How to get anxiety medication

Types of Anxiety Medications

What medications help with anxiety? How do they differ? These are common questions patients ask when seeking treatment. Anxiety medications fall into several categories, each working differently in the brain and offering unique benefits and considerations.

SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs are typically the first-line medication for most anxiety disorders. They work by increasing serotonin levels in the brain, which helps regulate mood, emotion, and anxiety responses.

• Common examples: Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil)
• Best for: Generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD)
• Onset of action: 2-6 weeks for full effect

Research shows that approximately 60-70% of patients with anxiety disorders respond positively to SSRI treatment. At Next Step Psychiatry's medication management program, we carefully monitor response rates and adjust treatment plans accordingly.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

SNRIs affect both serotonin and norepinephrine levels, potentially offering broader symptom relief for some patients.

• Common examples: Venlafaxine (Effexor XR), Duloxetine (Cymbalta)
• Best for: GAD, social anxiety disorder, panic disorder, especially when depression co-occurs
• Onset of action: 2-8 weeks for full effect

Benzodiazepines

Benzodiazepines enhance the effect of the neurotransmitter GABA, which reduces neuronal excitability throughout the central nervous system.

• Common examples: Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Diazepam (Valium)
• Best for: Acute anxiety, panic attacks, short-term anxiety relief
• Onset of action: 30-60 minutes

While benzodiazepines provide rapid relief, they're generally recommended only for short-term use due to risks of tolerance, dependence, and withdrawal. Our specialized treatment approach carefully weighs these factors for each patient.

Buspirone (BuSpar)

Buspirone is a non-benzodiazepine anxiolytic that affects serotonin and dopamine receptors.

• Best for: GAD, particularly for patients concerned about dependency
• Onset of action: 2-4 weeks
• Unique benefit: No risk of dependency, minimal sedation, fewer cognitive effects

Learn more about Buspirone's timeline in our detailed Buspar for anxiety treatment guide.

Beta-Blockers

Beta-blockers block the effects of adrenaline, reducing physical symptoms of anxiety like rapid heartbeat, trembling, and sweating.

• Common examples: Propranolol (Inderal), Atenolol (Tenormin)
• Best for: Performance anxiety, situational anxiety with prominent physical symptoms
• Onset of action: 30-60 minutes

Other Medications

Several other medications may be prescribed for anxiety in specific situations:

• Hydroxyzine (Vistaril): An antihistamine with anxiolytic properties that works within 30 minutes. Learn more in our hydroxyzine for anxiety treatment guide.
• Pregabalin (Lyrica): An anticonvulsant sometimes used for GAD, particularly in Europe
• Tricyclic antidepressants: Older medications sometimes used when newer options aren't effective
• Atypical antipsychotics: Sometimes used as adjuncts for treatment-resistant anxiety

Medication Timeline: When to Expect Results

How long does it take for anxiety medication to work? This is one of the most common questions patients ask. Understanding the timeline helps set realistic expectations and improves treatment adherence.

Short-Term vs. Long-Term Medications

Anxiety medications fall into two general categories based on their onset of action:

Rapid-Acting Medications (Hours)

• Benzodiazepines: Relief begins within 30-60 minutes
• Beta-blockers: Physical symptom relief within 30-60 minutes
• Hydroxyzine: Effects noticeable within 30 minutes

These medications provide quick relief but are generally not recommended for long-term daily use due to tolerance, dependency concerns, or limited scope of action.

Gradual-Acting Medications (Weeks)

• SSRIs: Initial effects in 1-2 weeks, full benefits in 4-6 weeks
• SNRIs: Initial effects in 1-2 weeks, full benefits in 4-8 weeks
• Buspirone: Gradual improvement over 2-4 weeks

These medications take longer to work but provide sustainable anxiety relief with fewer dependency concerns, making them suitable for long-term treatment.

