From the Guidelines
Bupropion (Wellbutrin) is a recommended weight-neutral or weight-negative anxiolytic medication besides fluoxetine, often associated with weight loss and can help with anxiety, particularly when combined with other treatments. Several other options are available, including escitalopram (Lexapro) and sertraline (Zoloft), which are SSRIs that tend to be more weight-neutral than some alternatives 1. Venlafaxine (Effexor) and duloxetine (Cymbalta), both SNRIs, can be weight-neutral options for many patients. Buspirone (BuSpar) specifically targets anxiety without typically causing weight gain and has minimal side effects. For short-term anxiety relief, hydroxyzine (Vistaril/Atarax) is an antihistamine that doesn't cause weight gain. Beta-blockers like propranolol can help with physical anxiety symptoms without affecting weight.
Some key points to consider when choosing an anxiolytic medication include:
- The medication's potential impact on weight, with some medications like bupropion associated with weight loss and others like fluoxetine being weight-neutral 1
- The patient's specific anxiety symptoms and other health conditions, which can influence the choice of medication 1
- The medication's side effect profile, with some medications like buspirone having minimal side effects 1
- The potential for interactions with other medications, which can be a concern with certain SSRIs like fluoxetine 1
Overall, the best choice of anxiolytic medication will depend on the individual patient's needs and circumstances, and should be guided by the most recent and highest-quality evidence available 1.
From the Research
Weight-Neutral or Negative Antianxiety Medications
Besides fluoxetine, several antianxiety medications are considered weight-neutral or may have a negative effect on weight. These include:
- SSRIs such as citalopram 2, sertraline, and escitalopram 3
- SNRIs like venlafaxine 4, 3 and duloxetine 3
- Buspirone, which is a non-benzodiazepine anxiolytic 4, 5, 6
- Pregabalin, an anticonvulsant with anxiolytic properties 5, 3
- Quetiapine, an atypical antipsychotic that may be used off-label for anxiety 5, 3
Comparison of Medications
A systematic review and network meta-analysis found that duloxetine, pregabalin, venlafaxine, and escitalopram were more efficacious than placebo in treating generalized anxiety disorder, with relatively good acceptability 3. Another study found that buspirone was comparable to diazepam in the treatment of patients with generalized anxiety disorder, but had a better side effect profile 6.
Considerations for Treatment
When choosing an antianxiety medication, it's essential to consider the potential side effects, including weight changes. Medications like benzodiazepines may be effective but can have a higher risk of dependence and withdrawal symptoms 4. On the other hand, medications like buspirone and pregabalin may have a lower risk of dependence and weight gain 5, 6. Ultimately, the choice of medication should be based on individual patient needs and medical history.