugs raises the risk of overdose and death[15].

Medications for Anxiety and Depression

Anxiety and depression often travel together, and several medications are approved for both. Escitalopram, paroxetine, venlafaxine and duloxetine treat depression and generalized anxiety disorder[3][5][7][8]. Sertraline treats depression along with panic attacks, social anxiety disorder and PTSD[4]. Antidepressants usually take 4 to 8 weeks to work, and sleep, appetite, energy and concentration often improve before mood lifts[1]. Read more about depression and substance use.

Medications for Anxiety and Panic Attacks

For panic disorder, the options include sertraline, paroxetine, fluoxetine and venlafaxine[4][5][6][7]. Providers typically start with an SSRI or SNRI for panic disorder[1]. Alprazolam and clonazepam are also used for panic[12][14], generally for shorter periods because of the risk of dependence.

Which Anxiety Medications Are Addictive?

Of the ten, benzodiazepines are the ones with a real risk of addiction. The FDA warns that even at recommended doses, benzodiazepine use can lead to misuse, abuse and addiction, and that physical dependence can develop when they are taken steadily for several days to weeks, even as prescribed[15].

Dependence on a prescription is not a moral failing. It is how the brain adapts to a medication taken regularly. But it does change what stopping looks like. If you have been taking more than prescribed, running out early or combining a benzodiazepine with alcohol, our page on benzodiazepine addiction treatment explains what help looks like.

SSRIs, SNRIs, buspirone and hydroxyzine are not considered addictive in the same way. Antidepressants can still cause withdrawal symptoms if they are stopped suddenly[3][7], which is one more reason to change them only with your prescriber.

Stopping Anxiety Medication Safely

Do not stop a prescribed medication on your own, even if you feel better. A health care provider can lower the dose slowly and safely[1].

With benzodiazepines, this matters most. Stopping them abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life threatening[15]. Our articles on Xanax withdrawal seizures and Klonopin withdrawal go into what a safe taper involves, and medically supervised detox is the safest setting when use has been heavy or long term.

Therapy and Anxiety Medication Work Better Together

Treatment for generalized anxiety disorder typically involves psychotherapy, medication or both[2]. Cognitive behavioral therapy, or CBT, helps people notice automatic ways of thinking that are inaccurate or harmful and then question them[2]. Medication can take the edge off symptoms, and therapy builds the skills that keep working after a prescription ends.

When Anxiety and Alcohol or Drug Use Overlap

Generalized anxiety disorder is commonly associated with alcohol and substance misuse[2]. Often it starts as a way to take the edge off: a drink to settle down at night, or an extra benzodiazepine on a hard day. Over time, the substance tends to make the anxiety worse.

Virtue treats substance use disorder, and anxiety is treated at the same time, by the same team, through therapy and medication management for anxiety. If you already take anxiety medication, our medical team reviews it at intake, and it is typically continued throughout treatment. Learn more about dual diagnosis treatment, or check your insurance coverage.

Do not stop a benzodiazepine abruptly. Withdrawal can cause seizures. If you or someone you know is having thoughts of suicide, call or text 988, the Suicide & Crisis Lifeline. For a medical emergency, call 911.

FAQs About Anxiety Medications

What is the most common medication for anxiety?

Antidepressants from the SSRI and SNRI classes, such as escitalopram, sertraline and venlafaxine, are the medications providers usually start with, because they have fewer side effects than other options. Which one works best varies from person to person.

Which anxiety medications are addictive?

Benzodiazepines, including alprazolam (Xanax), lorazepam (Ativan) and clonazepam (Klonopin), can cause physical dependence within days to weeks, even when taken as prescribed, and can lead to misuse and addiction. SSRIs, SNRIs, buspirone and hydroxyzine are not considered addictive in the same way, although some antidepressants cause withdrawal symptoms if stopped suddenly.

What medication helps with both anxiety and depression?

Several antidepressants are approved for both. Escitalopram, paroxetine, venlafaxine and duloxetine treat depression and generalized anxiety disorder, and sertraline treats depression along with panic attacks, social anxiety disorder and PTSD.

What medication is used for panic attacks?

Sertraline, paroxetine, fluoxetine and venlafaxine are all used for panic disorder or panic attacks. Alprazolam and clonazepam are benzodiazepines that are also used for panic disorder, usually for a shorter period because of the risk of dependence.

How long do anxiety medications take to work?

Antidepressants usually take 4 to 8 weeks to work fully, and sleep, energy and concentration often improve before mood does. Buspirone can also take several weeks. Benzodiazepines work quickly.

What are the side effects of Ativan?

Common side effects of lorazepam (Ativan) include drowsiness, dizziness, weakness and unsteadiness. Alcohol can make these effects worse. Lorazepam may be habit forming, and it should not be stopped suddenly without talking to your doctor.

Can I stop taking anxiety medication on my own?

No. Stopping many anxiety medications suddenly can cause withdrawal symptoms, and stopping a benzodiazepine abruptly can cause seizures that can be life threatening. Talk to your prescriber, who can lower the dose slowly and safely.

Sources

1. [1] National Institute of Mental Health. Mental Health Medications. National Institutes of Health.
2. [2] National Institute of Mental Health. Generalized Anxiety Disorder: When Worry Gets Out of Control. National Institutes of Health.
3. [3] MedlinePlus. Escitalopram. U.S. National Library of Medicine.
4. [4] MedlinePlus. Sertraline. U.S. National Library of Medicine.
5. [5] MedlinePlus. Paroxetine. U.S. National Library of Medicine.
6. [6] MedlinePlus. Fluoxetine. U.S. National Library of Medicine.
7. [7] MedlinePlus. Venlafaxine. U.S. National Library of Medicine.
8. [8] MedlinePlus. Duloxetine. U.S. National Library of Medicine.
9. [9] MedlinePlus. Buspirone. U.S. National Library of Medicine.
10. [10] MedlinePlus. Hydroxyzine. U.S. National Library of Medicine.
11. [11] MedlinePlus. Propranolol. U.S. National Library of Medicine.
12. [12] MedlinePlus. Alprazolam. U.S. National Library of Medicine.
13. [13] MedlinePlus. Lorazepam. U.S. National Library of Medicine.
14. [14] MedlinePlus. Clonazepam. U.S. National Library of Medicine.
15. [15] U.S. Food and Drug Administration (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class.

This article is for informational purposes only and is not a substitute for professional medical advice. It does not include doses. Talk to your prescriber before starting, stopping or changing any medication.

Written by

Heather Cariker, MSN, APRN, PMHNP-BC

Psychiatric Nurse Practitioner

Heather Cariker is a board-certified Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC) serving at Virtue Recovery Center Killeen, providing psychiatric evaluation, diagnosis, and medication management for clients in addiction and co-occurring mental health treatment. She joined Virtue as a Registered Nurse in 2022 before advancing into the psychiatric nurse practitioner role. She earned her Master of Science in Nursing as a Psychiatric Mental Health Nurse Practitioner from Texas Tech University.

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Medically reviewed by Heather Cariker, MSN, APRN, PMHNP-BC, Psychiatric Nurse Practitioner