Over-the-Counter Medications for Anxiety
There are no effective over-the-counter (OTC) medications recommended for treating anxiety disorders based on current clinical guidelines. The evidence-based treatments for anxiety require prescription medications (SSRIs/SNRIs) or psychotherapy, neither of which are available OTC 1, 2.
Why OTC Options Are Not Recommended
Prescription SSRIs and SNRIs are the only pharmacological treatments with established efficacy for anxiety disorders, showing small to medium effect sizes compared to placebo (standardized mean difference -0.55 for generalized anxiety disorder, -0.67 for social anxiety disorder) 2. No OTC medications have demonstrated comparable efficacy in treating anxiety disorders 1, 3.
Common OTC Products That Should Be Avoided
Antihistamines (e.g., diphenhydramine/Benadryl): While these cause sedation, they are not effective treatments for anxiety disorders and tolerance to sedative effects develops completely within 3 days of regular use 4. These are marketed for sleep but have no evidence supporting their use for anxiety management 4.
Herbal supplements: These are not included in any major anxiety treatment guidelines due to lack of adequate evidence for efficacy 5, 1.
Beta blockers: While propranolol is sometimes used for performance anxiety, it requires a prescription and guidelines specifically recommend against beta blockers for social anxiety disorder based on negative evidence 1.
Evidence-Based Treatment Recommendations
If you are experiencing anxiety symptoms, you need prescription medication and/or psychotherapy, not OTC products. The following represents the standard of care:
First-Line Prescription Treatments
SSRIs are the gold standard first-line pharmacological treatment, with escitalopram (10-20 mg/day) and sertraline (50-200 mg/day) being the preferred agents due to favorable side effect profiles and lower discontinuation symptoms 1, 6.
SNRIs are equally effective alternatives, including venlafaxine extended-release (75-225 mg/day) and duloxetine (60-120 mg/day), though venlafaxine requires blood pressure monitoring 1, 2.
Cognitive behavioral therapy (CBT) has the strongest evidence among psychotherapies, with large effect sizes (Hedges g = 1.01 for generalized anxiety disorder), and individual CBT is superior to group therapy 1, 2.
Expected Timeline for Prescription Treatment
Statistically significant improvement begins by week 2, clinically meaningful improvement by week 6, and maximal benefit by week 12 or later 1, 6.
Most side effects (nausea, headache, insomnia) emerge in the first few weeks and typically resolve with continued treatment 1, 6.
Medications should be continued for 6-12 months after remission to prevent relapse 3.
Non-Pharmacological Strategies (Adjunctive Only)
While these do not replace prescription treatment, the following can be helpful alongside evidence-based therapies:
Regular cardiovascular exercise provides moderate to large reductions in anxiety symptoms 1.
Breathing techniques, progressive muscle relaxation, grounding strategies, and mindfulness are useful adjunctive strategies but insufficient as monotherapy 1.
Psychoeducation about anxiety symptoms and treatment is recommended as a first step 5, 1.
Critical Clinical Pitfalls
Do not use benzodiazepines for routine anxiety treatment due to risks of dependence, tolerance, and withdrawal; these should be reserved for short-term use only 1, 3.
Do not abandon treatment before 12 weeks, as SSRI response follows a logarithmic pattern requiring patience 1, 6.
Do not discontinue SSRIs/SNRIs abruptly; taper gradually to avoid withdrawal symptoms, particularly with shorter half-life agents like sertraline and paroxetine 1, 6.
Next Steps
Consult a healthcare provider for proper evaluation and prescription treatment. Brief screening tools like the Generalized Anxiety Disorder-7 (GAD-7) can aid in diagnosis (sensitivity 57.6-93.9%, specificity 61-97%) 2. Treatment selection should consider your preference between medication, psychotherapy, or combination therapy, as combining SSRI/SNRI with CBT provides superior outcomes to either alone 1, 6.