Anxiety Medication: The Main Types and How Prescribers Choose

Anxiety medication usually means one of a handful of groups. For ongoing anxiety, guidelines name SSRI and SNRI antidepressants as the first-line medications, and they take several weeks to work (AAFP (opens in a new tab)). Buspirone, hydroxyzine, benzodiazepines and beta-blockers each have narrower roles. There is no single best choice for everyone, and talk therapy can work as well as medication for many people.

This guide is education, not advice. It explains what each type is, how it is used and what to watch for, so your next conversation with a prescriber is easier. Do not start, stop or change any medication based on an article.

What medications are used for anxiety?

The National Institute of Mental Health groups anxiety medications into antidepressants, such as SSRIs and SNRIs, and anti-anxiety medications, such as benzodiazepines, buspirone and beta-blockers (NIMH (opens in a new tab)). The table below is a plain-language anti-anxiety medication list. It covers what each type is, how it is used and the main cautions. It does not rank them, and it leaves out doses on purpose.

What are the boxed warnings on anxiety medications?

A boxed warning is the FDA’s most prominent safety warning. Two apply to the medications above.

Antidepressants, including SSRIs and SNRIs, carry a boxed warning about an increased risk of suicidal thoughts and behavior in children, teens and young adults (FDA label (opens in a new tab)). MedlinePlus notes the risk is highest in the first few months of treatment and when a dose is raised (MedlinePlus (opens in a new tab)). This is a reason for close follow-up early on, not a reason to fear treatment.

Benzodiazepines have carried a boxed warning since September 2020 about abuse, misuse, addiction, physical dependence and withdrawal reactions, which can happen even at recommended doses. The FDA warns that stopping suddenly or cutting the dose quickly can cause withdrawal, including seizures, and that combining benzodiazepines with opioids can cause dangerous breathing problems (FDA (opens in a new tab)). In Arizona, prescribers must check the state’s Controlled Substances Prescription Monitoring Program before prescribing a benzodiazepine, with a few narrow exceptions (A.R.S. 36-2606 (opens in a new tab)).

Is there a “best” anxiety medication?

No. NIMH says the right treatment depends on a person’s needs, preferences and medical situation (NIMH (opens in a new tab)). A medication that suits one person well can be a poor fit for the next. When a prescriber recommends an option, these are the things being weighed:

• Your other conditions. Depression, sleep problems, asthma, diabetes, heart rhythm problems and liver or kidney disease can each rule an option in or out.
• Everything else you take. NIMH advises telling your provider about all medications, vitamins and supplements (NIMH (opens in a new tab)). Opioids, other sedatives and MAO inhibitors are examples of combinations that need care (FDA (opens in a new tab), MedlinePlus (opens in a new tab)).
• Side effects you can live with. Drowsiness, weight gain and other side effects affect people differently.
• Pregnancy and breastfeeding, now or planned. MedlinePlus asks you to tell your prescriber about both before starting medications such as buspirone (MedlinePlus (opens in a new tab)).
• What has worked before, and what caused problems.
• Alcohol and substance use history, which changes the risks of benzodiazepines and other sedating medications.
• Your preferences, including whether you want to try therapy first and how you feel about taking a daily medication.

Is Lexapro used for anxiety?

Yes. Lexapro (escitalopram) is an SSRI, and its FDA label lists generalized anxiety disorder in adults and in children and teens age 7 and older, as well as major depressive disorder (FDA label (opens in a new tab)). It carries the antidepressant boxed warning, and it may take several weeks to feel the full benefit (MedlinePlus (opens in a new tab)). Whether it fits you depends on the factors in the list above.

Is Wellbutrin used for anxiety?

Wellbutrin (bupropion) is not FDA-approved for anxiety. The Wellbutrin XL label lists two uses: major depressive disorder and prevention of seasonal affective disorder (FDA label (opens in a new tab)). Bupropion is also used to help people stop smoking, and MedlinePlus lists anxiety and agitation among its common side effects (MedlinePlus (opens in a new tab)). If you have both depression and anxiety, ask your prescriber how any option fits both, rather than assuming one medication covers everything.

Is there an over-the-counter anxiety medication?

Not in the sense most people mean. Every medication in the table above needs a prescription. Products sold on store shelves for stress or anxiety are generally dietary supplements, and the FDA does not approve supplements before they are sold. Only a drug can legally claim to treat a disease (FDA (opens in a new tab)).

The National Center for Complementary and Integrative Health reviews the evidence for popular options. Kava has been linked to a risk of severe liver damage. Studies of chamomile are preliminary, and research on lavender is too small and low in quality for firm conclusions (NCCIH (opens in a new tab)). NCCIH also reminds readers that “natural” does not always mean safe. Tell your prescriber about any supplement you take, because some interact with prescription medications.

How long does anxiety medication take to work?

• SSRIs and SNRIs: antidepressants usually take 4 to 8 weeks to work, and sleep, appetite and energy often improve first (NIMH (opens in a new tab)).
• Buspirone: 3 to 4 weeks of daily use for full effect (NIMH (opens in a new tab)).
• Benzodiazepines: work quickly, which is why they are reserved for short-term use (NIMH (opens in a new tab)).
• After it helps: guidelines recommend continuing an antidepressant for at least 6 to 12 months after a good response, to lower the chance of relapse (AAFP (opens in a new tab)).

Feeling better is not a signal to stop. NIMH advises against stopping a prescribed medication on your own, even when you feel well, because a provider can lower the dose slowly and safely (NIMH (opens in a new tab)). Antidepressants can cause withdrawal symptoms such as dizziness and irritability when stopped abruptly (MedlinePlus (opens in a new tab)), and benzodiazepines need a gradual, personal taper (FDA (opens in a new tab)).

Do you need medication, or is therapy enough?

Medication is not the only first-line treatment. A 2022 review in American Family Physician found that psychotherapy can be as effective as medication for generalized anxiety and panic disorder, with the strongest evidence for cognitive behavioral therapy (CBT). It also found that physical activity reduces anxiety symptoms (AAFP (opens in a new tab)). NIMH calls CBT the “gold standard” psychotherapy for generalized anxiety (NIMH (opens in a new tab)).

Many people start with therapy, some start with medication, and many use both. The article on medication management vs. therapy explains how the two fit together. If panic attacks are the main problem, see how panic attacks are treated. Because thyroid problems, sleep and other health issues can drive or mimic anxiety, it also helps to read about physical causes of anxiety. Living in Arizona adds one more question to ask: how psychiatric medications interact with summer heat.

Video · 6:42 · UC Davis HealthUnderstanding Anxiety - A Psychiatrist Explains Symptoms, Medication and Therapy | UC Davis Health

How Better Place Now approaches anxiety medication

At Better Place Now, care starts with a full 60-minute evaluation with Dr. Justin Schwarting, DNP, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner. The visit covers mood, sleep, health, stress, history and every medication already in the picture. Medication decisions are evidence-based, and the goal is the smallest change likely to help, not more medication by default. Every option is explained with its purpose and tradeoffs, and you choose together.

Follow-ups are 30 minutes, often every two to four weeks at first, and changes are made one at a time so you can tell what helped. Controlled medications, which include benzodiazepines, are prescribed only when clinically appropriate after a complete evaluation, generally not at the first visit, and the Arizona prescription monitoring program is checked before every controlled prescription. With your written permission, care is coordinated with your therapist.

Visits are by video anywhere in Arizona, or in person in the Phoenix area by arrangement. Most patients use insurance; self-pay is $220 for the first visit and $120 for a follow-up. Learn more about anxiety and depression care and medication management, or request an appointment. Most replies come within one business day.