Anxiety is a phantom weight that you carry with you and it feels heavier each day. Inside your mind is a storm, and for many people, medications act like lighthouses to help people navigate the rocky shoreline of anxiety disorder. With anxiety affecting roughly 20% of adults in the United States (over 300 million people around the world), we will take a look at what medications are available to ease your voyage toward the tranquillity you seek.
Which anxiety medication is suitable for you depends on what type of anxiety the individual has, and how severe it is, how the individual is going to respond to medications, as well as the side effects.
Contrary to what many may think, Gabapentin is the most prescribed medication for treating anxiety in 2024, making up around 22% of all anti-anxiety prescriptions. Originally developed to treat seizure disorders, Gabapentin is used for treating anxiety through what physicians refer to as "off-label" use - intentionally prescribing medications for a reason other than an FDA approved one.
Gabapentin works from a physiological level by calming overactive nerve activity in your brain. This med changes the neurotransmitter gamma- aminobutyric acid (GABA) which calms down any over activity in your nervous system naturally.
Bupropion hydrochloride is found in second place for anti-anxiety use. It is completely different approach from a medication perspective. If you think about it, most medications for anxiety focus on serotonin but Bupropion focuses on dopamine and norepinephrine. These are neurotransmitters that are involved with stimulations, pleasure, and mind concentrations.
Bupropion is a single option for anxiety medications because it does not cause any dose-related weight gain or sexual side effects, which other medications tend to create. If you are experiencing anxiety, fatigue and a lack of motivation, Bupropion could assist in both areas. Think about it, you have two rooms connecting with a door in-terms of mental wellness, and you could open both of them with one key.
Trazodone hydrochloride works for anxiety and sleep issues. Trazodone was established in the market as a treatment for anxiety with insomnia; another common partner of anxieties. Trazodone acts by changing the level of serotonin in your brain, but in a different way than many other drugs. It raises the serotonin available and also blocks certain serotonin receptors. This dual action helps explain its success for anxiety although it promotes sleep.
Alprazolam is a member of the benzodiazepine family of medications, a class known for their action on acute anxiety. Along with Lorazepam, this class of anxiolytics (anti-anxiety medications) are some of the few medications able to provide fast relief for anxiety symptoms.
Most other treatment options for anxiety are built over time that escalate in impact. Some medications will take a few weeks or even a few months to show their full potential, but Alprazolam will be effective in 30 minutes. This is precisely why Alprazolam is so effective for panic attacks or instances in which someone is trying to gain immediate relief from severe anxiety symptoms.
In effect, it works on enhancing the action of GABA (gamma-aminobutyric acid) in your brain which is a natural calming system that your brain uses. If your brain's alarm system was on full volume, Alprazolam helps lower that volume. The effectiveness of alprazolam will start to diminish over time because of your body developing a tolerance (which can create a need for higher doses).
There are also considerations for dependency that are likely to lead to the short-term use or as-needed prescription instead of long-term, ongoing treatment. The half-life of Alprazolam is more moderate when compared to other anti-anxiety medications leading to the potential for anxiety-like symptoms to return between doses — this may lead to "rebound anxiety."
Clonazepam is a benzodiazepine, like Alprazolam, but it is longer acting (8- 12 hours) while Alprazolam is shorter acting (4- 6 hours), meaning the effects of Clonazepam can be extended to provide more consistent “around the clock” anxiety relief during the day, while reducing multiple doses.
This is for those who suffer from all-day persistent anxiety, rather than anxiety that just occurs episodically and suddenly as in panic. Benzodiazepines that have a long duration of action, can be viewed as "stabilizing", which may help people living with more chronic forms of anxiety.
As with all benzodiazepines, Clonazepam must be used cautiously. Having a longer duration of action can also mean increasingly powerful sedation effects, especially during initiation of the medication. All benzodiazepines can have substantial interaction effects when used with alcohol, which may multiply the sedative effects (and associated hazards) of whatever you drank.
Venlafaxine at lower doses, is a predominantly negative effect on the serotonin mechanism, but as the dose is increased norepinephrine will be affected. There are accumulative net effects of having engaged specific neurotransmitter systems to allow for relief of symptoms, and it is not uncommon for some to feel themselves to be individualizing treatment with the opioid prescriptions of Venlafaxine.
Lamotrigine was primarily designed for other purposes – namely epilepsy and bipolar disorder — but has since been used for some anxiety patients. The way these agents function is distinct from many other anxiety medications, because instead of just targeting some of the behaviors associated with anxiety disorders, Lamotrigine instead seeks to stabilize the electrical activity in the brain and modulate the excitatory neurotransmitter glutamate.
Lorazepam can be beneficial in the short-term treatment of acute anxiety situations (like a panic attack), with the benefit of a longer duration than Alprazolam. For someone who believes that Clonazepam is too sedating or too long a duration, it may be a more effective option at meaningfully reducing anxiety.
Topiramate was originally created for epilepsy treatment. Its mechanism of action is complicated and is likely acting on several aspects of brain function including sodium channels, certain glutamate receptors, and enhanced GABA activity. These multiple actions can explain its utility across all of these conditions.
From your experience in taking Topiramate, you may notice some atypical side effects compared to other anxiety medications. It can cause altered sense of tastes initially, and at times cognitive effects like difficulties in finding right word(s).
Like many other treatments on this list, Levetiracetam was developed for epilepsy, but it has now been used to treat anxiety for individuals who have not responded to more traditional treatments. The exact way Levetiracetam works in anxiety is not entirely clear. It seems to modulate certain calcium channels and modulate a brain protein SV2A that affects neurotransmitter release.