Medicines for anxiety

Medicine is one of the two main treatments for anxiety. The other is talk therapy. Some people use one, and some use both. The right choice depends on your symptoms, your health and what you prefer.^7,13

This page explains the main kinds of anxiety medicine, how well they work, and their side effects. It also covers benzodiazepines, a group of fast-acting "nerve pills" with serious risks, especially after age 65.

Do you need medicine?

Not everyone with anxiety needs medicine. Talk therapy, such as cognitive behavioral therapy (CBT), works well for many people. The UK's national guideline says neither therapy nor medicine has been shown to be better for generalized anxiety. It suggests choosing based on what you prefer.⁷

Medicine may make sense if your anxiety is severe, if therapy is hard to get, or if therapy alone has not helped enough. Some people use medicine to calm symptoms enough to start therapy. See Treatment for anxiety for the full picture.

Your doctor may also check whether a health problem or another medicine is adding to your anxiety. See What causes anxiety and Medicines that can affect mood and memory.

The main medicines at a glance

Sources for the table: NIMH, MedlinePlus and AGS Beers Criteria.^2,5,10,11,12

SSRIs and SNRIs: usually the first choice

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are antidepressants. They change the levels of chemical messengers in the brain. They also treat generalized anxiety, panic disorder and social anxiety.²

How fast they work. These medicines take time. Many people need 4 to 8 weeks to feel the full benefit. Sleep, appetite and energy often improve before mood does.² Keep taking the medicine even after you feel better, unless your doctor says otherwise.¹²

How long to stay on them. If the medicine helps, the UK guideline suggests staying on it for at least a year. Stopping sooner makes it more likely that anxiety comes back.⁷

Common side effects. These can include nausea, trouble sleeping or sleepiness, sweating and sexual problems.¹² Some people feel more jittery or anxious, or sleep worse, when they first start. Ask your doctor what to expect.⁷ Your doctor usually starts with a low dose and raises it slowly to keep side effects down.

Safety points to know:

• Young people. Antidepressants can raise suicidal thoughts in some children, teens and young adults under 25, mostly in the first weeks or after a dose change.^2,12
• Bleeding. SSRIs raise the risk of bleeding, especially in older adults and people who also take aspirin or pain relievers like ibuprofen.^7,12
• Low sodium. SSRIs and SNRIs can lower the salt level in the blood. Doctors are advised to check sodium closely in older adults when starting or changing the dose.⁵
• Falls. For older adults who have had falls or broken bones, expert guidance says to avoid these medicines unless safer choices are not available. The risk may be higher with SNRIs.⁵
• Paroxetine (Paxil) is an SSRI that is also anticholinergic (it blocks a brain chemical needed for memory). The Beers Criteria advise older adults to avoid it.⁵
• Stopping suddenly can cause dizziness, irritability, nausea, tingling and poor sleep. Your doctor will lower the dose slowly.¹²

For more about this group of medicines, see Antidepressant medicines.

Buspirone

Buspirone is an anxiety medicine that is not a sedative. It is used for long-lasting anxiety. You take it every day, and it needs about 3 to 4 weeks to reach its full effect. It does not work if you take it only when you feel anxious.² Moderate evidence

In the 2019 review, buspirone helped and was well tolerated, but the studies were small.³ Common side effects include dizziness, nausea, headache, tiredness and trouble sleeping.¹¹ Avoid large amounts of grapefruit or grapefruit juice while taking it.¹¹

Hydroxyzine

Hydroxyzine (Vistaril) is an antihistamine, the same family as some allergy pills. Doctors prescribe it to ease anxiety and tension, and to stop itching.¹⁰ It often makes people sleepy.

It has drawbacks, especially later in life:

• It can cause confusion, dry mouth and dizziness, and confusion is more likely in older adults.¹⁰
• It can affect heart rhythm. Tell your doctor if you have heart disease or a slow or irregular heartbeat.¹⁰
• The 2023 Beers Criteria list hydroxyzine among antihistamines older adults should avoid. These drugs are strongly anticholinergic. Long-term use of this kind of drug is linked to falls, delirium (sudden confusion) and dementia.⁵

Pregabalin: a note for readers outside the U.S.

Pregabalin (Lyrica) is approved for generalized anxiety in Europe and has been since 2004.⁸ The UK guideline suggests it for people who cannot take SSRIs or SNRIs.⁷ In the 2019 review, it worked better than a placebo and most people could stay on it.³

In the United States, pregabalin is not approved for anxiety. It is approved for some kinds of nerve pain, fibromyalgia and some seizures.⁹ A U.S. doctor may still prescribe it "off-label" (for a use not on the label) in some cases.