Detailed Timeline for SSRIs and SNRIs

Since SSRIs and SNRIs are first-line treatments for most anxiety disorders, understanding their timeline is particularly important:

Weeks 1-2:

• Some patients may notice initial changes in sleep, energy, or appetite
• Side effects may appear before therapeutic benefits
• Anxiety symptoms typically haven't improved significantly yet

Weeks 2-4:

• Many patients begin noticing reduced anxiety intensity
• Initial side effects often start to diminish
• Sleep may improve

Weeks 4-6:

• Significant reduction in anxiety symptoms for most responders
• Improved ability to manage stressful situations
• Most side effects have subsided

Weeks 6-12:

• Full therapeutic benefits typically achieved
• Stabilization of mood and anxiety response
• Better overall functioning in daily activities

For a detailed timeline on specific medications, see our guides on Zoloft for anxiety and how long it takes Lexapro to work.

Medication Comparison Table

This comparison highlights the diversity of treatment options available. At Next Step Psychiatry, we use pharmacogenetic testing to help determine which medications may work best for your specific genetic profile.

How to Choose the Right Anxiety Medication

Why do psychiatrists prescribe different medications for anxiety? The answer lies in personalization. Selecting the right anxiety medication involves considering multiple factors unique to each patient.

Factors That Influence Medication Selection

Type of Anxiety Disorder

• Generalized Anxiety Disorder (GAD): SSRIs, SNRIs, and buspirone are typically first-line
• Panic Disorder: SSRIs, particularly sertraline (Zoloft) and paroxetine (Paxil), have strong evidence
• Social Anxiety Disorder: SSRIs, particularly sertraline, paroxetine, and escitalopram
• Performance Anxiety: Beta-blockers like propranolol for physical symptoms
• PTSD: SSRIs, particularly sertraline and paroxetine
• OCD: SSRIs, often at higher doses than used for other anxiety disorders

Symptom Profile

• Predominantly physical symptoms: Beta-blockers may help with trembling, racing heart
• Insomnia with anxiety: Medications with mild sedative effects may be beneficial
• Rumination and worry: SSRIs and SNRIs often help reduce persistent thought patterns
• Panic attacks: Both long-term (SSRIs) and as-needed (benzodiazepines) medications may be considered

Comorbid Conditions

• Depression with anxiety: SSRIs and SNRIs treat both conditions
• Chronic pain with anxiety: SNRIs like duloxetine may address both issues
• Bipolar disorder with anxiety: Mood stabilizers may be prioritized before antidepressants
• Substance use concerns: Non-addictive options like SSRIs, SNRIs, or buspirone are preferred

Patient Factors

• Age: Older adults may be more sensitive to side effects
• Pregnancy/breastfeeding status: Some medications have better safety profiles
• Prior medication response: Previous positive or negative experiences guide selection
• Family history: Relatives' responses to medications can predict effectiveness
• Genetic factors: Pharmacogenetic testing can identify metabolic variations affecting medication response

Practical Considerations

• Cost and insurance coverage: Some newer medications may be more expensive
• Dosing schedule: Once-daily medications may improve adherence
• Potential for drug interactions: Important for patients taking multiple medications
• Time to effectiveness: Whether rapid relief is needed alongside long-term treatment

At Next Step Psychiatry, we conduct thorough evaluations to consider all these factors before recommending a treatment plan.

Starting Medication: What to Expect

How should I prepare for starting anxiety medication? What's normal during the first few weeks? These questions are common among patients beginning treatment.

