What is the best antidepressant to take for anxiety? (3+ effective options)
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In this article, we will discuss the best antidepressants to use for anxiety. We will also discuss some common side effects associated with these medications, and what other medications are available for anxiety if antidepressant-monotherapy is not effective enough.
What is the best antidepressant to take for anxiety?
The best antidepressants to take for anxiety are:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Mirtazapine
- Vilazodone
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are considered the first line of therapy for anxiety and related symptoms. SSRIs primarily inhibit the reuptake of serotonin by blocking serotonin transporters (SERT). (1)
This can increase the availability of serotonin, thereby managing the symptoms of anxiety and depression. SSRIs, the entire class, are considered safe and effective for anxiety, especially for long-term use. (1)
These medications are available in different doses, and some SSRIs have a good safety profile, making dose escalation a possibility if lower doses fail to achieve the desired therapeutic outcome. SSRIs, as they are antidepressants, are also effective for depression comorbid with anxiety.
SSRIs typically include: (1)
- Sertraline
- Fluoxetine
- Escitalopram
- Citalopram
- Paroxetine
It is important to note that SSRIs take time to work. These medications typically take 1-2 weeks to manage anxiety and 4-6 weeks to manage depression symptoms, and some people may take longer than that.
Furthermore, SSRIs may cause anxiety as an early side effect and may worsen it. However, this is just a temporary side effect that begins to subside as the body adjusts to the medication.
It is important to note that SSRIs are prescription medications and should not be taken without consulting your healthcare provider.
Side effects associated with SSRIs
SSRIs are commonly associated with the following side effects: (1)
- Nausea
- Insomnia
- Sexual dysfunction
- Weight gain
- Diarrhoea
- Dry mouth
- Sweating
- Drowsiness
- Headache
- Agitation
- Nervousness
- Tremor
- Increased appetite
- Constipation
- Elevated blood pressure
- Blurred vision
- Fatigue
Dosage recommendation of SSRIs for anxiety
| SSRIs | Generic names | Typical Doses for Anxiety |
| Prozac | Fluoxetine | 20-60 mg/day |
| Zoloft | Sertraline | 50-200 mg/day |
| Lexapro | Escitalopram | 10-20 mg/day |
| Celexa | Citalopram | 20-40 mg/day |
| Paxil | Paroxetine | 20-60 mg/day |
| Luvox | Fluvoxamine | 50-300 mg/day |
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs are also used as a first line of therapy for anxiety, preferably if they are better tolerated by an individual compared to SSRIs. SNRIs typically work by inhibiting the reuptake of serotonin as well as norepinephrine, two monoamine excitatory neurotransmitters (2).
They do so by blocking both the serotonin transporter (SERT) and norepinephrine transporters (NET). This can manage the symptoms of both anxiety and depression (2). SNRIs also have a good safety profile, with some SNRIs being safer than others.
SNRIs typically include: (2)
- Duloxetine
- Venlafaxine
- Desvenlafaxine
- Milnacipran
However, the effects of these meds vary from person to person. SNRIs also support dose escalation and can benefit people who have anxiety comorbid with depression.
These medications can also be combined with other medications for enhanced anti-anxiety or antidepressant effects. However, SNRIs are also prescription medications and should be taken when prescribed by a qualified healthcare provider.
Side effects associated with SNRIs
SNRIs are commonly associated with the following side effects: (2)
- Nausea
- Headache
- Insomnia
- Drowsiness
- Fatigue
- Dry mouth
- Sweating
- Constipation
- Loss of appetite
- Weight loss
- Increased blood pressure
- Sexual dysfunction
- Increased heart rate
- Tremor
- Dizziness
Dosage recommendation of SNRIs for anxiety
| SNRIs | Generic Names | Typical Doses for Anxiety |
| Effexor | Venlafaxine | 75-225 mg/day |
| Cymbalta | Duloxetine | 30-120 mg/day |
| Pristiq | Desvenlafaxine | 50-100 mg/day |
| Savella | Milnacipran | 50-200 mg/day |
Mirtazapine
Mirtazapine is an atypical antidepressant which is also used for anxiety. Although it may not be as frequently prescribed as SSRIs or SNRIs, research suggests that mirtazapine has a good safety and tolerability profile when used for anxiety.
