6.5 Antianxiety Medications

Antianxiety medications help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common class of antianxiety medications is benzodiazepines. Benzodiazepines are used to treat generalized anxiety disorder, although SSRIs or other antidepressants are typically used to treat panic disorder or social phobia (i.e., social anxiety disorder). Beta-blockers and buspirone may also be prescribed for anxiety.^[1]

Benzodiazepines

Benzodiazepines are used to treat anxiety and are also used for their sedation and anticonvulsant effects because they bind to GABA receptors and stimulate the effects of GABA (an inhibitory neurotransmitter). Benzodiazepines include clonazepam, alprazolam, and lorazepam. Benzodiazepines are a Schedule IV controlled substance because they have a potential for misuse and can cause dependence. Short-acting benzodiazepines (such as lorazepam) and beta-blockers are used to treat the short-term symptoms of anxiety. Lorazepam is available for oral, intramuscular, or intravenous routes of administration.^[2]

Beta-Blockers

Beta-blockers, such as propranolol, are medications that block the effects of the sympathetic nervous system by acting on Beta-1 receptors in the heart and other areas of the body. While they are most commonly prescribed to treat high blood pressure, heart rhythm disorders, and other cardiac conditions, beta-blockers may also be used off-label to help manage the physical symptoms of anxiety—such as trembling, rapid heartbeat, and sweating—especially in short-term or situational anxiety, such as public speaking or test anxiety. In these cases, they are often prescribed “as needed” rather than for continuous daily use. They may be prescribed to manage the physical symptoms of anxiety (such as trembling, rapid heartbeat, and sweating) for a short period of time or used “as needed” to reduce acute physical symptoms.^[3]

Buspirone

Buspirone is an antianxiety medication that works differently from benzodiazepines. It is primarily used to treat generalized anxiety disorder (GAD) and is not classified as a controlled substance because it has no risk of physical dependence or misuse. Buspirone acts by stimulating serotonin (5-HT1A) receptors in the brain and modulating dopamine receptors, which helps reduce anxiety symptoms over time. Unlike benzodiazepines, buspirone does not cause sedation, muscle relaxation, or have anticonvulsant properties, and it does not enhance GABA activity.^[4]