Introduction: Common Medications for Anxiety Disorders

Here you will first find a list of all the major medications and the problems they address. Then you will see each of the major problems (panic attacks, generalized anxiety, and so forth), with descriptions of the commonly recommended medications for that difficulty.

(I gratefully acknowledge James Ballenger, MD, of the Medical University of South Carolina, for his review of this section.)

BENZODIAZEPINES

• alprazolam (Xanax) panic, generalized anxiety, phobias, social phobias
• clonazepam (Klonopin) panic, phobias, social phobia
• diazepam (Valium) generalized anxiety, panic, phobias
• lorazepam (Ativan) generalized anxiety, panic, phobias
• oxazepam (Serax) generalized anxiety, phobias
• chlordiazepoxide (Librium) generalized anxiety, phobias

BETA BLOCKERS

• propranolol (Inderal) social phobia
• atenolol (Tenormin) social phobia

TRICYCLIC ANTIDEPRESSANTS

• imipramine (Tofranil) panic, depression, generalized anxiety
• desipramine (Norpramin, Pertofrane and others) panic, depression
• nortriptyline (Aventyl or Pamelor) panic, depression
• amitriptyline (Elavil) panic, depression
• doxepin (Sinequan or Adapin) panic, depression
• clomipramine (Anafranil) panic, OCD, depression
• venlafaxine (Effexor) OCD, depression

MONOAMINE OXIDASE INHIBITORS (MAOIs)

• phenelzine (Nardil) panic, social phobia, depression
• tranylcypromine (Parnate) panic, depression

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

• fluoxetine (Prozac) OCD, depression, panic, social phobia
• fluvoxamine (Luvox) OCD, depression, panic, social phobia
• sertraline (Zoloft) OCD, depression, panic, social phobia
• paroxetine (Paxil) OCD, depression, panic, social phobia

MILD TRANQUILIZER

• buspirone (BuSpar) generalized anxiety, OCD

ANTICONVULSANT

• Valproate (Depakene) panic

A. Panic Attacks

For panic attacks, the greatest benefit that medications can provide is to enhance the patient's motivation and accelerate progress toward facing panic and all of its repercussions. For a drug to help in this area, it must help in at least one of the two stages of panic. The first stage is anticipatory anxiety: all the uncomfortable physical symptoms and negative thoughts that rise up as you anticipate facing panic. The second stage is the symptoms of the panic attack itself. Both current research and clinical experience suggest that certain medications may help reduce symptoms during one or both of these stages for some people. However, if a medication can specifically block the panic attack itself, many patients no longer anticipate events with such anxiety and can overcome their phobias more quickly.

The primary medications used today for panic disorder are the benzodiazepines, several types of antidepressants and the new selective serotonin reuptake inhibitors (SSRIs), sometimes in combination with these benzodiazepines.

The most common benzodiazepines for panic attacks are alprazolam (Xanax) and clonazepam (Klonopin). They both block panic attacks quicker than the antidepressants, often in a week or two. They also tend to have fewer side effects than the antidepressants. Both, however, can have withdrawal symptoms as you taper off them. Because alprazolam is quicker acting than clonazepam, its withdrawal effects can be stronger as well. In studies on panic disorder, 43% of patients on alprazolam improved after eight weeks on less than 4 mg per day, and 30% get better on 4 to 6 mg per day.

The quick acting nature of alprazolam makes it an ideal medication to take as needed just before panic-provoking events. It takes about 15 to 20 minutes to offer you its anxiety-reducing benefits. If you place it under your tongue to dissolve (called sublingual), it can offer benefits within 5 to 8 minutes. Be ready for its bitter taste!