Anxiety Medication: Names, Drug Classes and What Trials Show

Anxiety medication falls into a handful of drug classes: SSRIs and SNRIs, benzodiazepines, buspirone, the antihistamine hydroxyzine, and drugs used off-label such as beta blockers^[1]. SSRIs and SNRIs are the first-line choice for panic disorder, generalized anxiety disorder and social anxiety disorder^[1]. How common anxiety disorders are is covered on our pillar page; this guide covers what each drug class is and what trials show.

NIMH describes anti-anxiety medications as drugs that reduce symptoms such as panic attacks and extreme fear and worry^[3]. Anxiety disorders are generally treated with psychotherapy, medication or both^[7]. For how many Americans take these drugs, including benzodiazepine trends, see our analysis of anxiety medication statistics.

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) were developed as antidepressants, and NIMH notes they improve symptoms across a broad group of depressive and anxiety disorders^[3]. For panic disorder and social anxiety disorder, prescribers typically start with an SSRI or another antidepressant because these drugs have fewer side effects than other options^[3].

FDA-approved examples include escitalopram and duloxetine for generalized anxiety disorder, sertraline for panic disorder and social anxiety disorder, and paroxetine for all three^[1]. Venlafaxine XR is approved in adults for GAD, social anxiety disorder and panic disorder^[8].

Onset is slow. Antidepressants usually take 4 to 8 weeks to work^[3], and a 2020 review describes treatment courses that may be as short as 3 to 6 months or run 1 to 2 years or longer^[1].

Common SSRI and SNRI side effects

Early side effects include nausea, headache, dry mouth, diarrhea and constipation, which the review describes as usually manageable or short-lived^[1]. Sexual dysfunction tends to be more durable, and some people feel jittery or more anxious at the start of treatment^[1].

According to NIMH, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior, especially in the first weeks or after a dose change, and combining these drugs with other serotonergic products such as triptans or St. John's wort can cause serotonin syndrome^[3]. Anyone in crisis can call or text 988 to reach the 988 Suicide & Crisis Lifeline^[3].

No single anxiety medication is best for everyone, but the largest contemporary comparison, by its authors' description, is a 2019 network meta-analysis in The Lancet that pooled 89 randomized trials with 25,441 adult outpatients with GAD, covering 22 drugs and placebo^[2]. It measured efficacy as change on the Hamilton Anxiety Rating Scale (HAM-A) and acceptability as the rate of dropping out for any reason^[2].

Duloxetine, pregabalin, venlafaxine and escitalopram were more effective than placebo with relatively good acceptability^[2]. Mirtazapine, sertraline, fluoxetine, buspirone and agomelatine also looked effective and well tolerated, but those results rested on small samples^[2].

Quetiapine, an antipsychotic, had the largest effect on HAM-A scores but was poorly tolerated, and paroxetine and benzodiazepines were effective but also poorly tolerated compared with placebo^[2]. The authors concluded that several effective choices exist across drug classes and that failure of a first medication might not be a reason to abandon medication as a strategy^[2].

In absolute terms, the four better-tolerated drugs improved HAM-A scores by 2.45 to 3.13 points more than placebo^[2]. The included trials were published from 1994 to 2017 and enrolled people with GAD only, so the ranking does not carry over directly to panic disorder or social anxiety disorder^[2].

SSRIs and SNRIs are the classes that overlap: NIMH notes these antidepressants improve symptoms of a broad group of depressive and anxiety disorders^[3]. Venlafaxine XR, for example, is FDA-approved in adults for major depressive disorder as well as GAD, social anxiety disorder and panic disorder^[8]. Escitalopram and duloxetine, two drugs in this group, were among the better-performing GAD treatments in the 2019 meta-analysis^[2].

Benzodiazepines do not fill that dual role. FDA lists their approved uses as generalized anxiety disorder, insomnia, seizures, social phobia and panic disorder, and depression is not among them^[4]. For how widely antidepressants are prescribed, see antidepressant usage statistics and our depression page.

Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan) and diazepam (Valium) bind to GABA receptors and slow brain activity, which produces calming or drowsy effects^[4]. NIMH describes them as useful as needed for severe short-term anxiety, usually prescribed for short periods and tapered slowly^[3].

They are widely used: an estimated 92 million benzodiazepine prescriptions were dispensed from U.S. outpatient pharmacies in 2019, led by alprazolam at 38%, clonazepam at 24% and lorazepam at 20%^[4]. In 2018, about half of patients dispensed an oral benzodiazepine received it for two months or longer^[4].

In September 2020, FDA required an updated boxed warning on every benzodiazepine covering abuse, misuse, addiction, physical dependence and withdrawal reactions^[4]. Physical dependence can develop after several days to weeks of steady use, even as prescribed, and stopping abruptly or cutting the dose too fast can cause withdrawal reactions, including seizures^[4]. The agency flagged the highest risk when benzodiazepines are combined with opioids, alcohol or other drugs that depress the central nervous system^[4].

Common side effects listed by FDA are drowsiness, dizziness, weakness and slowed breathing^[4]. Use trends and overdose data for this class are covered in our anxiety medication statistics post.

Beta blockers such as propranolol are not FDA-approved for any anxiety disorder and are prescribed off-label^[1]. NIMH says prescribers use them for short-term physical symptoms of anxiety, such as rapid heart rate, sweating and tremors, including in phobias like fear of public speaking^[3].

The trial evidence is thin. A 2025 systematic review in the Journal of Affective Disorders screened 3,068 records, included 10 studies and pooled 5 of them covering 179 participants^[5]. It found no evidence that beta blockers beat placebo or benzodiazepines for social phobia or panic disorder, even though prescriptions for patients with anxiety rose substantially between 2003 and 2018^[5].

The authors called for a large randomized trial to settle whether beta blockers are effective and safe for anxiety^[5]. NIMH notes they are generally not recommended for people with asthma or diabetes because they may worsen both conditions^[3].

Buspirone is a different type of anti-anxiety medication that can be used over longer periods; it must be taken daily for 3 to 4 weeks to reach full effect and does not work on an as-needed basis^[3]. It is FDA-approved for anxiety, is commonly added to an SSRI or SNRI for GAD, and has nausea, dizziness and headache among its reported side effects^[1].

Hydroxyzine, an antihistamine, is FDA-approved for anxiety^[1]. Pregabalin and quetiapine have no FDA anxiety indication and are used off-label^[1]. In the 2019 meta-analysis, pregabalin was effective with relatively good acceptability, while quetiapine was effective but poorly tolerated^[2].

No ingredient is recognized by FDA as safe and effective for over-the-counter use as a daytime sedative, a category that covers claims such as "occasional simple nervous tension" and "helps you relax"^[6]. Under the same federal rule, any OTC product labeled or promoted that way needs an approved new drug application^[6].

Dietary supplements sold for stress are a separate category. NCCIH reports that kava may have a small effect on anxiety but has been linked to severe liver injury, that chamomile findings for GAD are preliminary, and that oral lavender studies are too limited for firm conclusions^[7]. Melatonin is regulated as a dietary supplement, which means less strict FDA oversight than a prescription or OTC drug, and a 2017 test of 31 melatonin products found that most did not match their labeled amount^[7].

Among non-drug approaches, a 2023 randomized trial of 208 adults with anxiety disorders found mindfulness-based stress reduction was not less effective than escitalopram^[7]. For the symptoms that lead people to seek an evaluation, see our guide to signs of anxiety.