SSRIs and SNRIs, the first-line medications for anxiety, are considered safer alternatives to non-controlled substances.
Anxiety disorders are the most common group of psychiatric disorders in both adults and adolescents. Millions of people are prescribed anti-anxiety medications to help relieve their debilitating symptoms.
Benzodiazepines, which became available in the 1960s, were some of the first medications prescribed specifically for anxiety. While these drugs work quickly and effectively, they carry a high risk of dependence, sedation, and tolerance buildup.
Additionally, they also target the symptoms of anxiety rather than the cause of anxiety, so symptoms are likely to recur if the medication is stopped.
Today, there are several non-controlled substance alternatives to benzodiazepines. Two of the most common include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
When we talk about “non-controlled” medications, we’re referring to medications that do not carry the risk of dependence or addiction according to the U.S. Drug Enforcement Administration (DEA).
Benzodiazepines, such as Xanax and Valium, are the oldest and most well-known controlled substances for anxiety. While they have the advantage of working very quickly, they carry the risk of dependence, sedation, and tolerance buildup.
Because of this, it’s important for people with anxiety to have alternatives to benzodiazepines.
Today, the first-line medications for anxiety are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
One of the core differences between SSRIs and SNRIs compared to Benzodiazepines is that the former substances actually treat the source of the anxiety, whereas the latter substance only treats the symptoms.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR), there are several types of anxiety, including generalized anxiety, separation anxiety, social anxiety, panic disorder, specific phobias, and others.
While they are all treated differently, SSRIs and SNRIs are among the first-line options for almost all anxiety types.
Other non-controlled medications include the following:
Note that not all of the medications listed above are first-line for all anxiety disorders, and some are only indicated in certain anxiety disorders.
SSRIs improve your brain chemistry by keeping more serotonin available in the synaptic spaces between nerve cells. Serotonin is a neurotransmitter that plays a key role in mood and sleep.
SSRIs are effective for generalized anxiety disorder (GAD), phobias, and panic disorder.
SSRIs commonly prescribed for anxiety disorders include:
- sertraline (Zoloft)
- fluoxetine (Prozac)
- citalopram (Celexa)
- paroxetine (Paxil)
- escitalopram (Lexapro)
Similar to SSRIs, SNRIs increase the amount of serotonin available in the brain. But these drugs also increase the availability of norepinephrine (noradrenaline), a neurotransmitter that plays a role in attention, arousal, and alertness.
These drugs are effective for GAD and panic disorder.
The most commonly prescribed SNRIs include:
- duloxetine (Cymbalta)
- venlafaxine (Effexor)
- desvenlafaxine (Pristiq)
- levomilnacipran (Fetzima)
Buspirone (Buspar) belongs to a group of medications known as azapirones. These drugs act on the 5-HT1A receptor, a type of serotonin receptor.
Buspirone works well when there are high levels of worry, tension, irritability, or a mix of depression and anxiety.
Buspirone is considered a second-line medication to be used when a person does not respond well to SSRIs. It can also be added to an SSRI, particularly to help reduce the SSRIs sexual side effects.
Tricyclics were one of the first type of antidepressants ever developed. An
Typically, SSRIs and SNRIs are tried first before tricyclics are prescribed.
Propranolol (Inderal) belongs to a group of medications called beta-blockers. These drugs block the effects of the stress hormones adrenaline and noradrenaline.
Propranolol is a short-acting medication approved to treat high blood pressure and heart problems. It’s also prescribed off-label for anxiety – particularly for performance anxiety.
Pregabalin (Lyrica) is a type of medication known as a calcium channel modulator. It may be prescribed off-label for anxiety and insomnia. This drug reduces the release of excitatory neurotransmitters like glutamate, which in turn gives off a calming and sometimes sleepy effect.
According to a
Hydroxyzine pamoate (Vistaril)
Hydroxyzine pamoate (Vistaril) is an antihistamine that’s sometimes prescribed to treat anxiety or insomnia. It’s a short-term medication that can be used as an alternative to benzodiazepines.
Not all cases of anxiety need to be treated with medication, especially when symptoms are mild, transient, or don’t cause functional impairment. In fact, many people can reduce their symptoms with cognitive behavioral therapy (CBT) alone.
Still, medication may be needed if you experience high levels of distress or if the anxiety has led to substance misuse, suicidal thoughts, or depression.
According to 2014 research, the most common anxiety disorders include the following:
- specific phobia (10.3% of population)
- panic disorder with or without agoraphobia (6%)
- social anxiety disorder (2.7%)
- generalized anxiety disorder (2.2%)
The study also reported that most people who seek professional help for anxiety tend to have GAD, panic disorder, or social anxiety disorder. People with specific phobias are least likely to seek professional help.
Controlled medications for anxiety, such as benzodiazepines, work by binding to the brain’s GABA receptors. This action makes you feel calm and helps reduce nervousness and muscle spasms.
Benzodiazepines are considered controlled substances because the brain and body quickly build up a tolerance, requiring larger doses to get the same effect. When you use these medications regularly, it teaches your body to depend on outside means to relax. So when you don’t take the drug, you may become restless, tense, and irritable.
Non-controlled medications affect the brain in a different way. For instance, SSRIs act slowly on the serotonin system; while SRNIs act on both serotonin and norepinephrine. These medications are safer for long-term use, whereas benzodiazepines become less effective over time.
If you live with anxiety, you’re not alone. Anxiety disorders are the most prevalent psychiatric disorder in the world, affecting 40 million adults in the United States.
If your anxiety symptoms are interfering with your daily life and causing significant distress, consider reaching out to a mental health professional.
With the right treatment, you can reduce your symptoms and significantly improve your quality of life.