What Are the Top 10 Medications for Anxiety?

Here are the top 10 medications for anxiety, which aim to treat the associated symptoms rather than cure the disorder.

The top 10 medications for anxiety are summarized below:

1. Benzodiazepines (also called tranquilizers)
   • How they work: The exact mechanism of action of benzodiazepines is not well understood. These drugs mainly act by increasing the levels of a chemical substance in the brain and spinal cord (neurotransmitter) called gamma-aminobutyric acid or GABA. Raised GABA levels have a calming effect on nerve cells that relieve anxiety symptoms.
   • Examples: Valium (diazepam), Ativan (lorazepam), and Xanax (alprazolam)
   • Side effects: Confusion, dizziness, drowsiness, unsteadiness, sleep disturbances, feeling disoriented, memory impairment, irritability, and aggression
2. Beta-blockers (also called beta-adrenergic blockers)
   • How they work: They block the effect of the hormone epinephrine (adrenaline). This results in lowering the rate and force of contraction of the heart. Consequently, the symptoms such as a racing heartbeat or palpitations are relieved.
   • Examples: Inderal (propranolol), Sectral (acebutolol), and Zabeta (bisoprolol)
   • Side effects: Fatigue, weight gain, cold hands or feet, trouble breathing, difficulty sleeping, and disturbed blood lipid levels may trigger asthma in susceptible individuals.
3. Serotonin-norepinephrine reuptake inhibitors (SNRIs) (also called selective serotonin-norepinephrine reuptake inhibitors or SSNRIs)
   • How they work: They increase the brain levels of the two hormones called serotonin and norepinephrine. These hormones are types of feel-good hormones that improve mood. SNRIs act by blocking or reducing the reuptake of these two hormones by the nerve cells, thus increasing their activity in the brain.
   • Examples: Pristiq (desvenlafaxine), Cymbalta (duloxetine), and Effexor (venlafaxine)
   • Side effects: Constipation, dry mouth, dizziness, headache, hot flushes, nausea, diarrhea, reduced libido, and erectile dysfunction
4. Selective serotonin reuptake inhibitors
   • How they work: They increase the brain levels of serotonin by blocking its reuptake by the nerve cells. Increased serotonin levels improve mood and help relieve anxiety.
   • Examples: Lexapro (escitalopram), Prozac (fluoxetine), and Celexa (citalopram)
   • Side effects: Headache, disturbed sleep, drowsiness, nausea, vomiting, diarrhea, blurred vision, nervousness, restlessness, agitation, and sexual dysfunction
5. Tricyclic antidepressants
   • How they work: These medications act by restoring the balance of certain neurotransmitters in the brain. They do this by increasing the levels of serotonin and norepinephrine while reducing the levels of another neurotransmitter called acetylcholine.
   • Examples: Tofranil (imipramine), Elavil (amitriptyline), and Sinequan (doxepin)
   • Side effects: Dry mouth, constipation, weight gain, blurred vision, rash, hives, increased heart rate, and postural hypotension (fall in blood pressure on standing)
6. Azospirodecanediones
   • How they work: The exact mechanism of action is not known, but it is thought to modulate serotonin levels in the brain. 
   • Examples: Buspar or Vanspar (buspirone)
   • Side effects: Headache, drowsiness, dizziness, disturbed sleep, nausea, nervousness, excitement, and allergic reactions in some people (seen as hives, rashes, swelling over the face, and difficulty breathing)
7. Antipsychotic medications
   • How they work: They change the levels of neurotransmitters, namely, dopamine, acetylcholine, serotonin, and adrenaline in the brain.
   • Examples: Seroquel (quetiapine), Risperdal (risperidone), and Abilify (aripiprazole)
   • Side effects: Drowsiness, sexual dysfunction, postural hypotension, palpitations, constipation, and weight gain
8. Antihistamines
   • How they work: They have a calming effect by blocking certain types of receptors in the brain. 
   • Examples: Atarax or Vistaril (hydroxyzine) and Sominex (diphenhydramine)
   • Side effects: Drowsiness, confusion, dry nose/mouth/throat, increased heart rate, nervousness, blurred vision, low blood pressure, appetite loss, and menstrual disturbances
9. Monoamine oxidase inhibitors
   • How they work: These drugs block the action of certain chemicals (enzymes) called monoamine oxidases (MAO) in the brain. MAO breaks down neurotransmitters such as dopamine, serotonin, and norepinephrine. By blocking MAO, levels of these neurotransmitters are increased in the brain, which relieves certain anxiety symptoms.
   • Examples: Marplan (isocarboxazid), Nardil (phenelzine), and Parnate (tranylcypromine)
   • Side effects: Dizziness, drowsiness, trouble sleeping, nausea, weight gain, muscle pain, fluid retention, pins and needles sensation, and sexual dysfunction
10. Alpha-blockers (also called alpha-adrenergic antagonists)
    • How they work: These medications block the action of the hormone norepinephrine in the brain. This helps relieve nightmares in people with post-traumatic stress disorder.
    • Examples: Minipress (prazosin)
    • Side effects: Drowsiness, headache, tiredness, blurred vision, diarrhea, constipation, and dizziness

Several medications are available for the treatment of anxiety disorders.

Although medications do not cure anxiety, they help relieve the associated symptoms, such as increased heartbeat, restlessness, nervousness, fear, and uneasiness. Treatment mainly depends upon the type of anxiety and the severity of symptoms.

Besides medications, psychotherapy, and counseling also play a great role in managing anxiety.

Anxiety medications may interact with certain medications that you may be taking. Hence, it is important to discuss with your doctor if you are taking any medications or have any underlying health conditions such as diabetes, kidney or liver diseases, and high blood pressure.

Although most side effects of these medications are mentioned above, you must report to your doctor if you notice any other adverse complications besides these. Never start or stop your anxiety medications or change their dosages without consulting your doctor.

Do not take any other drugs or supplements while on anxiety medications without consulting your doctor.