What do most psychiatrists prescribe for anxiety? A comprehensive guide to modern treatment options

October 7, 2025 •

4 min read

Anxiety disorders affect approximately 40 million adults in the United States every year, making them the most common type of mental health condition. To manage these symptoms, psychiatrists most often prescribe SSRIs and SNRIs as the first-line and long-term treatment options for anxiety.

Quick Summary

This article explores the most common medications psychiatrists prescribe for anxiety, detailing how SSRIs, SNRIs, and benzodiazepines work. It covers their typical uses, including long-term versus short-term applications, common side effects, and the importance of combining pharmacotherapy with talk therapy for optimal results.

Key Points

First-Line Options are SSRIs and SNRIs: Psychiatrists typically start with SSRIs like escitalopram (Lexapro) or sertraline (Zoloft) and SNRIs like venlafaxine (Effexor XR) for long-term anxiety management.
Benzodiazepines are for Short-Term Use: Medications like clonazepam (Klonopin) and alprazolam (Xanax) are prescribed for acute, short-term relief of severe anxiety due to their rapid effect and potential for dependence.
Medication and Therapy Combination is Key: A combination of medication and psychotherapy, such as Cognitive Behavioral Therapy (CBT), generally provides the most effective and lasting results for anxiety disorders.
Other Medications are Available: For patients who don't respond to first-line drugs, other options like buspirone (Buspar) or beta-blockers may be prescribed, targeting different aspects of anxiety symptoms.
Treatment Requires Medical Supervision: Finding the right medication and dosage requires careful management by a healthcare provider, and abrupt discontinuation can cause withdrawal symptoms.
Medication Affects Neurotransmitters: Anxiety medications work by regulating neurotransmitters like serotonin, norepinephrine, and GABA to improve mood and reduce hyperarousal in the brain.

While there is no one-size-fits-all treatment, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are widely considered the first-line medication choices for most anxiety disorders. The specific medication and treatment approach depend on the type of anxiety, its severity, and the patient's overall health profile. These medications work by targeting key neurotransmitters in the brain to help regulate mood and emotional responses.

First-Line Treatments: SSRIs and SNRIs

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most frequently prescribed type of medication for anxiety disorders. They work by blocking the reabsorption (or reuptake) of serotonin, a neurotransmitter that regulates mood and behavior, allowing more of it to remain active in the brain. This helps to alleviate anxiety and improve mood over time. While SSRIs have a generally favorable side effect profile compared to older antidepressants, they may take four to six weeks to build up in the system and become fully effective.

Commonly prescribed SSRIs for anxiety disorders include:

Escitalopram (Lexapro): Often noted for its mild side effect profile.
Sertraline (Zoloft): Effective for a range of anxiety disorders including GAD, panic disorder, and social anxiety disorder.
Paroxetine (Paxil): Used for GAD, social anxiety disorder, and PTSD.
Fluoxetine (Prozac): Also effective for panic disorder and OCD.
Fluvoxamine (Luvox): Primarily used for obsessive-compulsive disorder (OCD).

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are another common first-line treatment, particularly for generalized anxiety disorder (GAD). They work similarly to SSRIs but block the reuptake of both serotonin and norepinephrine. This dual action can be beneficial for patients who have not responded adequately to an SSRI. Like SSRIs, SNRIs may take several weeks to reach their full effect.

Examples of SNRIs used for anxiety include:

Venlafaxine (Effexor XR): Approved for GAD, social anxiety disorder, and panic disorder.
Duloxetine (Cymbalta): Approved for GAD and also useful for treating chronic pain conditions that can co-occur with anxiety.

Short-Term Options: Benzodiazepines

For short-term, rapid relief of acute, severe anxiety or panic attacks, psychiatrists may prescribe benzodiazepines. These medications work quickly, often within minutes to an hour, by enhancing the effect of the neurotransmitter GABA, which produces a calming, sedative effect.

However, due to the high risk of dependence and withdrawal symptoms, benzodiazepines are not recommended for long-term daily use. They are typically prescribed for a period of weeks or on an as-needed basis for specific situational anxiety. Common examples include:

Clonazepam (Klonopin): A longer-acting option.
Alprazolam (Xanax): A shorter-acting option for rapid relief.
Lorazepam (Ativan): Another short-acting choice.

