Antidepressants for Anxiety: Which One Is the Best?

If you’ve been diagnosed with an anxiety disorder, your healthcare provider may recommend one of several medications, including anti-anxiety medications, beta-blockers and, for certain types of anxiety, antidepressants.

Although antidepressants are typically viewed as treatments for depression, several modern antidepressants are approved to treat anxiety disorders such as generalized anxiety disorder (GAD) and panic disorder. 

Below, we’ve explained how antidepressants may help to treat anxiety, as well as the specific antidepressants your healthcare provider may prescribe if you have an anxiety disorder.

We’ve also discussed how long it usually takes for anxiety to improve, the side effects you may experience while using antidepressants to treat anxiety and more.

Antidepressants for Anxiety: The Basics

• Some antidepressants may help to improve the way your brain uses chemicals that control stress and mood, reducing feelings of anxiety.
  

• Not all antidepressants are approved to treat anxiety. When an antidepressant is used to treat an anxiety disorder, it’s generally a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).
  

• Older antidepressants such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are less commonly used as first-line treatments for anxiety.
  

• Antidepressants can take several weeks to start working, meaning it’s important to keep using them even if you don’t notice an immediate improvement in your feelings, anxiety levels and general mood.
  

• If you’ve been diagnosed with an anxiety disorder, your healthcare provider may suggest undergoing psychotherapy in addition to using medication.
  

• Antidepressants can be extremely helpful, but they can also have drawbacks. You might experience side effects while using antidepressants, or need to try several medications before finding one that’s a good fit for you.
  

• If you’re prescribed an antidepressant to treat anxiety, don’t change your dosage or stop taking it without first talking to your healthcare provider. 

Stopping antidepressants suddenly can cause antidepressant discontinuation syndrome and withdrawal symptoms. 

How Antidepressants Can Help to Treat Anxiety

Two types of antidepressants are typically used to treat anxiety disorders — selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

SSRIs and SNRIs function by changing the levels of certain neurotransmitters in your brain and body.

Neurotransmitters are chemical messengers that are used by your body to communicate between nerve cells and regulate your mood, behavior and other bodily functions. 

More specifically, SSRIs work by increasing the amount of serotonin that’s present in your brain.

Serotonin is sometimes referred to as a “happy hormone” or “happy chemical.” This is because it plays a key role in regulating your mood and feelings of well-being.

It also assists in reducing feelings of depression and regulating your levels of anxiety.

Research has shown that low levels of serotonin are linked to depression, anxiety disorders and suicidal behavior.

If you are feeling any of these consult a healthcare provider immediately. 

SNRIs work by increasing the amounts of serotonin and norepinephrine that are present in your brain.

Like serotonin, norepinephrine is a neurotransmitter that’s responsible for regulating mood and behavior.

More specifically, it’s responsible for everything from helping you focus, to assisting in the management of your sleep-wake cycle, your response to stress and your memory.

By increasing levels of these neurotransmitters, SSRI and SNRI antidepressants may help to improve mood and provide relief from anxiety. 

Which Antidepressants Are Used to Treat Anxiety?

Currently, the FDA has approved several antidepressants to treat anxiety disorders. Most of the antidepressants approved to treat anxiety disorders are SSRIs and SNRIs, although some older antidepressants are also approved for certain anxiety disorders. 

Selective Serotonin Reuptake Inhibitors (SSRIs) for Anxiety

Selective serotonin reuptake inhibitors (SSRIs) approved by the FDA to treat anxiety disorders include:

• Fluoxetine. Sold under the brand name Prozac®, fluoxetine is approved as a treatment for several anxiety disorders, such as panic disorder and obsessive-compulsive disorder (OCD).
  

• Paroxetine. Sold under the brand name Paxil®, paroxetine is approved as a treatment for panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD) and post-traumatic stress disorder (PTSD).
  

• Sertraline. Sold under the brand name Zoloft®, sertraline is approved as a treatment for panic disorder, social anxiety disorder (SAD), obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
  

• Escitalopram. Sold under the brand name Lexapro®, escitalopram is approved as a treatment for generalized anxiety disorder (GAD).
  

• Fluvoxamine. Sold under the brand name Luvox® CR, fluvoxamine is approved as a treatment for obsessive-compulsive disorder and social anxiety disorder.

Some other SSRIs, such as citalopram (sold as Celexa®), aren’t approved by the FDA to treat anxiety disorders,  but may be prescribed off-label by your healthcare provider to treat anxiety disorders if deemed safe and appropriate.

Serotonin-Norepinephrine Reuptake Inhibitors (SSRIs) for Anxiety

Serotonin-norepinephrine reuptake inhibitors (SNRIs) approved by the FDA to treat anxiety disorders include:

• Duloxetine. Sold under the brand name Cymbalta®, duloxetine is approved as a treatment for generalized anxiety disorder (GAD).
  

• Venlafaxine. Sold under the brand name Effexor®, venlafaxine is approved as a treatment for generalized anxiety disorder (GAD), social anxiety disorder (SAD) and panic disorder.

