What works better than buspirone for anxiety? Exploring alternatives

October 10, 2025 •

4 min read

According to the Anxiety & Depression Association of America (ADAA), buspirone may be considered a secondary treatment option for anxiety, often reserved for those who do not respond well to first-line medications. For individuals whose anxiety symptoms persist, exploring alternatives to buspirone is a crucial step towards finding a more effective treatment plan.

Quick Summary

Several medication classes offer more robust or faster-acting relief for anxiety than buspirone, such as first-line SSRIs and SNRIs, and shorter-term options like benzodiazepines. Selection depends on individual needs, side effects, and desired onset.

Key Points

SSRIs and SNRIs are first-line: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are often more effective for chronic anxiety than buspirone, though they take several weeks to work.
Benzodiazepines offer quick, short-term relief: Medications like Xanax and Ativan provide fast-acting relief for severe or acute anxiety and panic attacks but carry a high risk of dependence, making them unsuitable for long-term use.
Hydroxyzine provides non-addictive, rapid relief: This antihistamine works quickly to calm anxiety, particularly when coupled with sleep issues, and does not have the risk of dependence associated with benzodiazepines.
Propranolol manages physical symptoms: For individuals with situational or performance anxiety, beta-blockers like propranolol can help control physical symptoms such as racing heart and shaking by blocking adrenaline.
Other options for refractory anxiety: In cases where other treatments fail, anticonvulsants like pregabalin (Lyrica) and gabapentin (Neurontin) may be used off-label, though they carry their own risks and side effects.
Consider combination therapy: Buspirone can be added to an SSRI or SNRI regimen to enhance effects, though research on its benefit as an adjunct is mixed.
Individualized treatment is key: What works best depends on the patient's specific anxiety disorder, symptom severity, side effect tolerance, and other health conditions.

Buspirone is a non-sedating anxiolytic that is less effective for severe anxiety or panic disorders, and its effects can take several weeks to manifest. While it offers advantages like a low risk of dependence, many individuals may find their symptoms are better managed with other, more potent or targeted medications.

First-Line Antidepressants (SSRIs and SNRIs)

For most anxiety disorders, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered the first-choice treatment options due to their established effectiveness and tolerability. These work by adjusting neurotransmitter levels in the brain over several weeks to produce a calming and mood-stabilizing effect.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs like escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil) are frequently prescribed for generalized anxiety disorder (GAD).

How they work: SSRIs increase serotonin levels in the brain by blocking its reuptake, helping to regulate mood and reduce anxiety over time.
Considerations: While very effective, SSRIs can take 4-6 weeks to reach their full therapeutic effect. Common side effects can include nausea, headaches, and sexual dysfunction, though these often decrease over time.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs such as duloxetine (Cymbalta) and venlafaxine (Effexor XR) are also highly effective for GAD and other anxiety-related conditions.

How they work: SNRIs increase both serotonin and norepinephrine levels in the brain, which can help with both mood and energy regulation.
Considerations: Side effects for SNRIs can be similar to SSRIs, but they may also cause increased blood pressure in some individuals.

Fast-Acting Anxiolytics

For severe, short-term anxiety or panic attacks, healthcare providers may prescribe fast-acting medications for immediate relief.

Benzodiazepines

Benzodiazepines, including alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan), offer rapid relief from intense anxiety symptoms.

How they work: They enhance the effect of the neurotransmitter GABA, producing a calming, sedative effect.
Considerations: Due to the risk of dependence, withdrawal symptoms, and sedative effects, benzodiazepines are recommended for short-term use only or as-needed dosing.

Hydroxyzine (Atarax, Vistaril)

This antihistamine has sedative properties and can be used for short-term anxiety relief.

How it works: Its sedative effects help to calm the nervous system.
Considerations: Hydroxyzine is not habit-forming but can cause significant drowsiness, making it unsuitable for daytime use for many individuals.

Beta-Blockers

Beta-blockers like propranolol (Inderal) primarily target the physical symptoms of anxiety, such as a rapid heart rate, sweating, and shaking.

How they work: They block the effects of adrenaline, which is responsible for the 'fight-or-flight' response.
Considerations: They do not address the psychological components of anxiety and are often used for situational anxiety, such as performance anxiety, rather than generalized anxiety disorder.