Pregabalin can cause dizziness and sleepiness. Stopping it suddenly can cause withdrawal.⁹ In the UK, it is a controlled drug because some people misuse it.⁷ Expert guidance for older adults says to avoid taking it with opioid pain medicines, because the mix can slow breathing dangerously.⁵

Other medicines you may hear about

• Beta-blockers such as propranolol are heart medicines. Some doctors prescribe them off-label to calm a racing heart or shaky hands before a stressful event, like a speech. They are often not a good fit for people with asthma or diabetes.² Limited research
• Quetiapine is an antipsychotic medicine. It eased anxiety in trials, but many people stopped it because of side effects.³ The UK guideline says not to use antipsychotics for generalized anxiety in primary care.⁷

Benzodiazepines: fast relief, serious risks

Benzodiazepines are sedatives. They can calm anxiety quickly. Doctors may use them for severe anxiety or for a short time.^2,13 The UK guideline advises using them only short term during a crisis.⁷

They are very common. U.S. pharmacies filled about 92 million benzodiazepine prescriptions in 2019. About half of the people who got them in 2018 took them for two months or longer.¹

The 2020 FDA boxed warning. In September 2020, the FDA required its strongest warning, called a boxed warning, on all benzodiazepines. It warns about:¹

• Misuse and addiction. Some people take more than prescribed or come to crave the drug.
• Physical dependence. After regular use, the body gets used to the drug. This can happen even when you take it exactly as prescribed.
• Withdrawal. Stopping suddenly or cutting the dose too fast can cause withdrawal. Withdrawal can include seizures, which can be life-threatening.
• Long-lasting withdrawal. Some people have symptoms like anxiety, poor sleep, memory trouble or ringing in the ears for many months.

Long-term use can also cause tolerance, meaning the same amount works less well over time.²

Extra risks for older adults

Bodies change with age. Many medicines stay in the body longer and hit harder. The American Geriatrics Society keeps a list of medicines that are often risky for people 65 and older, called the Beers Criteria. It was last updated in 2023. It is meant to guide a shared choice between you and your doctor, not to replace it.⁴

For benzodiazepines, the Beers Criteria say:⁵

• Avoid them in most cases. A few exceptions include seizure disorders, alcohol withdrawal and severe generalized anxiety.
• All benzodiazepines raise the risk of memory and thinking problems, delirium, falls, broken bones and car crashes.
• Shorter-acting kinds are not safer than longer-acting ones for people who have fallen.
• Taking them every day for a long time can lead to physical dependence.

A fall can change an older person's life. If you or a parent takes one of these medicines and feels unsteady, foggy or forgetful, talk with the doctor. Do not stop on your own. See Anxiety in later life, Fear of falling and Medicines that can worsen memory.

Coming off a benzodiazepine safely

Many people want to cut back after years of use. This can be done, but it must be done slowly and with your doctor.

In 2025, the American Society of Addiction Medicine and other medical groups published a joint guideline on tapering these medicines. It says:⁶

• Doctors should not stop a benzodiazepine suddenly, or cut the dose quickly, in someone who may be dependent.
• Doctors should check the risks and benefits regularly and offer a taper when the risks outweigh the benefits.
• Tapers start with small cuts spaced a few weeks apart. The doctor watches for withdrawal after each step.
• The plan should fit the person. People who have taken these medicines for years may need a year or more to taper.
• You and your doctor should decide together.

The FDA also says no single tapering schedule fits everyone. If withdrawal symptoms appear, the doctor may pause the taper or go back a step.¹

Questions to ask your doctor or pharmacist

Choosing a medicine

• Should I try therapy first, medicine first or both?
• Why this medicine for me? How long until I notice a change?
• What side effects should I watch for? Which ones mean I should call you?

If I am 65 or older

• Is this medicine on the Beers list? Is there a safer choice?
• Could it raise my risk of falls or memory problems?
• Does it mix safely with my other medicines, including over-the-counter sleep aids?

If I already take a benzodiazepine

• Do the benefits still outweigh the risks for me?
• Would a slow taper make sense? What would the plan look like?
• What should I do if withdrawal symptoms start?

A memory notebook can help you keep a list of medicines and questions for each visit.

When to get help

• Call 911 for trouble breathing, a person who cannot be woken up, or a seizure.^10,12
• Call your doctor right away if anxiety, agitation or depression gets worse after starting or changing a medicine, or if you have new thoughts of harming yourself.¹²
• Call or text 988, the Suicide and Crisis Lifeline, any time you have thoughts of suicide or are in emotional crisis. It is free and open 24 hours a day.
• Talk with your doctor or pharmacist before changing anything. Do not stop, start or change the dose of any anxiety medicine on your own.

See also Getting help, the Anxiety overview, Generalized anxiety disorder, Panic attacks, Social anxiety and Self-help for anxiety.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.