Other Prescription Medications

Psychiatrists also have several other options in their toolkit for treating anxiety, particularly when first-line options prove ineffective or are not well-tolerated:

Buspirone (Buspar): This is a non-sedating antianxiety medication that is not related to benzodiazepines. It is often prescribed for GAD and has a lower risk of dependence, but it may not be effective for panic attacks.
Beta-Blockers (e.g., Propranolol): These medications are primarily used for heart conditions but can be used to manage the physical symptoms of anxiety, such as a rapid heart rate, sweating, and shaking. They are typically used for situational or performance anxiety.
Atypical Antidepressants: In some cases, atypical antidepressants like mirtazapine may be used, particularly if a patient also experiences insomnia, due to its more sedating effects.

The Role of Psychotherapy

It is widely recognized that combining medication with psychotherapy often yields the best long-term results for treating anxiety disorders. Cognitive Behavioral Therapy (CBT) is one of the most effective forms of psychotherapy, focusing on teaching coping skills and changing negative thought patterns. When beginning an anxiety medication, many psychiatrists will recommend concurrent therapy for a more comprehensive treatment plan.

Comparison of Common Anxiety Medication Classes


Medication Class	How it Works	Typical Use	Onset of Action	Key Considerations
SSRIs	Increases serotonin levels by blocking reuptake.	First-line, long-term treatment for various anxiety disorders.	4–6 weeks for full effect.	Safer for long-term use, generally well-tolerated, may cause sexual side effects.
SNRIs	Increases both serotonin and norepinephrine levels.	First-line, long-term treatment, especially for GAD.	6–8 weeks for full effect.	May be more effective than SSRIs for some, can affect blood pressure.
Benzodiazepines	Enhances GABA, a calming neurotransmitter.	Short-term relief for acute, severe anxiety and panic attacks.	Rapid, within minutes to hours.	High potential for dependence, not for long-term use.
Buspirone	Partial agonist of the 5-HT1A serotonin receptor.	Long-term treatment for GAD, lacks anti-panic properties.	Longer onset of action, can take 2-3 weeks.	Low abuse potential, non-sedating.
Beta-Blockers	Blocks effects of adrenaline.	Managing physical symptoms of situational anxiety (e.g., performance anxiety).	Rapid, often within 30 minutes to an hour.	Targets physical symptoms only, not the underlying anxiety.

Conclusion

Most psychiatrists prescribe first-line medications such as SSRIs (e.g., Lexapro, Zoloft) and SNRIs (e.g., Effexor XR, Cymbalta) for the long-term management of anxiety disorders due to their effectiveness and safety profile. Short-acting benzodiazepines are reserved for acute situations where immediate relief is necessary but are used cautiously to avoid dependence. The optimal treatment strategy, however, is a holistic approach, often combining pharmacotherapy with psychotherapy like Cognitive Behavioral Therapy (CBT) and healthy lifestyle changes. Always consult with a qualified medical professional to determine the most suitable treatment plan for your specific needs.

For more information on anxiety treatments, refer to the resources provided by the Mayo Clinic.

Frequently Asked Questions

SSRIs are typically used for long-term management of anxiety and take several weeks to become fully effective. Benzodiazepines, on the other hand, provide rapid, short-term relief for acute anxiety or panic attacks but have a high potential for dependence.

It can take between four and six weeks for the full therapeutic effects of an SSRI to be felt. A psychiatrist will typically start with a low dose and gradually increase it until an effective dosage is found.

Benzodiazepines are not recommended for long-term use primarily because of the risk of developing tolerance and dependence. Over time, patients may require higher doses to achieve the same effect, and abrupt cessation can lead to withdrawal symptoms.

Common side effects can include nausea, headaches, weight changes, fatigue, insomnia, and sexual dysfunction. Most side effects tend to decrease after the first few weeks of treatment.

While medication can significantly reduce symptoms, research shows that combining medication with psychotherapy, such as Cognitive Behavioral Therapy (CBT), yields better long-term outcomes than either treatment alone. A comprehensive approach addresses both the biological and psychological aspects of anxiety.

Yes. First-line treatments like SSRIs, SNRIs, and other medications such as buspirone are not considered addictive in the same way as benzodiazepines. However, discontinuation should still be done gradually under medical supervision to avoid withdrawal symptoms.

Beta-blockers help manage the physical symptoms of anxiety, such as a rapid heartbeat and trembling, by blocking the effects of adrenaline. They are often used for situational anxiety, like performance anxiety, and do not address the psychological components of the condition.