From the Guidelines
Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft, 50-200mg daily), escitalopram (Lexapro, 10-20mg daily), and fluoxetine (Prozac, 20-80mg daily) are typically first-line treatments for anxiety disorders, taking 2-4 weeks to reach full effectiveness.
Medication Options
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor XR, 75-225mg daily) and duloxetine (Cymbalta, 30-120mg daily) are also commonly used 1.
- For more immediate relief, benzodiazepines like lorazepam (Ativan, 0.5-2mg as needed), alprazolam (Xanax, 0.25-0.5mg three times daily), and clonazepam (Klonopin, 0.5-1mg twice daily) work quickly but carry risks of dependence and are typically prescribed for short-term use only 1.
- Buspirone (BuSpar, 7.5-30mg twice daily) is a non-addictive option that takes 2-4 weeks to become effective.
- Some patients also benefit from beta-blockers like propranolol (10-40mg as needed) for physical symptoms of anxiety, particularly in performance situations.
Key Considerations
- These medications work by regulating neurotransmitters like serotonin, norepinephrine, and GABA in the brain, which helps control anxiety symptoms 1.
- It's essential to start at lower doses and gradually increase as needed under medical supervision, as side effects can occur, particularly during the initial weeks of treatment 1.
- The choice of medication should be informed by side-effect profiles, interactions, response, patient age, and preference, with consideration for short-term duration and regular monitoring for adherence, side effects, and adverse events 1.
From the FDA Drug Label
The efficacy of sertraline in the treatment of social anxiety disorder was established in two placebo-controlled trials of adult outpatients with a diagnosis of social anxiety disorder as defined by DSM-IV criteria Alprazolam tablets are indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual [DSM-III-R] diagnosis of generalized anxiety disorder)
The medications for anxiety disorder are:
- Sertraline for social anxiety disorder 2
- Alprazolam for generalized anxiety disorder and panic disorder 3
From the Research
Medications for Anxiety Disorder
The following medications are used to treat anxiety disorders:
- Benzodiazepines, such as diazepam, for acute anxiety 4
- Tricyclic antidepressants, such as imipramine, for long-term treatment 4, 5, 6
- Monoamine oxidase inhibitors for long-term treatment 4, 7, 6
- Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and paroxetine, for long-term treatment 4, 7, 8, 5, 6
- Serotonin-noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine, milnacipran, and duloxetine, for relieving anxiety symptoms within depression and certain anxiety disorders 4, 7, 5
- Buspirone, a non-benzodiazepine anxiolytic, for generalized anxiety disorder 7, 5
- Anticonvulsants, such as carbamazepine, valproic acid, topiramate, and gabapentin, for post-traumatic stress disorder (PTSD) with co-morbidity of bipolar disorder 7
- Atypical antipsychotics for PTSD with paranoia or flashbacks 7
Specific Anxiety Disorders
The following medications are used to treat specific anxiety disorders:
- Post-traumatic stress disorder (PTSD): SSRIs, such as sertraline and paroxetine, SNRIs, such as venlafaxine, and atypical antipsychotics 7
- Generalized anxiety disorder (GAD): benzodiazepines, SSRIs, such as paroxetine and sertraline, SNRIs, such as venlafaxine, and buspirone 4, 7, 5
- Panic disorder: tricyclic antidepressants, SSRIs, and SNRIs 6
- Obsessive-compulsive disorder (OCD): SSRIs 6
- Social phobia: SSRIs 6