Classes of Medications for Anxiety Disorders

Class

Examples

Mechanism of Action

Indications

Advantages

Disadvantages

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs): fluoxetine, sertraline, paroxetine, citalopram, escitalopram Serotonin-norepinephrine reuptake inhibitors (SNRIs): venlafaxine, duloxetine Tricyclic antidepressants (TCAs): imipramine, clomipramine Monoamine oxidase inhibitors (MAOIs): phenelzine, tranylcypromine

Increase the availability of serotonin and/or norepinephrine in the brain by inhibiting their reuptake by presynaptic neurons. MAOIs also inhibit the enzyme that breaks down these neurotransmitters.

All types of anxiety disorders, especially panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Often used as first-line agents.

Effective for both anxiety and depression symptoms. Have a low potential for abuse or dependence. Have a long duration of action.

May take several weeks to achieve full therapeutic effect. May cause initial worsening of anxiety symptoms. May cause sexual dysfunction, weight gain, nausea, insomnia, headache, dry mouth, and other side effects. May interact with other medications or foods containing tyramine (MAOIs). Require careful monitoring for suicidal ideation or behavior in children and adolescents.

Benzodiazepines

Diazepam, lorazepam, alprazolam, clonazepam

Enhance the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain that reduces neuronal excitability and induces relaxation.

All types of anxiety disorders, especially panic disorder and generalized anxiety disorder. Often used as second-line agents or as adjuncts to antidepressants. Also used for acute management of severe anxiety or agitation.

Rapid onset of action. Effective for reducing acute anxiety symptoms. Have sedative-hypnotic, anticonvulsant, and muscle relaxant properties.

May cause drowsiness, dizziness, confusion, impaired memory and coordination, dependence, tolerance, withdrawal symptoms, rebound anxiety, and respiratory depression. May interact with alcohol and other CNS depressants. May worsen depression or increase suicidal risk in some patients.

Buspirone

Buspirone

Partially agonizes serotonin 5-HT1A receptors and antagonizes dopamine D2 receptors in the brain. Modulates neuronal activity in the limbic system and prefrontal cortex.

Generalized anxiety disorder and social anxiety disorder. May also be used as an adjunct to antidepressants for other types of anxiety disorders.

Does not cause sedation, cognitive impairment, dependence, tolerance, or withdrawal symptoms. Has a low potential for abuse or interaction with other substances. Does not worsen depression or increase suicidal risk.

May take several weeks to achieve full therapeutic effect. May cause nausea, headache, dizziness, restlessness, nervousness, and insomnia. May interact with grapefruit juice or other medications that affect liver enzymes (CYP3A4).

Beta-blockers

Propranolol, atenolol

Block beta-adrenergic receptors in the heart and blood vessels and reduce the effects of adrenaline and noradrenaline on the cardiovascular system. Decrease heart rate, blood pressure, cardiac output, and oxygen consumption.

Social anxiety disorder and specific phobias (especially performance-related). May also be used as an adjunct to antidepressants for other types of anxiety disorders or for physical symptoms of anxiety (such as palpitations or tremors).

Rapid onset of action. Effective for reducing somatic symptoms of anxiety (such as sweating or blushing). Have anti-arrhythmic and anti-anginal properties.

May cause fatigue, drowsiness, insomnia, nightmares, depression, bradycardia, hypotension, bronchospasm, and sexual dysfunction. May interact with other medications that affect blood pressure or heart rate (such as calcium channel blockers or digoxin). May mask signs of hypoglycemia in diabetic patients.

Antihistamines

Hydroxyzine

Block histamine H1 receptors in the brain and periphery and exert sedative-hypnotic effects.

Generalized anxiety disorder and social anxiety disorder. May also be used as an adjunct to antidepressants for other types of anxiety disorders or for insomnia caused by anxiety or other medical conditions.

Rapid onset of action. Effective for reducing mild to moderate anxiety symptoms. Have anti-nausea and anti-pruritic properties. Have a low potential for abuse or dependence.

May cause drowsiness, dry mouth, blurred vision, constipation, urinary retention, and weight gain. May interact with alcohol and other CNS depressants. May worsen depression or increase suicidal risk in some patients.

Anticonvulsants

Pregabalin, gabapentin, carbamazepine, oxcarbazepine, lamotrigine, valproate

Modulate the activity of various neurotransmitters and ion channels in the brain that are involved in neuronal excitability and synaptic transmission. May affect GABA, glutamate, calcium, or sodium.

Generalized anxiety disorder and social anxiety disorder. May also be used as an adjunct to antidepressants for other types of anxiety disorders or for treatment-resistant anxiety.

Effective for reducing both somatic and psychic symptoms of anxiety. Have antiepileptic and mood-stabilizing properties. Have a low potential for abuse or dependence.

May take several weeks to achieve full therapeutic effect. May cause dizziness, drowsiness, weight gain, edema, rash, nausea, headache, and cognitive impairment. May interact with other medications that affect liver enzymes or blood levels (such as oral contraceptives or warfarin). May cause serious adverse effects such as Stevens-Johnson syndrome, agranulocytosis, hepatotoxicity, or pancreatitis.