Other Medication Options

Pregabalin (Lyrica)

While primarily used for nerve pain and seizures, pregabalin can also be effective for GAD.

How it works: It affects the central nervous system to help reduce nerve cell activity.
Considerations: It is a controlled substance and can cause side effects like weight gain and drowsiness.

Gabapentin (Neurontin)

Also an anticonvulsant, gabapentin is sometimes used off-label to treat anxiety.

How it works: It mimics the neurotransmitter GABA to have a calming effect on the nervous system.
Considerations: Off-label use means less clinical data is available for its efficacy in treating anxiety, and it requires careful monitoring by a doctor.

Comparison of Buspirone Alternatives for Anxiety


Medication Class	Examples	Onset of Action	Primary Use	Risk of Dependence	Common Side Effects
SSRIs	Lexapro, Zoloft, Paxil	Weeks	First-line, chronic anxiety	Low	Nausea, sexual dysfunction, headache
SNRIs	Effexor XR, Cymbalta	Weeks	First-line, chronic anxiety	Low	Nausea, dry mouth, increased blood pressure
Benzodiazepines	Xanax, Ativan, Klonopin	Hours	Short-term or as-needed	High	Sedation, dizziness, memory issues
Hydroxyzine	Vistaril, Atarax	Minutes to an hour	Short-term or as-needed	Low	Drowsiness
Beta-Blockers	Propranolol	1-2 hours	Situational anxiety	Low	Dizziness, fatigue, slow heart rate
Pregabalin	Lyrica	Weeks	Refractory or add-on therapy	Moderate	Drowsiness, dizziness, weight gain
Gabapentin	Neurontin	Weeks	Refractory or add-on therapy	Low	Dizziness, drowsiness, nausea

Conclusion

While buspirone offers a safer, non-addictive option for anxiety, its gradual onset and lower efficacy for severe symptoms make it unsuitable for everyone. For those seeking alternatives, first-line treatments like SSRIs and SNRIs are often the most effective long-term solution. Patients needing immediate relief may find benzodiazepines or hydroxyzine more appropriate for short-term use, while beta-blockers target the physical manifestations of anxiety. The right medication depends on a person's specific anxiety profile, side-effect tolerance, and overall treatment goals. Anyone exploring a change in their anxiety medication should do so in close consultation with a qualified healthcare provider to determine the best path forward. For additional information on anxiety treatment options, refer to resources like the Anxiety & Depression Association of America website.

Frequently Asked Questions

A person might switch from buspirone if they experience persistent anxiety, as it is often less effective for severe symptoms or panic attacks compared to other options. Its gradual onset of action also means it isn't suitable for immediate relief. Some medical guidelines even recommend it as a secondary option after other treatments fail.

Buspirone and SSRIs like Lexapro or Zoloft differ significantly in their mechanism and use. SSRIs are considered first-line and generally more effective for long-term anxiety management, while buspirone is often a second-choice or add-on treatment. Buspirone also acts differently on brain receptors and lacks the sedative or addictive properties of other anti-anxiety drugs.

Benzodiazepines, such as Xanax and Ativan, work much more quickly than buspirone, with effects often felt within an hour. In contrast, buspirone requires consistent, long-term use, typically taking 2 to 4 weeks to show its full effect.

Propranolol, a beta-blocker, is used to manage the physical symptoms of anxiety, such as a racing heart, trembling, and sweating, rather than the psychological ones. It is particularly useful for situational or performance-based anxiety and is not habit-forming.

Yes, hydroxyzine is a non-addictive antihistamine that can provide relatively fast, short-term relief from anxiety and can also help with associated insomnia. It does, however, cause significant drowsiness.

Yes, buspirone is sometimes prescribed as an add-on therapy, or adjunct, to an SSRI or SNRI regimen when a person needs additional relief. However, studies on the effectiveness of this combination have produced mixed results.

A doctor's recommendation will depend on the individual's specific needs, side effect tolerance, symptom severity, and other medical conditions. They will likely consider first-line options like SSRIs or SNRIs, or may recommend short-term alternatives like benzodiazepines or hydroxyzine based on the patient's anxiety profile.