Before Starting

• Medical evaluation: Your psychiatrist will assess your overall health, current medications, and medical history
• Baseline symptoms: Tracking your anxiety symptoms before starting helps measure improvement
• Medication education: Understanding potential side effects, when to take the medication, and what to expect
• Support system: Informing trusted friends or family about your treatment plan

The First Few Days

• Initial side effects: Some medications, particularly SSRIs and SNRIs, may cause temporary side effects like nausea, headache, or sleep changes
• Adjustment period: Your body needs time to adapt to the medication
• Dosing schedule: Following the prescribed schedule carefully
• Monitoring: Keeping track of any side effects or changes in symptoms

The First Few Weeks

• Gradual improvement: For SSRIs and SNRIs, anxiety symptoms typically begin improving after 2-4 weeks
• Side effect resolution: Initial side effects often diminish as your body adjusts
• Dosage adjustments: Your psychiatrist may adjust your dose based on your response
• Regular check-ins: Follow-up appointments to assess progress

Long-Term Expectations

• Continued improvement: Benefits often continue to increase over 8-12 weeks
• Maintenance phase: Once stabilized, regular monitoring ensures continued effectiveness
• Lifestyle integration: Medication becomes part of your routine
• Complementary strategies: Combining medication with therapy and lifestyle changes for optimal results

Our medication management program provides structured support throughout this process, ensuring you never feel alone in your treatment journey.

Managing Side Effects

What side effects should I watch for with anxiety medication? How can I manage them? Understanding potential side effects and strategies to address them is crucial for successful treatment.

Common Side Effects by Medication Class

SSRIs and SNRIs

• Initial nausea: Taking with food, starting with lower doses
• Sleep changes: Adjusting timing of medication (morning vs. evening)
• Headaches: Usually temporary; over-the-counter pain relievers if needed
• Sexual side effects: Dose adjustments, timing changes, or medication switches if persistent
• Increased anxiety (initially): Sometimes occurs in first 1-2 weeks; temporary and usually resolves

Benzodiazepines

• Sedation: Caution with driving or operating machinery
• Cognitive effects: Memory or concentration issues, especially in older adults
• Balance problems: Fall precautions, especially for elderly patients
• Tolerance: Effectiveness may diminish over time with regular use

Buspirone

• Dizziness: Taking with food can help
• Headache: Usually mild and temporary
• Nausea: Taking with food often helps

Beta-Blockers

• Fatigue: Dosage adjustments may help
• Cold extremities: Wearing warm clothing
• Lightheadedness: Rising slowly from sitting or lying positions

General Strategies for Managing Side Effects

• Start low, go slow: Beginning with lower doses and gradually increasing can minimize side effects
• Timing adjustments: Taking medication with food or changing the time of day
• Hydration and nutrition: Staying well-hydrated and maintaining regular meals
• Sleep hygiene: Establishing good sleep habits to counteract sleep-related side effects
• Regular communication: Keeping your psychiatrist informed about side effects
• Patience: Many side effects are temporary and resolve within 1-2 weeks

When to Contact Your Doctor

While many side effects are mild and temporary, some require prompt medical attention:

• Severe allergic reactions (rash, itching, swelling)
• Significant changes in mood, including increased depression or suicidal thoughts
• Unusual agitation or restlessness
• Severe dizziness or fainting
• Persistent or severe gastrointestinal issues
• Any side effect that significantly impacts your daily functioning

At Next Step Psychiatry, we provide telepsychiatry services for convenient check-ins about medication side effects, allowing for prompt adjustments when needed.

Complementary Approaches to Anxiety Treatment

What can I do alongside medication to manage anxiety? Research consistently shows that combining medication with other approaches yields better outcomes than medication alone.

Therapy Options

• Cognitive Behavioral Therapy (CBT): Helps identify and change thought patterns that trigger anxiety
• Exposure Therapy: Gradually facing feared situations to reduce anxiety responses
• Acceptance and Commitment Therapy (ACT): Focuses on accepting anxiety while committing to behavior change
• Mindfulness-Based Cognitive Therapy: Combines mindfulness practices with cognitive techniques

Research shows that combining medication with therapy results in approximately 85% better outcomes than medication alone for most anxiety disorders.

Lifestyle Modifications

• Regular exercise: 30 minutes of moderate activity 5 times weekly reduces