Other Antidepressants Used to Treat Anxiety

In addition to SSRIs and SNRIs, some older or atypical antidepressants may be used to treat anxiety disorders. Some of these medications are approved by the FDA to treat anxiety, while others may be prescribed off-label:

• Tricyclic antidepressants. Some tricyclic antidepressants, such as doxepin (sold as Sinequan® and under other brand names), are occasionally prescribed to treat certain anxiety disorders.

• Monoamine oxidase inhibitors (MAOIs). An older class of antidepressants, some MAOIs are used to treat anxiety. For example, phenelzine (sold as Nardil®) may be prescribed off-label as a treatment for social anxiety disorder (SAD).

Due to the higher risk of side effects and drug interactions with older antidepressants, these medications generally aren’t used as first-line treatments for depression or anxiety.

Other Medications Used to Treat Anxiety

In addition to antidepressants, several other types of medications are used as treatments for anxiety disorders. Other medications used to treat anxiety include: 

• Benzodiazepines. Benzodiazepines such as alprazolam (Xanax®), diazepam (Valium®) and lorazepam (Ativan®) are often used to treat generalized anxiety disorder (GAD) and several other anxiety disorders.
  Benzodiazepines have both advantages and disadvantages as anxiety treatments. While they’re usually effective and begin working quickly, people treated with benzodiazepines can quickly develop a tolerance and, in some cases, become dependent on them.
  

• Buspirone. Buspirone is a non-benzodiazepine medication that’s used to treat anxiety disorders, particularly generalized anxiety disorder (GAD). It’s often used when SSRIs aren’t effective or produce unpleasant side effects.
  Buspirone can take several weeks to start working effectively. Unlike benzodiazepines, there’s no risk of dependence or withdrawal in people treated for anxiety disorders with buspirone.
  

• Beta-blockers. Beta-blockers, which are commonly used to treat hypertension (high blood pressure), are also used to treat the physical symptoms of anxiety.
  Beta-blockers start working quickly and are effective for controlling shaking, trembling, rapid heartbeat and other physical anxiety symptoms for short periods, such as during an event, performance or other anxiety-producing situation.

In addition to medication, anxiety disorders are often treated using psychotherapy. Therapeutic options such as cognitive behavioral therapy (CBT) can often help people develop new ways of thinking and behaving that assist in reducing anxiety.

Antidepressant Safety and Side Effects

Although most new antidepressants, such as SSRIs and SNRIs, are well tolerated, you may experience side effects while using antidepressants to treat anxiety. Common side effects of SSRIs and SNRIs include:

• Agitation

• Anxiety

• Difficulty sleeping

• Difficulty reaching orgasm

• Dizziness

• Headache

• Nausea

• Reduced sex drive

Some SSRIS and SNRIs are associated with sexual side effects, including erectile dysfunction in men. Sexual side effects can often be treated by changing medications, adjusting dosage or using erectile dysfunction (ED) medications such as Viagra® (sildenafil) or Cialis® (tadalafil).

In some cases, SSRIs and SNRIs can cause severe side effects, including serotonin syndrome and an increased risk of suicidal ideation and behavior.

We’ve explained these in more detail in our full guide to SSRIs. 

If you’re prescribed an older type of antidepressant, such as a tricyclic antidepressant or MAOI, you may experience more side effects.

These medications may also cause a range of drug and food interactions, as we’ve explained in our full guide to MAOIs. 

If you experience any side effects after you start using an antidepressant, it’s best to talk to your healthcare provider.

If your side effects don’t disappear on their own over time, your healthcare provider may recommend adjusting your dosage or switching to a different medication. 

Learn More About Treating Anxiety

Anxiety disorders are extremely common, with data from the National Institute of Mental Health indicating that an estimated 31.1 percent of American adults will experience an anxiety disorder at some point in life.

Our guide to coping with anxiety goes into more detail about the treatments that are available for anxiety disorders, from cognitive behavioral therapy (CBT) to meditation and more. 

Frequently Asked Questions About Antidepressants and Anxiety

How Long Do Antidepressants Take to Work for Anxiety?

The effects of antidepressants aren’t immediate. Typically, it takes about two to four weeks (or, in some cases, as long as six weeks) for most SSRIs and SNRIs prescribed to treat anxiety to produce a noticeable effect.

Some side effects of antidepressants, such as jitteriness or anxiety symptoms, may be stronger during the first two weeks of treatment.

If you don’t experience any improvements after using an SSRI or SNRI for six weeks or longer, do not make any changes to your dosage or stop using your medication.

Instead, talk to your healthcare provider — if appropriate, they may recommend a different type of medication. 

Can Antidepressants Treat Sleep Difficulties and Anxiety? 

Yes. Some antidepressants, such as doxepin, are prescribed to treat sleeping issues such as insomnia. Other antidepressants used to treat sleep-related issues include trazodone, which may be prescribed off-label for this purpose.

If you have insomnia or other difficulties sleeping in addition to anxiety, make sure that you tell your healthcare provider before discussing the use of medication.