What Are the Best Medications for Anxiety and Depression?

Megan Nunn, PharmD
·11 min read
2

Medically reviewed by Alex Yampolsky, PharmD

Anxiety and depression are common but serious mental health issues that can cause a dramatic decrease in functioning and quality of life. In the United States, about 1 in 5 people experience anxiety, and 1 in 10 have depression.

Symptoms of anxiety include the following:

Symptoms of depression include the following:

Both genetic and environmental factors can contribute to anxiety and depression. Some of the causes of these disorders overlap, including the following:

Here's what you need to know about treatment options for anxiety and depression.



What to Do If You're Feeling Depressed or Anxious

If you or a loved one is struggling with anxiety or depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.

If you have suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one is in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.



What Medications Are Available for Anxiety and Depression?

There are several classes of medications used to treat anxiety and depression. The drugs in these classes work by increasing the activity of chemical messengers (neurotransmitters) that are involved in mood regulation, such as:

The right medicine for you depends on your symptoms, other medications you take, and how severe your anxiety or depression is.

Often, healthcare providers select a medication with side effects that can improve your symptoms. For example, an antidepressant that causes weight gain may be a good choice for someone with depression who is also experiencing reduced appetite and weight loss.

Here's a summary of the most common medications for anxiety and depression.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) increase serotonin levels. They are typically the first choice for people with the following conditions:

Side Effects

The most significant side effects of SSRIs are:

Dosage

Typical doses of common SSRIs, which, unless otherwise specified, treat both anxiety and depression, include:

  • Celexa (citalopram): 20 to 40 milligrams (mg) daily

  • Lexapro (escitalopram: 5 to 20 mg daily for depression; 10 to 20 mg daily for anxiety

  • Paxil (paroxetine): 20 to 40 mg daily for depression; 20 to 60 mg daily for anxiety

  • Zoloft (sertraline): 50 to 200 mg daily

  • Prozac (fluoxetine): 20 to 60 mg daily

<p>MTStock Studio / Getty Images</p> Young Asian female using laptop to speak with her healthcare provider while sitting on sofa in living room at home.

MTStock Studio / Getty Images

Young Asian female using laptop to speak with her healthcare provider while sitting on sofa in living room at home.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase levels of both serotonin and norepinephrine. They are typically prescribed first for people with the following conditions:

  • Depression plus chronic pain

  • Severe depression

  • Anxiety disorders, including GAD, social anxiety disorder, or panic disorder

Antidepressant effects of SNRIs may be seen earlier than with SSRIs.

Side Effects

Adverse effects of SNRIs include the following:

Dosage

Typical doses of SNRIs to treat depression or anxiety are:

  • Effexor (venlafaxine): 75 to 375 mg daily for depression or anxiety

  • Pristiq (desvenlafaxine): 25 to 50 mg daily for depression; 50 to 100 mg daily for anxiety

  • Cymbalta (duloxetine): 30 to 60 mg daily for depression or anxiety

  • Savella (milnacipran): 12.5 to 100 mg daily for depression

  • Fetzima (levomilnacipran): 20 to 120 mg daily for depression

Tricyclic Antidepressants (TCAs)

Like SNRIs, tricyclic antidepressants (TCAs) increase levels of serotonin and norepinephrine. They are most helpful for people with the following conditions:

  • Depression plus pain due to fibromyalgia, nerve pain, or irritable bowel syndrome

  • Severe depression

  • Anxiety disorders like GAD or panic disorder

TCAs should be used with caution in people who have heart disease.

Side Effects

Side effects of TCAs include the following:

TCAs are particularly dangerous in overdose situations. If you or a loved one has taken too much of a TCA, seek medical help immediately.

Dosage

Although this class of drugs is prescribed off-label for anxiety—meaning TCAs are not approved by the Food and Drug Administration (FDA) to treat anxiety but have been proven to help the condition—typical doses of TCAs prescribed for anxiety and depression include the following:

  • Elavil (amitriptyline): 50 to 200 mg daily for depression

  • Pamelor (nortriptyline): 25 to 150 mg daily for depression; 50 to 150 mg daily for anxiety

  • Tofranil (imipramine): 75 to 150 mg daily for depression; 100 to 300 mg daily for anxiety

  • Norpramin (desipramine): 100 to 300 mg daily for depression; 100 to 200 mg daily for anxiety

  • Anafranil (clomipramine): 100 to 250 mg daily for anxiety

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) were the first antidepressants discovered in the 1950s. They increase serotonin, norepinephrine, and dopamine levels by blocking an enzyme that breaks down these chemical messengers.

Some serious side effects and interactions with other medicines limit their use. Although they aren't used often, MAOIs can be good choices for treatment-resistant depression (when other medications have failed).

Side Effects

MAOIs may cause the following side effects:

Serotonin syndrome can be life-threatening. The following symptoms characterize serotonin syndrome:

MAOIs are the main drug class associated with serotonin syndrome, so if you take one of these medications, watch for any of these effects. These are signs of an emergency, so go to your nearest emergency room or call 911 if you experience any of them.

Dosage

Typical doses of MAOIs for depression or anxiety are:

  • Marplan (isocarboxazid): 20 to 60 mg daily for depression

  • Nardil (phenelzine): 45 to 90 mg daily for depression; 30 to 90 mg daily for anxiety

  • Emsam (selegiline patch): 6 to 12 mg applied to the skin every 24 hours for depression

Benzodiazepines

Benzodiazepines (sometimes referred to as benzos) are controlled substances that are also used for seizures and muscle spasms. They increase the effects of GABA and can help treat anxiety but not depression.

