Anxiety Medication

Are anti-anxiety drugs right for you? Learn about common side effects, risks, and how to take them responsibly.

The role of medication in anxiety treatment

When you’re overwhelmed by heart-pounding panic, paralyzed by fear, or exhausted from yet another sleepless night spent worrying, you’ll do just about anything to get relief. And there’s no question that when anxiety is disabling, medication may help. But are drugs always the best answer?

Many different types of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs such as benzodiazepines (typically prescribed for short-term use) and newer options like SSRI antidepressants (often recommended as a long-term anxiety solution). These drugs can provide temporary relief, but they also come with side effects and safety concerns—some significant.

They are also not a cure. In fact, there are many questions about their long-term effectiveness. According to the American Academy of Family Physicians, benzodiazepines lose their therapeutic anti-anxiety effect after 4 to 6 months of regular use. And a recent analysis reported in JAMA Psychiatry found that the effectiveness of SSRIs in treating anxiety has been overestimated, and in some cases is no better than placebo.

What’s more, it can be very difficult to get off anxiety medications without difficult withdrawals, including rebound anxiety that can be worse than your original problem.

So where does that leave you if you’re suffering? Even when anxiety relief comes with side effects and dangers, that can still sound like a fair trade when panic and fear are ruling your life.

The bottom line is that there’s a time and place for anxiety medication. If you have severe anxiety that’s interfering with your ability to function, medication may be helpful—especially as a short-term treatment. However, many people use anti-anxiety medication when therapy, exercise, or other self-help strategies would work just as well or better, minus the drawbacks.

Anxiety medications can ease symptoms, but they’re not right for everyone and they’re not the only answer. It’s up to you to evaluate your options and decide what’s best for you.

Benzodiazepines for anxiety

Benzodiazepines (also known as tranquilizers) are the most widely prescribed type of medication for anxiety. Drugs such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam) work quickly, typically bringing relief within 30 minutes to an hour. That makes them very effective when taken during a panic attack or another overwhelming anxiety episode. However, they are physically addictive and not recommended for long-term treatment.

Benzodiazepines work by slowing down the nervous system, helping you relax both physically and mentally. But it can also lead to unwanted side effects. The higher the dose, the more intense these side effects typically are—although some people feel sleepy, foggy, and uncoordinated even on low doses. This can cause problems with work, school, or everyday activities such as driving. The medication hangover can last into the next day.

Common side effects of benzodiazepines include:

Drowsiness

Dizziness

Poor balance or coordination

Slurred speech

Trouble concentrating

Memory problems

Confusion

Stomach upset

Headache

Blurred vision

According to the FDA, benzodiazepines can worsen cases of pre-existing depression, and more recent studies suggest that they may potentially lead to treatment-resistant depression. Furthermore, benzodiazepines can cause emotional blunting or numbness and increase suicidal thoughts and feelings.

Benzodiazepine safety concerns

Benzodiazepines are generally not recommended for long-term use since the safety concerns and risk of abuse increase as you build up a tolerance to the medication.

When taken regularly, benzodiazepines lead to physical dependence and tolerance, with increasingly larger doses needed to get the same anxiety relief as before. This happens quickly—usually within a couple of months, but sometimes in as little as a few weeks.

If you abruptly stop taking your medication, you may experience severe withdrawal symptoms such as:

Increased anxiety, restlessness, shaking.

Insomnia, confusion, stomach pain.

Depression, confusion, panic attacks.

Pounding heart, sweating, and in severe cases, seizure.

Many people mistake withdrawal symptoms for a return of their original anxiety condition, making them think they need to restart the medication. Gradually tapering off the drug will help minimize the withdrawal reaction.

While benzodiazepines are relatively safe when taken only occasionally and in small doses, they can be dangerous and even deadly when combined with other central nervous system depressants. Always talk to your doctor or pharmacist before combining medications.

Don’t drink on benzodiazepines. When mixed with alcohol, benzodiazepines can lead to fatal overdose.

Don’t mix with painkillers or sleeping pills. Taking benzodiazepines with prescription pain or sleeping pills can also lead to fatal overdose.

Antihistamines amplify their effects. Antihistamines—found in many over-the-counter sleep, cold, and allergy medicines—are sedating on their own. Be cautious when mixing with benzodiazepines to avoid over-sedation.

Be cautious when combining with antidepressants. SSRIs such as Prozac and Zoloft can heighten benzodiazepine toxicity. You may need to adjust your dose accordingly.

The benzodiazepines work because they slow down the nervous system. But sometimes, for reasons that aren’t well understood, they have the opposite effect. Paradoxical reactions are most common in children, the elderly, and people with developmental disabilities. They include:

Increased anxiety, irritability, agitation, aggression, and rage

Mania, impulsive behavior, and hallucinations

Anyone who takes benzodiazepines can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:

People over 65. Older adults are more sensitive to the sedating effects of benzodiazepines. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Benzodiazepine use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents. Long-term benzodiazepine use also increases the risk of Alzheimer’s disease and dementia.

People with a history of substance abuse. Because they’re physically addicting and on their own and dangerous when combined with alcohol and other drugs, anyone with a current or former substance abuse problem should use benzodiazepines only with extreme caution.

Pregnant and breastfeeding women. Benzodiazepine use during pregnancy can lead to dependence in the developing baby, with withdrawal following birth. Benzodiazepines are also excreted in breast milk. Therefore, pregnant women need to have a thorough discussion about the risks and benefits of these medications with their prescribing doctor. If medication is necessary, the goal is the smallest effective dose.

Benzodiazepines cause drowsiness and poor coordination, which increases your risk for accidents at home, at work, and on the road. When on benzodiazepines, be very careful when driving, operating machinery, or doing anything else that requires physical coordination.

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