Antidepressants for Anxiety: How They Work and What to Expect

Generalized anxiety disorder (GAD) is one of the most common mental health conditions in the world. In the U.S. alone, over 1 in 20 people will have GAD at some point in their life. And this number seems to be going up in recent years. According to the CDC, about 1 in 6 adults said they had experienced some symptoms of anxiety within the past 2 weeks. 

With this in mind, there’s a high chance that either you — or a friend or family member — will deal with anxiety at some point. But there are many good treatments that can help if anxiety is disrupting your life. And antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are some of the best choices. 

What is generalized anxiety disorder?

Generalized anxiety disorder (GAD) is a mental health condition where your fears and worries are hard to control. People with GAD have anxiety almost every day, to the point where it causes problems at work, school, or home. 

Symptoms of GAD include:

• Feeling anxious or worried most of the time

• Having a hard time managing your worries

• Feeling restless, jittery, or on edge

• Getting tired easily

• Having a hard time concentrating, or feeling like your mind “goes blank”

• Feeling irritable

• Having muscle tension

• Experiencing difficulty falling asleep or staying asleep, or feeling like sleep isn’t restful

Can you have depression and anxiety at the same time?

Yes. Major depression and GAD are separate disorders, but it’s possible to have them both at the same time. They have their own unique symptoms, but both can make it hard to function in daily life. And both can be treated with therapy and/or medications — including antidepressants. 

Can SSRIs and SNRIs help with anxiety?

Yes. For many people, SSRIs and SNRIs are a great first-choice treatment for generalized anxiety. Though they’re technically called “antidepressants,” these medications are also used to treat many different anxiety disorders — including GAD. 

SSRIs and SNRIs used for GAD include:

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Sertraline (Zoloft)

• Paroxetine (Paxil)

• Fluoxetine (Prozac) 

• Fluvoxamine (Luvox)

• Duloxetine (Cymbalta)

• Venlafaxine (Effexor)

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Some of these medications are FDA approved for generalized anxiety, while others are used “off-label.” 

How do SSRIs and SNRIs work for anxiety?

Experts don’t know exactly how SSRIs and SNRIs work for anxiety. They seem to boost the activity of certain chemical messengers (neurotransmitters) in the brain, especially serotonin and norepinephrine. These chemicals play a role in anxiety, mood, and general feelings of well-being.   

What’s the difference between SSRIs and SNRIs?

The main difference is that SSRIs mostly affect serotonin, while SNRIs affect both serotonin and norepinephrine. SSRIs and SNRIs also have slightly different side effects, medication interactions, and dosage options. 

When to talk to your doctor about antidepressants for anxiety

If you’re considering antidepressants, talk with your healthcare provider. They’ll take note of your symptoms and confirm if you have GAD. You and your provider can then work together to decide if it makes sense to try a daily medication for anxiety, like an SSRI or a SSRI. 

Your provider can also help you understand what other things might be helpful for your anxiety, like therapy or other types of medications (more on these below). And they can figure out whether any other health conditions could be affecting your anxiety, like diabetes or insomnia. 

How long should you take antidepressants for anxiety?

SSRIs and SNRIs for anxiety take about 1 month to start working. If the medication seems helpful, your provider may suggest you continue taking it for 6 to 12 months. 

After this time period, some people work with their provider to taper down and stop the medication. Other times, it can make sense to continue antidepressants for a longer time. It all depends on your unique symptoms, and whether other things have been helpful for your anxiety, too — like therapy or lifestyle changes.  

Can antidepressants make anxiety worse at the start?

Yes. In fact, about 2 in 3 people feel more anxious, irritable, and agitated in the first couple weeks after starting an antidepressant. This seems especially common in people with major depression, but it can happen with GAD too.  

These “jittery” feelings usually start to fade after the first week. In some cases, your healthcare provider might prescribe another short-term medication, like a benzodiazepine, to help you feel better during these first few weeks. 

Do SSRIs and SNRIs have side effects?

Yes. Side effects are possible when taking these medications. Common side effects of SSRIs and SNRIs include fatigue, upset stomach, trouble sleeping, and sexual problems. 

Keep in mind: If you do have side effects, they often go away within the first few weeks of starting the medication. Sexual side effects, like erectile dysfunction or low libido, are the most likely to stick around. 

Additional medications to help treat anxiety

SSRIs and SNRIs are great first-choice medications for anxiety. But if your anxiety doesn’t get better, or only partially improves, after you start taking medication, your provider might suggest another approach. This could mean switching to another SSRI or SNRI. Or it might mean trying a different type of medication altogether.  

Other types of medications that can be helpful for anxiety include:

• Buspirone (Buspar)

• Pregabalin (Lyrica)

• Mirtazapine (Remeron)

• Quetiapine (Seroquel)

• Hydroxyzine (Atarax)

• Imipramine (Tofranil)

These medications can be prescribed on their own, or they can be used to boost the effectiveness of an SSRI or SNRI.

As mentioned above, benzodiazepines like lorazepam (Ativan) can also be used to help treat anxiety. These types of medications are often prescribed just for short-term use, usually to help manage anxiety symptoms while you’re waiting for an SSRI or SNRI to take effect.

Therapy vs. medication for anxiety: Which is better?

Therapy and medications are both great options for treating anxiety. There’s evidence that cognitive behavioral therapy (CBT) actually works just as well as medication for treating anxiety. 

So how do you decide? Remember that anxiety treatment doesn’t have a one-size-fits-all approach. The right treatment for you depends on:

• Your personal preferences

• Whether you have access to therapist

• How much a medication will cost

• Your symptoms

• Whether you have other mental and physical health problems

Many people also choose to do therapy and take medication at the same time. Again, when it comes to anxiety, it’s all about what works best for you. 

Lifestyle tips to help manage anxiety

In addition to medication and therapy, there are other things that can help with your anxiety. These include:

• Exercising 

• Practicing mindfulness, like yoga or meditation

• Eating nutritious foods

• Getting enough good-quality sleep every night

• Cutting down on alcohol

Certain herbs and supplements may also be helpful, like cannabidiol, chamomile, and fish oil. But be careful: Many over-the-counter products cause side effects and can interfere with other medications you are taking. Talk with your provider about whether these treatments could be right for you.

Research about antidepressants and anxiety

Researchers are continuing to investigate how and why antidepressants help to improve anxiety. Some researchers want to figure out the best length of treatment. Other researchers want to know why some people get better when taking SSRIs and SNRIs — and why others don't. 

Researchers are also looking into newer antidepressants like Viibryd, and other new types of medications like esketamine (Spravato). Understanding new brain pathways may also help scientists explore new treatments.

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Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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