Benzos have a rapid onset of action (they start acting quickly). They are typically used only as needed or as a bridge until antidepressants like SSRIs or SNRIs kick in.

Side Effects

Side effects associated with benzos include:

  • Dependence or drug use disorder

  • Respiratory depression (slow breathing)

  • Sedation

Dosage

Benzodiazepines are not used for depression, but may be used to treat anxiety at the following doses:

  • Klonopin (clonazepam ): 1 to 2 mg daily

  • Xanax (alprazolam): 1 to 4 mg daily

  • Ativan (lorazepam): 2 to 6 mg daily

  • Librium (chlordiazepoxide): 20 to 100 mg daily

  • Serax (oxazepam): 30 to 60 mg daily

Beta-Blockers

Beta-blockers are traditional heart medications. One of them, propranolol, is sometimes used off-label for performance anxiety (stage fright) or post-traumatic stress disorder (PTSD).

In low doses, propranolol can counteract the adrenaline rush that causes symptoms of stage fright, such as shaking and high heart rate. Overall, though, there's not much evidence to support using beta-blockers like propranolol for anxiety, and they are not appropriate treatments for depression.

Side Effects

Side effects of propranolol include the following:

Dosage

Propranolol at doses of 60 to 120 mg daily is used off-label for anxiety.

Atypical Antidepressants

Atypical antidepressants work by different pathways to increase dopamine or norepinephrine in the body. They are a good choice for people who have sexual dysfunction or other side effects related to the use of SSRIs or SNRIs.

Side Effects

Because medicines in this "catch-all" class aren't structurally related, side effects vary. Significant side effects associated with atypical antidepressants include:

  • Seizures with bupropion

  • Weight gain and sleepiness with mirtazapine

  • Liver toxicity with agomelatine

Note that bupropion should not be taken by people with seizure disorders or a history of seizures.

Dosage

Here are the typical doses used for these atypical antidepressants.

  • Wellbutrin (bupropion): 150 to 300 mg daily

  • Remeron (mirtazapine): 15 to 45 mg daily for depression or anxiety

  • Valdoxan (agomelatine): 25 to 50 mg daily for depression

Other Interventions

Depending on the severity of your anxiety or depression, other interventions may be helpful alone or in conjunction with medications. These interventions include:

  • Exercise: Exercise has been proven to be as effective as antidepressants or psychotherapy for mild or moderate depression and to augment the effects of other treatments on severe depression. The most significant benefit is seen with aerobic exercise (often called cardio). And while there are fewer studies of exercise's effects on anxiety, it seems to be about as effective as other treatments.

  • Cognitive behavioral therapy (CBT): In people who are depressed, CBT involves replacing negative thoughts and distortions with helpful techniques to improve mood. It can enhance the effects of antidepressants and lower the risk of relapse. CBT also has modest benefits for people with anxiety, especially those with obsessive-compulsive disorder (OCD), GAD, or acute stress disorder.

  • Meditation: There's not enough evidence to recommend meditation as the only treatment for anxiety or depression. That said, focusing on mindfulness is helpful for people with depression, and benefits can last up to six months. There isn't as much data supporting meditation for people with anxiety.

  • Yoga: This intervention is best as an add-on to conventional treatments for people with depression or panic disorder. Even just one hour-long session per week has been shown to reduce symptoms.

Discussing your mood and any symptoms you may have with your healthcare provider before self-treating is essential. This will ensure that you are getting all the help you need.

Nutrition Considerations

Herbal supplements that have been studied for anxiety and depression include the following:

Saint-John's-wort interacts with many medications. Before trying these or any other supplements, discuss them with your healthcare provider to ensure they don't interact with any other medications you may be taking. These are not safe choices for everyone.

Supplements that increase serotonin levels shouldn't be taken with SSRIs or SNRIs due to the risk of serotonin syndrome. A few of these supplements include the following:

Summary

Anxiety and depression are mental health disorders typically requiring treatments like antidepressants or psychotherapy.

Medications used for anxiety and depression are associated with side effects like sexual dysfunction, weight gain, and headaches. And they may take two to three weeks to see the effects. If you are experiencing side effects or not seeing improvement from your treatment, discuss this with your healthcare provider. Never stop taking antidepressants abruptly, as this could cause your symptoms to worsen.

Additional interventions that help depression or anxiety include CBT and meditation. The combination of antidepressants, psychotherapy, exercise, and good nutrition can be even more effective than medication alone.

Frequently Asked Questions

What medication is best for anxiety and depression?

SSRIs are the most effective medicines for treating both anxiety and depression and usually are the first prescribed. They are even more effective when combined with therapy.

What is the most recommended drug for anxiety?

Many anxiety disorders, including GAD, social anxiety disorder, and panic disorder, are first treated with SSRIs or SNRIs.

A review of 41 clinical trials showed that Cymbalta (duloxetine) and Lexapro (escitalopram) are the most effective medicines for adults with GAD.

Because SSRIs and SNRIs may take a few weeks to reach full effect, sometimes benzodiazepines are also given until the antidepressants kick in.

What is the safest antidepressant for anxiety?

All antidepressants have side effects. That said, newer classes of medicines like SSRIs and SNRIs have less severe side effects than older ones like TCAs and benzos.

How can I reduce stress?

There are many ways to manage stress, including getting enough sleep, asking for help, eating well, exercising, practicing meditation or yoga, and getting cognitive behavioral therapy.

Sometimes, stress can be overwhelming and challenging to manage on your own. Try to seek medical help if you feel overwhelmed or hopeless. You are not alone.

Contact the SAMHSA National Helpline at 800-662-4357 for information on support and treatment facilities in your area if you are struggling with anxiety.

Read the original article on Verywell Health.