How do anti-anxiety drugs work?

Hi. It’s Jenny from AnxietyBoss.com. Today’s question comes from Josh from New York. How do anti-anxiety drugs work?

There are several different classes of anti-anxiety medications and each comes with its own share of risks and benefits. The different classes of medications for anxiety have different mechanisms of action.

• SSRI

So let’s start with SSRIs, selective serotonin reuptake inhibitors. These are the most widely prescribed medications for anxiety. They are something that doctors prefer over the others as they’re non-addictive and have fewer side effects than the other medications for anxiety. One side effect that is problematic is that SSRIs can cause sexual dysfunction, with decreased libido and arousal. In addition, SSRIs take a long time to take effect, up to four to six weeks. SSRIs increase the amount of the neurotransmitter serotonin in the synapse, the space between neurons, by blocking the reuptake of serotonin. Prozac, Celexa, and Zoloft all work in this way.

• SNRI

With SNRIs or serotonin norepinephrine reuptake inhibitors like Effexor, Pristiq and Cymbalta, it’s the same story as with SSRIs, except that they also increase norepinephrine in the synapse by blocking the reuptake of norepinephrine.

• Benzodiazepines

Diazepam, alprazolam, clonazepam, and lorazepam are benzodiazepines. Although benzodiazepines are quick-acting in reducing anxiety, they need to be used with caution. This is because they have a high addictive potential, and withdrawal symptoms may ensue when the medication is discontinued. They can also cause excessive sedation. Benzodiazepines are commonly prescribed in combination with SSRIs and SNRIs until the SSRI/SNRI becomes fully effective 4 to 6 weeks later. Benzodiazepines work by enhancing the function of GABA, or gamma amino butyric acid, an inhibitory central nervous system (CNS) neurotransmitter, and they slow down the fast processes along the neurons.

• Buspirone

Buspirone, brand name Buspar, enhances the activity of serotonin. Buspirone has hardly any side effects, but it also may not be that effective for anxiety. The only side effect of significance is sedation at the beginning of treatment.

• Gabapentin

Gabapentin, brand name Neurontin, decreases glutamate, norepinephrine, substance P and calcitonin gene-related peptide in CNS. This medication has sedation as a main side effect, and has questionable efficacy for anxiety.

This list covers some commonly prescribed medications for anxiety. Please click here for a more comprehensive discussion on prescription medications for anxiety.