Medications with addictive properties are best avoided when there is a non-addictive medication option available. This is especially the case for people with a history of addiction. People with anxiety disorders are more vulnerable to addiction because they may naturally seek to self-medicate their anxiety with medications that numb their symptoms.

Benzodiazepines are a common class of anxiety medication. These drugs are addictive and are also a controlled substance in the U.S. The common myth that all anxiety medications are addictive keeps some people with treatable anxiety disorders from seeking help. In fact, there are many non-habit-forming alternative medication options for treating anxiety, and many of them are effective alternatives to benzodiazepines.

This article reviews a list of non-addictive anxiety medications and treatments in the form of non-habit-forming anxiety medication and non-medication options.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are generally used to treat depression but are also highly effective for treating anxiety. They are the usual first-line pharmacological treatment for most anxiety disorders. There are a number of common SSRIs for anxiety currently in use including:

  • Fluoxetine
  • Fluvoxamine
  • Sertraline
  • Paroxetine
  • Citalopram
  • Escitalopram
  • Vilazodone
  • Vortioxetine

How do SSRIs work for anxiety? They correct brain chemical (neurotransmitter) deficiencies that cause the symptoms of anxiety. Though they may take time to take effect, often two to six weeks or longer, SSRI medications are well tolerated. Although 30% to 50% of people experience mild side effects, only about 19% discontinue the medication due to the effects. Importantly, SSRIs for anxiety have no addictive potential. They also have the added advantage of effectively treating depression, which commonly co-occurs with anxiety disorders.

SNRIs

Selective norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs in name and in function. SNRIs for anxiety are usually used after the failure of an SSRI.  The list of SNRIs for anxiety in common use is limited to two:

  • Duloxetine
  • Venlafaxine XR

How do SNRIs work for anxiety? Like SSRIs, they have a delayed onset of action, usually taking at least two weeks to show their anti-anxiety effects. While SNRIs work similarly to SSRIs, they focus on the neurotransmitter norepinephrine and can have energizing effects. This can worsen the physical symptoms of anxiety in some people.

Buspirone

Buspirone (brand name BuSpar) is an older synthetic medication that fell out of favor for a number of years. It has become increasingly popular in recent years for treating generalized anxiety disorder (GAD).

Buspirone for anxiety is completely different from other medications because it is its own unique class of medication. In fact, it is still unclear exactly how it works.

Buspirone is a second-line treatment for GAD after SSRIs, which are the usual first choice for most anxiety disorders. It is an attractive treatment option because it has a favorable side effect profile and does not have addictive properties. Buspirone may also have therapeutic effects on depression, but this has not been confirmed by clinical studies.

Recently, buspirone has been found to have positive results in reducing the withdrawal symptoms of people who are detoxifying from opioid use.

Beta-Blockers

Beta-blocker medications are used for a wide variety of medical conditions and are sometimes used “off-label” (without FDA approval) for treating anxiety symptoms. They work by blocking catecholamines, a type of natural body chemical that causes many physical anxiety symptoms. These symptoms include:

  • Rapid heartbeat
  • Blood vessel constriction
  • Blood pressure elevation
  • Feeling of anxiousness
  • Jitteriness

Many anxiety symptoms are brought on by anxiety-mediated release of catecholamines. Beta-blockers have been used to block these symptoms, especially the typical panic symptoms. Because of this, beta-blockers for anxiety are especially useful for treating panic disorder and people with physical anxiety symptoms, such as those with agoraphobia. It is also effective for preventing physical anxiety symptoms before specific situations, such as speaking in public or taking an exam.

There are many beta-blockers available on the market, but propranolol is the best studied and most used. Therefore, it is probably the best beta-blocker for anxiety currently.

Pregabalin (Lyrica)

Pregabalin (brand name Lyrica) is an anti-seizure medication that is effective for a number of medical uses besides treating seizures. Although not well supported by medical studies, Lyrica for anxiety has been shown to be effective in rapidly improving the psychological and physical symptoms of generalized anxiety disorder (GAD).

Use of pregabalin for GAD is plagued by the common side effects of the medication. These include:

  • Dizziness
  • Visual disturbances
  • Impaired muscle coordination
  • Dry mouth
  • Sexual dysfunction
  • Weight gain
  • Fatigue and lethargy

Although uncommon, pregabalin can have some serious, sometimes dangerous side effects. It has many potentially dangerous drug interactions, particularly with drugs of misuse as well as alcohol.

