From the Guidelines
Non-benzodiazepine medications for anxiety include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), buspirone, hydroxyzine, and beta-blockers, which offer alternatives to benzodiazepines with a lower risk of dependence and tolerance. These medications work by regulating neurotransmitters like serotonin, norepinephrine, and GABA that influence mood and anxiety. Some key options include:
- SSRIs like sertraline (50-200 mg daily), escitalopram (10-20 mg daily), and fluoxetine (20-80 mg daily) which are typically first-line treatments, taking 2-4 weeks to show full benefits but requiring consistent daily use 1.
- SNRIs such as venlafaxine (75-225 mg daily) and duloxetine (30-120 mg daily) which are also effective, particularly for anxiety with comorbid pain 2.
- Buspirone (15-60 mg daily, divided into 2-3 doses) which works on serotonin receptors and is non-sedating and non-addictive 3.
- Hydroxyzine (25-100 mg as needed) which can help with acute anxiety symptoms.
- Beta-blockers like propranolol (10-40 mg as needed) which effectively manage physical symptoms of anxiety such as trembling and rapid heartbeat. It's essential to consider the potential side effects and interactions of these medications, as well as individual patient factors, when selecting a treatment option 4, 5, 6.
From the FDA Drug Label
Buspirone hydrochloride tablets, USP are an antianxiety agent that is not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative/anxiolytic drugs. One non-benzodiazepine medication for anxiety is buspirone 7.
- Buspirone is an antianxiety agent that is not related to benzodiazepines.
From the Research
Non-Benzodiazepine Medications for Anxiety
Non-benzodiazepine medications for anxiety include:
- Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine 8, 9, 10
- Serotonin-noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine, milnacipran, and duloxetine 8, 11
- Atypical anxiolytics such as pregabalin 12
- Non-SSRI antidepressants such as nefazodone, trazodone, and mirtazapine 8
- Buspirone, a non-benzodiazepine anxiolytic 8, 11
Characteristics of Non-Benzodiazepine Medications
These medications have various characteristics, including:
- Rapid onset of action, with some medications showing efficacy within the first week of treatment 12
- Efficacy in treating symptoms of generalized anxiety disorder, post-traumatic stress disorder, and other anxiety disorders 8, 12, 9, 10, 11
- Favorable side effect profiles and safety records, making them suitable for long-term treatment 8, 9, 11
- Potential advantages over benzodiazepines, including reduced risk of dependence and withdrawal 11
Comparison of Non-Benzodiazepine Medications
Studies have compared the efficacy and tolerability of different non-benzodiazepine medications, including: