What medications, including Selective Serotonin Reuptake Inhibitors (SSRIs), Benzodiazepines, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs), are used to treat anxiety?

From the Guidelines

SSRIs, SNRIs, Benzodiazepines, TCAs, and MAOIs are the primary medication classes used to treat anxiety disorders, with SSRIs being the first-line treatment due to their effectiveness and favorable side effect profile. Several medications are commonly used to treat anxiety disorders, including:

• SSRIs: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil), which work by increasing serotonin levels in the brain 1
• SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta), which target both serotonin and norepinephrine and are often used when SSRIs aren't effective 1
• Benzodiazepines: lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin), which provide rapid relief but are generally prescribed for short-term use due to risks of dependence and tolerance
• TCAs: imipramine and amitriptyline, which are older medications that may be used when newer options fail, though they have more side effects
• MAOIs: phenelzine (Nardil), which are typically reserved as a last resort due to dietary restrictions and potential drug interactions

When prescribing these medications, it's essential to consider the specific anxiety disorder, patient history, potential side effects, and individual response. Treatment usually begins with lower doses that are gradually increased, with SSRIs and SNRIs often requiring 4-6 weeks to reach full effectiveness 1. A conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals. Faster up-titration may be indicated as tolerated for more severe anxiety presentations; however, it is not clear that dose of medication is related to magnitude of response, and higher doses or blood concentrations can be associated with more adverse effects 1.

From the FDA Drug Label

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination) seizures, and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including duloxetine delayed-release capsules, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St John’s Wort)

The medications used to treat anxiety include:

• Selective Serotonin Reuptake Inhibitors (SSRIs): sertraline, escitalopram
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): duloxetine
• Tricyclic Antidepressants (TCAs): mentioned as a class of drugs that can increase the risk of serotonin syndrome when used with other serotonergic drugs
• Monoamine Oxidase Inhibitors (MAOIs): mentioned as a class of drugs that are contraindicated with the use of certain antidepressants, such as duloxetine and escitalopram
• Benzodiazepines: not mentioned in the provided drug labels as a treatment for anxiety, but may be used in clinical practice for this purpose 2, 3, 4

From the Research

Medications Used to Treat Anxiety

The following medications are used to treat anxiety:

• Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline, paroxetine, fluoxetine, fluvoxamine, and escitalopram 5, 6, 7, 8, 9
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) such as venlafaxine and duloxetine 5, 6, 8
• Benzodiazepines such as clonazepam, alprazolam, and bromazepam, although they are not recommended for routine use due to potential depressogenic effects and risk of dependence 6, 7, 9
• Tricyclic Antidepressants (TCAs) such as imipramine and amitriptyline, although they are considered third-line treatment due to significant adverse effects and safety issues 7
• Monoamine Oxidase Inhibitors (MAOIs) such as phenelzine, although they are considered third-line treatment due to significant adverse effects and safety issues 7
• Other medications such as pregabalin, gabapentin, and buspirone may also be used to treat anxiety 6, 9

Classes of Medications

These medications belong to the following classes:

• Antidepressants: SSRIs, SNRIs, TCAs, and MAOIs 5, 6, 7, 8
• Anxiolytics: Benzodiazepines and buspirone 6, 7, 9
• Anticonvulsants: Pregabalin and gabapentin 6, 9

Efficacy and Acceptability

The efficacy and acceptability of these medications vary:

• SSRIs and SNRIs are considered first-line treatment for anxiety disorders due to their efficacy and relatively favorable adverse effect profile 5, 6, 8
• Benzodiazepines are effective in the short-term but are not recommended for routine use due to potential depressogenic effects and risk of dependence 6, 7, 9
• TCAs and MAOIs are considered third-line treatment due to significant adverse effects and safety issues 7