Mirtazapine primarily increases the release of serotonin and norepinephrine by blocking certain receptors, specifically the presynaptic alpha-2 adrenergic receptors (3). By doing so, it enhances the overall signalling of these neurotransmitters in the brain.
This increased neurotransmitter activity is thought to have anxiolytic effects, contributing to the medication’s efficacy in managing anxiety symptoms. However, Mirtazapine is also a prescription medication and should be used only when prescribed by a doctor.
Side effects associated with mirtazapine
Mirtazapine is commonly associated with the following side effects: (3,4)
- Dry mouth
- Anxiety
- Confusion
- Dizziness
- Drowsiness
- Constipation
- Increased hunger
Dosage recommendation of mirtazapine for anxiety
The typical dose for anxiety with mirtazapine is in the range of 15-45 mg/day. However, the actual dose can vary based on individual factors and should be determined by a qualified healthcare provider (3).
Vilazodone
Vilazodone is an atypical antidepressant which can help manage anxiety in certain individuals. It is not as commonly used for anxiety as SSRIs or SNRIs, but research does indicate its effectiveness for the management and treatment of generalised anxiety disorder (GAD).
Vilazodone helps with anxiety by adjusting serotonin levels in the brain. It does this by slowing down the reabsorption of serotonin (5). This results in increased serotonin levels, which can have a calming effect on your mind.
However, vilazodone is a prescription medication and might not be the best choice for everyone.
Side effects associated with vilazodone
Vilazodone is commonly associated with the following side effects: (6)
- Diarrhoea
- Nausea
- Dry mouth
- Insomnia
- Dizziness
- Sweating
- Fatigue
- Erectile dysfunction
- Vomiting
- Abdominal pain
Dosage recommendation of vilazodone for anxiety
The typical starting dose of vilazodone for anxiety is 10 mg once daily, which can be increased to a maximum dose of 40 mg per day (5). However, the specific dosage may vary based on individual factors and can be adjusted according to the patient’s needs.
What other medications can be used for anxiety?
There are some other medications that can be used for anxiety, including benzodiazepines, buspirone, etc (7,8). These medications can also be used along with SSRI or SNRI antidepressants for enhanced anxiolytic effects or for anxiety comorbid with depression.
However, antidepressants are still considered safer for long-term management of anxiety, as compared to drugs like benzodiazepines which should not be used for a long time due to their potential for causing addiction and abuse.
Furthermore, behavioural therapies may also sometimes be used along with pharmacological treatments to manage the symptoms of anxiety and depression more effectively.
In my healthcare experience, I have seen people battling anxiety for years. Such chronic cases require a treatment strategy that is safe and comfortable for the patient. This is why SSRIs can be a good option for anxiety.
Additionally, some doctors may pair SSRIs with other anxiolytics, like benzodiazepines or buspirone for short-term use. Such augmentations help accelerate the anti-anxiety effects and support the patient until their antidepressant kicks in.
Anyhow, it is important to remember that all of these drugs are prescription medications and should never be used without a proper diagnosis.
References
- Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32119293. https://pubmed.ncbi.nlm.nih.gov/32119293/
- Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300/
- Jilani TN, Gibbons JR, Faizy RM, Saadabadi A. Mirtazapine. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30085601. https://www.ncbi.nlm.nih.gov/books/NBK519059
- National Library of Medicine. Mirtazapine: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a697009.html#side-effects
- McCormack PL. Vilazodone: a review in major depressive disorder in adults. Drugs. 2015 Nov;75(16):1915-23. doi: 10.1007/s40265-015-0490-y. PMID: 26496736. https://pubmed.ncbi.nlm.nih.gov/26496736/
- National Library of Medicine. Vilazodone: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a611020.html#side-effects
- Bounds CG, Nelson VL. Benzodiazepines. 2023 Jan 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261973. https://www.ncbi.nlm.nih.gov/books/NBK470159
- Wilson TK, Tripp J. Buspirone. 2023 Jan 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30285372. https://www.ncbi.nlm.nih.gov/books/NBK531477
