Which anti-anxiety medication is right for me?

Anxiety disorders are the most common mental illness in the United States with 19 percent of the population affected every year. Though highly treatable, 63.1 percent of those suffering from an anxiety disorder do not receive treatment.

Joy Alonzo, PharmD, MEng, specialist in the pharmacotherapy of mental disorders and a clinical assistant professor of pharmacy practice at the Texas A&M College of Pharmacy, explains the difference between common anxiety medications. “If you understand the different types of medication, then you can become a better advocate for your anxiety treatment. Anxiety is one of the most undertreated mental illness, and we need to talk more about it.”

What are anxiety disorders?

Anxiety disorders affect 31.9 percent of people between the ages of 13 and 18, and women are twice as likely to develop an anxiety disorder as men. Common examples of anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, substance-induced anxiety disorder and specific phobias.

“An anxiety disorder does more than make you anxious. They can affect your entire life. Plus, untreated anxiety can lead to other mental health disorders and physical conditions,” Alonzo said. “We have no way of predicting what will cause someone to develop an anxiety disorder. However, you can take steps to reduce the impact of symptoms such as getting help from a health care professional early and avoiding the use of non-prescribed drugs and alcohol.”

Do I have an anxiety disorder?

Common signs and symptoms of anxiety include nervousness, restlessness or tenseness, a sense of impending danger or doom, increased heart rate, breathing rapidly, sweating, trembling, feeling weak or tired, trouble concentrating or sleeping, stomach aches and headaches and the urge to avoid things that trigger anxiety.

Anxiety disorders often develop from a complex set of risk factors. The risk factors may include exposure to trauma, certain medical problems like thyroid disease or heart disease, stress due to a severe illness and other mental health disorders like depression. The use or misuse of drugs and alcohol can worsen symptoms of anxiety.

“Anxiety disorders are best treated with a combination of therapy and medication,” Alonzo said. “It takes time to find the perfect combination for your symptoms. Your primary care provider is the best place to start that journey.”

Benzodiazepines for anxiety

“For years, providers have prescribed benzodiazepines to treat symptoms of acute anxiety,” Alonzo said. Benzodiazepines also treat severe muscle spasms, tremors and acute seizures.

Benzodiazepines, such as Xanax and Klonopin, provide rapid relief from a panic attack. Providers may also prescribe them to prevent cases of acute anxiety like those stemming from a plane ride, for those with a fear of flying, or the moments leading up to a surgery.

Unlike other anti-anxiety medications, benzodiazepines are controlled substances. You can develop a tolerance to benzodiazepines and a dependence to them over time. Additionally, trying to suddenly stop taking a benzodiazepine can cause life-threatening withdrawal that may include seizures. For these reasons, providers typically prescribe benzodiazepines at low doses for limited amounts of time.

Buspirone for anxiety

“Another common medication used to treat anxiety is buspirone, which is also known under the brand name Buspar,” Alonzo said. “It interacts with certain neuroreceptors in the brain that control mood which can decrease anxiety symptoms.”

Buspirone may help patients think more clearly and relax with less worry. It may also help anxiety symptoms like irritableness, sweating and trouble sleeping.

Alonzo cautions about consuming alcohol and grapefruit or grapefruit juice when taking buspirone. “Tell your health care provider or pharmacist about other medications, vitamins and herbal supplements you take, as well as if you drink alcohol, smoke, vape or use illegal substances,” Alonzo said. Common side effects of buspirone may include dizziness, nervousness, drowsiness and lightheadedness. “Avoiding anything that might make these side effects worse is a good strategy.”

Hydroxyzine for anxiety

Hydroxyzine, also known under the brand names Atarax and Vistaril, is an antihistamine that has an effect on regulating the chemicals in your brain, which helps control anxiety on a short-term basis. These medications have a calming effect on the brain, and providers may prescribe it prior to a surgery to ease nerves and help sleep.

“Hydroxyzine can cause drowsiness and decreased alertness,” Alonzo said. “It is important that patients take precautions not to drive and to be careful around the home, so they do not fall.”

The effects of hydroxyzine can happen quickly, unlike buspirone, which may take time to become effective. Hydroxyzine and buspirone are not controlled substances. They also do not cause tolerance, dependence or withdrawal.

Meclizine for anxiety

Meclizine, also an antihistamine, is most often used to treat motion sickness and dizziness. The drug, sold under the brand name Antivert, can also treat nausea and dizziness during panic attacks. However, there is no evidence that meclizine decreases anxiety long term.

“Meclizine may take up to an hour to become effective. It can help with nausea and dizziness associated with panic attacks,” Alonzo said. “Those with a specific anxiety trigger like air travel may take it before a flight, as the effects will last between eight and 24 hours.”

What are SSRIs and SNRIs?

Selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Prozac, and serotonin and norepinephrine reuptake inhibitors (SNRIs) like Effexor and Pristiq are antidepressant medications, but they can help with anxiety symptoms as well. For this reason, many providers will prescribe an SSRI or SNRI if you have a combination of depression and anxiety.

“SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief,” Alonzo said. “They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.”

Some patients may respond better to one of these medications than others. If after taking the medication for two weeks and symptoms have not improved, talk to your provider to have your medication regimen adjusted. Treatment trials with more than one medication are not uncommon.

Combining anti-anxiety medications, opioids and alcohol

More than 30 percent of overdoses involving opioids also involve anti-anxiety medications. Alonzo said. “Benzodiazepines and opioids both cause sedation and suppress breathing. Alcohol plays a role in decreasing consciousness and cognitive ability. These substances together can be incredibly dangerous, even fatal.”

Alonzo, an integral part of the Texas A&M Health Science Center Opioid Task Force, works to educate the community about the risks of opioid misuse. “The opioid crisis is an incredibly complex problem with many driving factors,” she said. “We need strategies to better educate both prescribers and patients alike on the dangers of certain prescription medications, especially when taken in combination and with alcohol.”

Patients who misuse prescription medications might believe that these substances are safer than illicit substances, which is not the case. Any patient under treatment with a prescription medication for a mental health disorder should discuss the use of alcohol, over-the-counter medications and other substances with their pharmacist or provider.

Are anti-anxiety medications safe when pregnant or breastfeeding?

“Before taking any prescription medication, you should always speak with your health care provider or pharmacist if you are pregnant or plan to become pregnant,” Alonzo said. “Certain medications like SSRIs and SNRIs have not been adequately studied in pregnancy. Everyone needs to have an open conversation about those risks.”

Generally, providers do not recommend benzodiazepines during pregnancy or during breastfeeding because they can get into breast milk. The nursing infant has the potential to experience symptoms like sedation, feeding difficulties and weight loss.

You and your health care team should evaluate the benefits of breastfeeding with the risk of potential infant drug exposure and an untreated or inadequately treated mental health disorder in the mother.

 Which anti-anxiety medication is best?

Anxiety disorders are treated differently depending on the person. “Mental health disorder treatments are not a one-size-fits-all approach. You need to include your primary care practitioner, therapist and pharmacist to find which treatment works best for you,” Alonzo said. “It may take time to find the right treatment. However, there is hope for your recovery and you are worth it.”

If you are having trouble managing your anxiety, then speak with a health care provider about your options.