Table 1.
Current treatments for anxiety disorders.
| Medication class | Mechanism of action | FDA approvals for anxiety disorder | Off-label uses | Therapeutic dose ranges (mg/day) |
|---|---|---|---|---|
| SSRIs: | ||||
| Fluoxetine Sertraline Citalopram Escitalopram Paroxetine Paroxetine ER Fluvoxamine |
Selective 5-HT reuptake inhibitor (20) | PD PD, SAD None GAD PD, SAD, GAD PD, SAD None |
GAD, SAD GAD GAD, PD, SAD PD, SAD None GAD GAD, PD, SAD |
20–60 50–200 20–40 10–20 20–60 27–75 100–300 |
| SNRIs: | ||||
| Duloxetine Venlafaxine (XR) Desvenlafaxine |
5-HT, NE (and DA) reuptake inhibitor (17) | GAD GAD None |
PD, SAD PD, SAD GAD, PD, SAD |
30–60 75–300 50–100 |
| TCAs: | ||||
| Clomipramine Imipramine Desipramine Nortriptyline |
NE and 5-HT reuptake inhibitor (20) | None None None None |
GAD, PD, SAD GAD, PD, SAD GAD, PD, SAD GAD, PD, SAD |
100–250 100–300 100–200 50–150 |
| MAOIs: | ||||
| Phenelzine | MAO inhibitor (21) | None | GAD, PD, SAD | 30–90 |
| Mixed antidepressants: | ||||
| Mirtazapine | 5-HT2, 5-HT3, α2, H1 antagonist (27) | None | Anxiety, GAD, PD, SAD | 15–45 |
| GABAergic drugs: | ||||
| Pregabalin Gabapentin |
Unclear, may modulate Ca channels (51) | None None |
GAD, SAD GAD, SAD, PD |
150–600 600–2,400 |
| Benzodiazepines: | ||||
| Clonazepam Alprazolam Lorazepam Chlordiazepoxide Oxazepam |
GABA-A agonist (44) | PD Anxiety, PD Anxiety Anxiety Anxiety |
Anxiety, GAD, PD, SAD GAD, PD, SAD GAD, PD, SAD GAD, PD, SAD GAD, PD, SAD |
1–2 1–4 2–6 20–100 30–60 |
| Antipsychotics: | ||||
| Trifluoperazine Olanzapine Quetiapine |
D2 antagonist (84) D2, 5-HT2 H1 antagonist (85) D2, 5-HT2 H1 antagonist (85) |
Anxiety None None |
GAD, PD, SAD Anxiety, GAD Anxiety, GAD |
2–6 5–15 50–300 |
| Beta-blockers: | ||||
| Propranolol | β-1, β-2 antagonist (77) | None | Anxiety, PD, SAD | 60–120 |
| Antihistamines: | ||||
| Hydroxyzine | H1 antagonist (76) | Anxiety | GAD, PD, SAD | 25–100 |
| Other anxiolytics: | ||||
| Buspirone | 5-HT1A partial agonist (22) | Anxiety | GAD | 15–60 |
Key: 5-HT, Serotonin; AGP, Agoraphobia; DA, Dopamine; D2, dopamine-2 receptor; ER, XR, Extended Release; FDA, Food and Drug Administration; GAD, Generalized Anxiety Disorder; GABA, Gamma Aminobutyric Acid; H1, Histamine 1 receptor; MAO, Monoamine Oxidase; MAOI, Monoamine Oxidase Inhibitors; NE, Norepinephrine; PD, Panic Disorder; SSRI, Selective Serotonin Reuptake Inhibitor; SNRI, Serotonin Norepinephrine Reuptake Inhibitor; SAD, Social Anxiety Disorder; TCA, Tricyclic Antidepressants.