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Anxiety

Anxiety is common and treatable. This hub explains what anxiety disorders look like and how care plans are built.

Use the medication roadmap to compare common first-line options and adjuncts, then print handouts for shared decision-making.

Understanding anxiety disorders

Anxiety becomes a disorder when worry or fear is persistent, hard to control, and interferes with daily life.

  • Common anxiety disorders include GAD (generalized anxiety disorder), panic disorder, social anxiety disorder, and specific phobias.
  • Physical symptoms can be prominent: restlessness, muscle tension, GI upset, sweating, palpitations, and insomnia.
  • Anxiety often overlaps with depression, trauma-related symptoms, substance use, and medical conditions such as thyroid disease.

If you feel unsafe or in crisis, use the crisis banner (988 in the U.S.) or seek emergency care.

Evaluation and diagnosis

A careful evaluation helps match treatment to the specific anxiety pattern.

  • Review triggers, duration, avoidance behaviors, and panic symptoms.
  • Screen for substances and medications that can worsen anxiety (stimulants, caffeine, steroids, withdrawal states).
  • Consider medical contributors (thyroid disease, arrhythmias, anemia) when symptoms are new or severe.
  • Track symptoms with a simple weekly check-in (sleep, appetite, functioning, panic frequency).

First-line: psychotherapy and skills

For many people, therapy is core treatment—often with or without medication.

  • CBT helps identify unhelpful thought patterns and reduce avoidance.
  • Exposure-based therapy is especially effective for panic and phobia-related anxiety.
  • Sleep, exercise, and structured routines can reduce baseline arousal and improve resilience.
  • If anxiety is tied to insomnia, pair anxiety treatment with a sleep-focused plan (see the insomnia hub).

If you have trauma symptoms, ask about trauma-focused therapy options.

Medication options (overview)

Medication choices depend on the anxiety subtype, co-occurring depression, sedation goals, and safety considerations.

  • First-line long-term options often include SSRIs/SNRIs such as sertraline, escitalopram, paroxetine, and venlafaxine.
  • Buspirone can help generalized anxiety, especially when sedation is undesirable.
  • Hydroxyzine is a short-term, sedating option for acute anxiety or insomnia overlap.
  • Propranolol is sometimes used for performance anxiety (tremor/palpitations).
  • Clonidine is sometimes used off-label as an adjunct for hyperarousal or withdrawal-related symptoms; monitor blood pressure, heart rate, and sedation.
  • Guanfacine is sometimes used off-label as a longer-acting alpha-2 agonist adjunct; monitor blood pressure, heart rate, and sedation and taper to avoid rebound.
  • Pregabalin and gabapentin are sometimes used off-label; discuss sedation, dizziness, and misuse risk.
  • Lorazepam, clorazepate, and other benzodiazepines can provide rapid relief but are usually time-limited because of dependence and withdrawal risk.

Medication effects build over weeks for SSRIs/SNRIs; early side effects often improve with time.

Medication roadmap for teams

Use compare presets to align options with patient goals (sleep, activation, side effects, interactions).

Use the Share button in Compare to keep a stable link for follow-ups.

Monitoring, side effects, and safety

Anxiety improves fastest when treatment plans include safety monitoring and follow-up.

  • Discuss activation vs sedation effects and how they fit work, school, driving, and sleep.
  • Review interactions with alcohol, cannabis, and other sedatives.
  • Plan taper strategies for benzodiazepines and avoid abrupt discontinuation.
  • If suicidality, severe depression, or mania emerges, seek urgent clinical support and reassess the diagnosis and treatment plan.

Staying current with evidence

Use evidence filters to keep pace with new trials and guidelines.

Medication index

Browse all medication pages covered by this hub. Use Compare for side-by-side decisions and Evidence for curated studies.

Antidepressants (often first-line) (33)
Benzodiazepines (12)
Other common anxiety adjuncts (8)

Frequently asked questions

What is usually tried first for anxiety?

Many people start with therapy (often CBT) and/or an SSRI or SNRI. The “best” first choice depends on symptoms (panic vs generalized worry), co-occurring depression, and side-effect preferences.

When are benzodiazepines appropriate?

Benzodiazepines can help short-term, severe anxiety or panic, but they carry dependence and withdrawal risk. They are usually used as a brief bridge while longer-term treatments take effect, or in carefully selected situations with close monitoring.

How often is this hub updated?

We refresh medication summaries, monitoring notes, and evidence links when labeling or guidelines change. The Evidence Library and Updates pages provide the quickest view of recent refreshes.