Medications,Pharmacology: What do doctors prescribe instead of diazepam?

October 10, 2025 •

4 min read

According to the Alcohol and Drug Foundation, regular use of benzodiazepines like diazepam can lead to dependence and withdrawal symptoms even after a short period, raising concerns among medical professionals about their long-term use. For this reason, healthcare providers are increasingly prescribing safer, non-addictive alternatives to address the question, 'What do doctors prescribe instead of diazepam?'.

Quick Summary

Doctors often prescribe a range of medications and therapies for anxiety to minimize the risk of dependency associated with diazepam. Alternatives include SSRIs, SNRIs, and buspirone for long-term management, alongside beta-blockers and antihistamines for short-term relief. Cognitive Behavioral Therapy is also a core component of modern anxiety treatment.

Key Points

Shift to Non-Addictive Options: Due to high dependency potential, long-term use of diazepam has been replaced by safer alternatives like SSRIs, SNRIs, and Buspirone.
SSRIs as First-Line Treatment: For chronic anxiety, SSRIs (e.g., sertraline, escitalopram) are often the first choice due to their long-term efficacy and low risk of dependence.
Buspirone for Low-Risk Management: Buspirone is a unique anxiolytic without sedative effects or dependence potential, making it a good option for generalized anxiety disorder.
Beta-Blockers for Situational Anxiety: Medications like propranolol are useful for managing the physical symptoms of performance or situational anxiety but do not address the psychological aspects.
Therapy as a Core Treatment: Cognitive Behavioral Therapy (CBT) is an evidence-based psychotherapy that can be used alone or with medication to build long-term coping skills.
Gabapentin for Treatment-Resistant Cases: Anticonvulsants like gabapentin may be used off-label for specific or hard-to-treat anxiety, but they are not typically first-line.
Professional Guidance is Key: A healthcare provider can determine the best individualized treatment plan by considering the patient's specific symptoms, history, and goals.

Safer and Effective Alternatives to Diazepam

Diazepam, a benzodiazepine, has been a common treatment for anxiety for decades due to its rapid effect. However, its potential for dependency, withdrawal symptoms, and cognitive side effects associated with long-term use have prompted a shift in medical practice. For ongoing management, doctors now favor alternative medications and therapies that pose less risk. These options are tailored to a patient's specific needs, symptom profile, and health history.

Non-Addictive Alternatives for Long-Term Management

For chronic anxiety, the first line of defense is often a non-addictive medication, which works over time to regulate mood and reduce overall anxiety levels.

Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are a class of antidepressants that are highly effective for treating anxiety disorders. By increasing the level of the neurotransmitter serotonin in the brain, they help stabilize mood and reduce anxiety over several weeks.

Examples: escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil).
Advantages: Proven long-term efficacy, low risk of dependence compared to benzodiazepines.
Considerations: Takes 2-4 weeks to start working, and common side effects can include nausea, headache, and sexual dysfunction.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs block the reuptake of both serotonin and norepinephrine, another neurotransmitter involved in mood regulation. They are often used when SSRIs are not effective and can be particularly helpful for patients with co-occurring pain conditions.

Examples: venlafaxine (Effexor XR) and duloxetine (Cymbalta).
Advantages: Broad spectrum of efficacy for anxiety and associated mood and pain issues.
Considerations: Side effects may include nausea, fatigue, and potential blood pressure elevation.

Buspirone (BuSpar): Buspirone is an anxiolytic that is not chemically related to benzodiazepines. It lacks their sedative effects and risk of dependence, making it a valuable alternative.

Mechanism: Its exact mechanism is unclear, but it is known to act on serotonin receptors.
Advantages: Minimal dependence risk, no sedation.
Considerations: Requires consistent daily use and can take 2-4 weeks to reach full effectiveness.

Medications for Acute or Specific Anxiety Symptoms

For immediate relief or specific situations, doctors may prescribe different classes of drugs that address the physical manifestations of anxiety without the dependency risk of diazepam.

Beta-Blockers (e.g., Propranolol): Beta-blockers are primarily used for cardiovascular conditions but are often prescribed off-label for situational anxiety, such as public speaking or performance anxiety.

Action: They block the effects of adrenaline, which reduces physical symptoms like a racing heart, trembling hands, and sweating.
Important Note: Propranolol does not address the psychological or emotional aspects of anxiety, only the physical ones.

