Medication treatment of anxiety is generally safe and effective. But it often takes time and patience to find the drug that works best for you.
The first line of treatment for an anxiety disorder is often cognitive-behavioral therapy, or CBT. This is a well-established, highly effective, and lasting treatment. Some people find that excessively high levels of anxiety make them unable to get the most out of such treatment, however. In this case, medication may allow full participation in CBT. Those without access to CBT or those who have not had a satisfactory response to it may benefit from medication treatment, too.
Listen to Dr. Roy-Byrne's podcast on medications. 
Have a discussion with your doctor about medication if you are suffering from significant insomnia, which is frequently associated with generalized anxiety disorder, or GAD. Distressed by repetitive and excessive worry, people with GAD usually focus on the day’s activities, such as what was left undone, what went wrong, what needs to be done tomorrow, and the like. People with this condition describe it as a difficulty turning their mind off, and they often have difficulty falling asleep. Improving sleep has been shown to reduce anxiety and depressive symptoms, and it can often be achieved with medication treatment.
Depression often complicates chronic anxiety. Don’t ignore a sad mood, bouts of tearfulness, low self-esteem, feelings of guilt or hopelessness, and other depressive symptoms. Medication is often helpful in reducing symptoms of anxiety and alleviating those of depression. Most drugs used to treat anxiety come from the antidepressant class of medication, so they can be used to treat both conditions effectively.
Four major classes of medications are used to treat anxiety disorders.
|Medication class||Generic names||How it works|
|SSRI (selective serotonin reuptake inhibitor)||citalopram, escitalopram, fluoxetine, paroxetine, sertraline||Relieves symptoms by blocking the reabsorption, or reuptake, of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which enhances neurotransmission—the sending of nerve impulses—and improves mood. SSRIs are “selective” because they affect only serotonin and not other neurotransmitters.|
|SNRI (serotonin-norepinephrine reuptake inhibitor)||venlafaxine, duloxetine||Increases the levels of the neurotransmitters serotonin and norepinephrine by inhibiting their reabsorption into cells in the brain.|
|Tricyclic antidepressant||amitriptyline, imipramine, nortriptyline||Inhibits the reabsorption of the neurotransmitters serotonin and norepinephrine. (Has been increasingly replaced by SSRIs.)|
|Benzodiazepine||alprazolam, clonazepam, diazepam, lorazepam||Promotes relaxation and reducing muscular tension and other physical symptoms of anxiety. Frequently used for short-term management of anxiety, such as for minor medical procedures.|
Other medications may also be used to treat anxiety disorders, including MAOI's (monoamine oxidase inhibitors), anticonvulsants, beta blockers, and atypical antipsychotics (also known as second-generation antipsychotics).
If you experience a side effect of any medication, contact your physician. Do not stop taking a medication abruptly because it may create other health risks.
If you and your doctor have decided on medication as a treatment option, you have many choices. Work with your doctor to find the medication that’s right for you. With patience and persistence, you will find a treatment that will help alleviate your anxiety symptoms.
Peter Roy-Byrne, MD
Chief of Psychiatry, Harborview Medical Center
Professor and Vice Chair, Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center
Director, Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP)