Doctors may prescribe off-label medications to help treat anxiety symptoms, especially when traditional anti-anxiety meds don’t work for you.
We all have unique brain chemistry, so a medication that works for one person may not work for someone else. You may even find that FDA-approved anxiety medications are not effective for you.
When this happens, your doctor may prescribe an off-label medication.
Off-label prescribing is when you’re given a medication that’s been approved, but not for the condition you have. This practice is quite common. About 1 in 5 prescriptions are off-label.
Healthcare professionals often prescribe off-label medications for anxiety disorders. In fact, research suggests that up to 40% of people with anxiety disorders don’t respond to current treatments for these conditions.
That’s a lot of people, since anxiety disorders are the most common class of mental health conditions, affecting about 264 million people around the world.
A note on safety
To minimize side effects and avoid interactions with other medications, it’s important to only take medications off-label when prescribed and monitored by a healthcare professional. In general, reaching out to a doctor or pharmacist before taking any new med or supplement can prevent any complications.
There are several off-label medications that a doctor might prescribe for anxiety, including beta-blockers or anti-seizure meds.
Propranolol is in a class of medications known as beta-blockers. These drugs are approved to treat heart conditions and high blood pressure. They block the effects of the stress hormones adrenaline and noradrenaline.
Propranolol is commonly prescribed off-label for anxiety. Many people, such as students, public speakers, and performers, take it to reduce physical anxiety symptoms before a test or getting onstage.
Propranolol may reduce the following symptoms of anxiety:
- rapid pulse
- dry mouth
- sweaty hands
Benzodiazepines are a class of medicine that’s FDA-approved for treating anxiety. They work by increasing the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, which has a relaxing, sedative effect.
Propranolol may be a good alternative to benzodiazepines, since many doctors are less inclined to prescribe them because of the higher chance of dependence and withdrawal.
Side effects of propranolol may include:
- tiredness and fatigue
- cold fingers or toes
- sleeping problems or nightmares
Pregabalin is an antiepileptic medication approved to treat partial seizures by slowing down impulses in the brain. It can also treat nerve pain by changing the brain chemicals that send pain signals across the nervous system.
Pregabalin is also prescribed off-label as an anti-anxiety medication. Experts believe that pregabalin lowers anxiety by reducing the release of excitatory neurotransmitters, such as glutamate.
Side effects of pregabalin may include:
- dry mouth
- blurred vision
- weight gain
- abnormal thinking
- drowsiness or sleepiness
More severe side effects include swelling of the throat or head, and hypersensitivity reactions, such as hives or difficulty breathing.
Gabapentin is another antiepileptic medication, approved for partial seizures and nerve pain.
It’s frequently used off-label to treat anxiety disorders and post-traumatic stress, as it enhances transmission of GABA.
Gabapentin also reduced participants’ anxiety before surgery, and reduced symptoms in some people with panic disorder.
In addition, there’s some evidence that gabapentin may work with fluoxetine (Prozac) to reduce symptoms of obsessive-compulsive disorder (OCD). However, the positive effects of adding gabapentin to fluoxetine treatment seemed to stop working by the fourth week.
Some states have recently classified gabapentin as a controlled substance. This is due to its potential for misuse, since it increases the effects of opioids and may contribute to overdose.
Common side effects of gabapentin may include:
- tiredness or weakness
- blurred vision
Memantine belongs to a class of medications known as NMDA receptor antagonists. This drug is currently approved for the treatment of Alzheimer’s disease, but there is growing interest in its potential use for OCD.
If you have OCD, you may also experience anxiety, though OCD isn’t officially considered an anxiety disorder by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Memantine appears to work by altering the activity of glutamate, a neurotransmitter increasingly believed to play a role in OCD.
In one small
No side effects were observed in the study, but more participation is needed for a better understanding of the medication’s effectiveness.
Side effects of memantine may include:
- body or joint aches
- nausea or vomiting
- gastrointestinal issues, including diarrhea or constipation
- weight gain
This medication carries the risk of severe side effects. Doctors tend to only prescribe it off-label if you have severe treatment-resistant anxiety or treatment-resistant depression.
Studies suggest quetiapine may be an effective treatment for GAD, but it tends to have poor tolerability, which is the degree to which people can handle the medication’s adverse effects.
Side effects of quetiapine may include:
- nausea and vomiting
- mood alterations
- dry mouth
More severe symptoms include uncontrolled muscle movements, high blood sugar levels, and difficulty speaking or swallowing.
Valproate and its many forms are medications primarily prescribed to treat epilepsy, migraine, and bipolar disorder. Here are some of its forms:
- valproic acid
- sodium valproate
- valproate semisodium
It increases GABA in the brain.
In a small 2020 study, 26 out of 36 men with GAD responded to valproate with at least a 50% reduction in symptoms. The most common side effects were dizziness and nausea.
Side effects of valproate may include:
- nausea or vomiting
- hair loss
Serious side effects include:
- low blood platelets
- suicidal thoughts
- encephalopathy, a change in brain function or structure
- low body temperature
Valproate is not considered safe to take during pregnancy.
Baclofen is in a class of medications known as skeletal muscle relaxants. Doctors commonly prescribe these medications for pain and muscle stiffness and spasms related to multiple sclerosis (MS) and spinal cord injuries.
Baclofen activates GABA receptors, leading to a feeling of calm.
Doctors may prescribe it off-label for anxiety, particularly anxiety related to alcohol withdrawal. A
Side effects of baclofen may include:
- muscle weakness
Risperidone is an atypical antipsychotic commonly used to treat:
- bipolar disorder manic episodes or mixed episodes
- irritability in autism
Risperidone may rebalance levels of the neurotransmitters dopamine and serotonin, which may improve mood, thinking, and behavior.
Doctors sometimes prescribe risperidone off-label for severe treatment-resistant anxiety. It’s been used for treating GAD, and increasing evidence suggests it may also help treat OCD.
Side effects of risperidone may include:
- weight gain
Severe side effects may include extrapyramidal symptoms, which are movement disorders induced by medications. These may include:
Taking any medication can come with risks, which is why it’s important to work closely with a healthcare professional when treating anxiety (or any other condition, for that matter).
The risks involved in taking off-label medications for anxiety will depend on the medication you take and your personal circumstances.
If you’re recommended or prescribed any medication, it can help to read the label closely and ask a doctor or pharmacist any questions you might have.
The best way to limit your risks — like interactions with other medicines or severe side effects — is to reach out to a doctor to tell them about your concerns, especially if you begin to experience any side effects.
There are many treatment options available for anxiety — but what works for one person may not work for you. It can take some trial and error to find the right combination of medication, therapy, and self-care.
While a doctor may start you with an FDA-approved anti-anxiety medication, they may later recommend an off-label medication for relieving your anxiety symptoms, especially if traditional medications are not working for you.
You might also consider trying some natural remedies for anxiety and stress. Many of these, like meditation and deep breathing practices, are low risk and may improve your symptoms.