Antihistamines (e.g., Hydroxyzine): Certain antihistamines, like hydroxyzine, have sedative properties that can be used for short-term anxiety relief.

Action: Provides immediate, calming effects, but is not for long-term management.
Considerations: Can cause significant drowsiness and is not a first-line choice for chronic anxiety.

Other Pharmaceutical and Therapeutic Options

Anticonvulsants (Gabapentin & Pregabalin): Used off-label for anxiety, these drugs may be considered for treatment-resistant cases, particularly those with comorbid conditions like neuropathic pain. They influence the brain's GABA activity, similar to benzodiazepines, but with potentially different side effect profiles. Gabapentin carries a lower risk of dependence compared to some other options but should be used cautiously.

Cognitive Behavioral Therapy (CBT): This is a non-pharmacological, evidence-based psychotherapy that can be used alone or in combination with medication for anxiety disorders. It helps patients identify and change problematic thought and behavior patterns that fuel anxiety. CBT is a cornerstone of long-term anxiety management, providing sustainable coping mechanisms that medication alone cannot achieve. For more on CBT, the National Institutes of Health provides research and insights on its effectiveness for anxiety disorders.

Comparison Table: Diazepam Alternatives


Feature	Diazepam	SSRIs (e.g., Sertraline)	Buspirone (BuSpar)	Beta-Blockers (e.g., Propranolol)	CBT
Primary Use	Short-term anxiety relief, muscle spasms, alcohol withdrawal	Long-term anxiety disorder management	Long-term generalized anxiety disorder	Situational anxiety (physical symptoms)	Long-term anxiety management, coping skills
Dependence Risk	High potential	Very low	Very low	Low	None
Onset of Action	Fast (30-60 minutes)	Slow (2-4 weeks)	Slow (2-4 weeks)	Fast (30-60 minutes)	Gradual over weeks/months
Addictive Potential	High	No	No	No	No
Side Effects	Drowsiness, dizziness, memory impairment	Nausea, insomnia, sexual dysfunction	Dizziness, headache, nausea	Fatigue, dizziness, low blood pressure	No pharmacological side effects
Long-Term Suitability	Not recommended	Yes, with regular monitoring	Yes, with regular monitoring	No, for situational use only	Yes, for sustainable results

Conclusion

The treatment landscape for anxiety has evolved significantly, moving away from relying heavily on potentially addictive benzodiazepines like diazepam. Today, doctors have a range of options, including non-addictive long-term medications, symptom-specific treatments, and evidence-based therapies like CBT. The best approach involves a comprehensive evaluation by a healthcare provider who can determine the most suitable strategy for each individual, considering their unique medical history and anxiety profile. The goal is to provide effective anxiety relief with the lowest possible risk, promoting both mental and physical well-being. A consultation with a mental health professional can help guide patients toward a personalized and sustainable treatment plan.

Frequently Asked Questions

Yes, many non-addictive medications are used for anxiety. Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), and buspirone are common examples used for long-term anxiety management.

Unlike the immediate effect of diazepam, non-addictive medications like SSRIs and buspirone typically take several weeks (2 to 4 or more) to build up in the system and achieve their full therapeutic effect.

Doctors may prescribe beta-blockers like propranolol to manage the physical symptoms of anxiety, such as a racing heart or shaking, especially in specific high-stress situations like performance anxiety.

CBT is a primary, evidence-based psychotherapy option for anxiety that can be used alone or in combination with medication. It teaches patients coping strategies to manage and change anxious thoughts and behaviors.

SSRIs primarily increase serotonin levels, while SNRIs increase both serotonin and norepinephrine levels in the brain. SNRIs may be used if SSRIs prove ineffective or for patients with co-occurring pain conditions.

Buspirone is specifically approved for generalized anxiety disorder (GAD) and is not typically used for immediate, acute panic attacks. It requires consistent use to be effective.

Yes, gabapentin is sometimes prescribed off-label for anxiety, particularly in cases that have not responded to first-line treatments. It has a lower risk profile than benzodiazepines for dependence.

Hydroxyzine, an antihistamine, is sometimes used for short-term anxiety relief due to its sedative effects. It is not intended for long-term management and can cause significant drowsiness.