Pregabalin for anxiety is not truly non-addictive and does carry a potential for misuse. Some people may experience euphoric effects from the drug. Withdrawal effects may also occur, especially if the drug has been used for a long time.

Obviously, pregabalin is not a first-choice medication for treating GAD. Its use for treating GAD is limited to situations where people have not responded to more conventional treatments (such as SSRIs) or for augmenting therapy in partial responders.

Gabapentin (Neurontin)

Gabapentin (brand name Neurontin) is closely related to pregabalin. They are chemically similar, work the same way and have a similar side effect profile. The main difference is that gabapentin has a more favorable risk-to-benefit ratio than pregabalin for the treatment of GAD. Because of this, it may be a better choice than pregabalin for use in GAD.

Like pregabalin, gabapentin’s unfavorable side effect profile, the potential for abuse and lack of supporting research evidence make gabapentin for anxiety a second-line option for difficult-to-treat cases.

Hydroxyzine (Vistaril)

Hydroxyzine (brand name Vistaril) is an antihistamine drug usually used for the treatment of environmental allergies and itchiness. However, hydroxyzine is sometimes used off-label to treat GAD.

Hydroxyzine for anxiety is often poorly tolerated because it is very sedating and causes dry mouth. People taking hydroxyzine should not use drugs or alcohol and should not drive a vehicle while taking the medication.

There is very little research evidence supporting the use of hydroxyzine in treating GAD. It has been shown to be better than placebos in treating GAD, but it has not been studied in comparison to more established anxiety medications. As such, Vistaril for anxiety is not a first-line choice.

The usual hydroxyzine dosage for anxiety (for treating GAD) is 50 mg per day, divided into four doses of 12.5 mg.

PanX

PanX is a group of newly patented drug products that combine two anxiety treatment drugs: the beta-blocker atenolol and the anti-nausea medication scopolamine.

The PanX drug products are newly available and are not yet supported by any quality, published independent studies. Their patent was issued in December 2016, and they do not yet have FDA approval for use in treating anxiety. However, PanX products are available by prescription in the U.S.

Two studies about PanX products for anxiety have been published, but these are suspect. One of the studies only included eight patients and used highly subjective non-validated end-points. One of the study authors (Thomas Dooley) developed and owns the patent for PanX and therefore stands to personally profit from its success. The other published study included only three patients, used subjective end-points and was also authored by the owner of the medication’s patent.

At the present time, any consideration of using this drug would be premature. It still needs FDA approval, quality research studies confirming its safety and comparisons of the drug to standard anxiety treatments.

Diphenhydramine

Diphenhydramine is an antihistamine from the same class of medication as hydroxyzine and scopolamine (contained in PanX). Its primary use is as an anti-allergy medication. Although it has not been well studied for anxiety, it has been shown to be effective in reducing anxiety symptoms and has little or no misuse potential. It also seems to work faster than some anti-anxiety medications, such as SSRIs.

However, diphenhydramine for anxiety has some downfalls that limit its use. It must be taken frequently throughout the day (usually every six hours), it is very sedating and it has a significant dry mouth effect. Diphenhydramine antihistamines and anxiety medications from other classes are usually used together.

Diphenhydramine is not a first-line agent for treating anxiety, but it may be a useful second-line medication for some people with treatment-resistant symptoms.

Other Options for Anxiety Treatment

It is always best to use non-pharmacological treatment for anxiety when possible. Even when people require medication, adding alternative treatments for anxiety is helpful for improving treatment outcomes.

Lifestyle modifications are an effective natural treatment for anxiety and are known to reduce anxiety symptoms. These include:

  • Reducing the use of caffeine and stimulants
  • Abstaining from drugs of abuse, including alcohol
  • Exercise
  • Relaxation breathing, meditation and biofeedback
  • Massage therapy and acupuncture (for GAD)

Cognitive behavioral therapy (CBT) is supported by an overwhelming amount of research evidence as an effective therapy for anxiety and other mental health disorders Combining CBT with medication therapy and lifestyle changes is an efficient way to treat anxiety symptoms and improve a person’s level of function and quality of life.

The professional staff at The Recovery Village have the expertise and experience to help people overcome anxiety disorders that are co-occurring with a substance use disorder. Contact us today for a confidential discussion if you have concerns about yourself or a loved one.