Did you know that almost 10% of Australians take some form of anxiety medication?
As a clinical psychologist practicing in Sydney, I do not prescribe medication. My focus is on non-drug-based solutions to overcoming anxiety, helping people build long-term skills to manage their mental health effectively. However, many of my clients are already taking anxiety medication prescribed by their doctors.
Because of this, I’ve made it a priority to be fully informed about these medications and read large volumes of journal articles on the subject. Over the years, I’ve had countless discussions with doctors and psychiatrists about their experiences with these treatments. While I don’t prescribe, I recognize that in some cases, short-term medication use can be valuable—especially when anxiety is so overwhelming that it interferes with day-to-day functioning.
Think of it like learning to sail. It’s much easier to develop new skills in a 1-metre swell than in a 10-metre swell. If emotions are completely overwhelming, it’s hard to think clearly, learn new coping strategies, or make meaningful progress in therapy. In these cases, medication may act as a stabilizer while you build long-term tools to manage anxiety effectively.
My goal is always to help people reach a point where they no longer need medication and instead have an optimized psychology with practical tools they can use whenever anxiety flares up in the future. This is why I believe it’s important to be educated about all treatment options—including medication.
👉 For a detailed breakdown of therapy-based anxiety treatments, see my guide on Managing Anxiety Disorders.
👉 You can also read about Cognitive Behavioral Therapy for Anxiety and how it works as an effective, long-term anxiety treatment.
This article provides a comprehensive overview of anxiety medication options available in Australia, including questions that many of my clients have asked their doctors over the years. Of course, this is not medical advice, and you should always consult your doctor about medication options. My hope is that this guide will help you have more informed conversations with your doctor and feel more confident in making decisions about your mental health.
Anxiety is a deeply ingrained and often overwhelming emotion that can make everyday situations feel daunting. It goes beyond occasional worry, presenting as persistent, excessive fear that disrupts daily life. This emotional strain is often accompanied by physical symptoms such as a racing heart, rapid breathing, sweating, and an underlying sense of restlessness—all of which can significantly impact a person’s well-being and ability to function.
As a group, anxiety disorders are among the most common mental health conditions worldwide, affecting millions of people. They include a range of specific disorders, such as generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, specific phobias, and post-traumatic stress disorder (PTSD). While each condition has its own unique symptoms, they all share a defining characteristic—intense and often irrational fear or dread that can feel impossible to control (Ravindran & Stein, 2010).
First-Line Anxiety Medication in Australia: SSRIs and SNRIs anxiety medications are the primary pharmacological treatments for anxiety disorders due to their efficacy and safety profile.
Second Line and Adjunctive Anxiety Medications: Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) are considered for people who do not respond to first-line treatments, despite their potential for more significant side effects. Anticonvulsants and atypical antipsychotics may be used in treatment-resistant cases.
Emerging Anxiety Medication Therapies in Australia: Research is exploring novel targets such as glutamate modulators, GABAergic medication for anxiety, neuropeptides, and cannabinoids, alongside the potential of ketamine, riluzole, and xenon, for future anxiety disorder treatments.
The impact of anxiety on individuals extends beyond mere emotional distress; it can lead to significant functional impairment, including difficulties in work performance, social interactions, and overall well-being. The pervasive nature of anxiety can also predispose individuals to a higher risk of developing other mental health disorders, such as depression, and can exacerbate existing health conditions (Garakani, Murrough, Freire, Thom, Larkin, Buono, & Iosifescu, 2020). Given its widespread prevalence and the potential for severe consequences, effective management of anxiety disorders is imperative.
Anti anxiety medication, alongside psychotherapy, plays a crucial role in the treatment of anxiety disorders. Pharmacological treatment offers relief from symptoms, enables individuals to participate more fully in psychotherapy, and, in many cases, is vital for managing the disorder long-term. The choice of medication, however, depends on the specific anxiety disorder, its severity, the presence of comorbid conditions, and the individual’s response to treatment.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are widely recognized as first-line treatments due to their efficacy and relatively favourable side-effect profiles. Benzodiazepines, although effective, are generally reserved for short-term use due to risks of dependence(Ravindran & Stein, 2010). The necessity for best medications for anxiety arises not only from the need to alleviate the immediate symptoms of anxiety but also to improve the overall functioning and quality of life for those affected, making it a pivotal component of comprehensive anxiety disorder treatment strategies.
In sum, anxiety disorders represent a significant public health issue, with a profound impact on individuals and society. The pharmacologic treatment of these disorders has evolved considerably, offering many individuals effective relief from symptoms and a path toward recovery. However, the quest for optimising treatment continues, highlighting the importance of ongoing research into novel therapeutic options.
What kind of adult anxiety medication Australia is available? Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are primary tools in treating anxiety disorders, primarily due to their specific actions on neurotransmitter levels which are essential for regulating mood and alleviating anxiety. These anxiety medications are preferred over older antidepressants because of their effectiveness and favourable safety profiles.
SSRIs are a class of medication for anxiety commonly prescribed for depression, anxiety, and other mood disorders. The process through which they operate is cantered on the neurotransmitter serotonin, which plays a key role in regulating mood, anxiety, and happiness.
SNRIs anti anxiety medication function similarly to SSRIs but with an additional mechanism that targets norepinephrine, another neurotransmitter involved in mood regulation.
Fluoxetine (Prozac): Enhances serotonin activity, used for major depressive disorder, OCD, panic disorder, and other conditions.
Sertraline (Zoloft): Increases serotonin levels, effective in treating depression, panic attacks, OCD, PTSD, and social anxiety disorder.
Paroxetine (Paxil): Inhibits serotonin reuptake, used for depression, OCD, panic attacks, social anxiety disorder, and PTSD.
Citalopram (Celexa): Elevates serotonin levels, prescribed for depression and sometimes for eating disorders, alcoholism, panic disorder, and premenstrual dysphoric disorder.
Escitalopram (Lexapro): Acts on serotonin reuptake, indicated for major depressive disorder and generalised anxiety disorder.
These ranges are not recommendations and are just listed for education purposes. You need to consult your licenced medical professional before considering taking any of these anxiety medications.
Venlafaxine (Effexor): Inhibits the reuptake of both serotonin and norepinephrine, used for major depressive disorder, generalised anxiety disorder, panic disorder, and social phobia.
Duloxetine (Cymbalta): Blocks the reuptake of serotonin and norepinephrine, prescribed for depression, generalised anxiety disorder, fibromyalgia, and neuropathic pain.
These ranges are not recommendations and are just listed for education purposes. You need to consult your licenced medical professional before considering taking any of these anxiety medications.
Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan) are critical for their immediate anxiolytic effects in treating panic disorder and generalised anxiety disorder.
Mechanism of Action: These drugs potentiate the effect of the neurotransmitter GABA at the GABA_A receptor, resulting in enhanced inhibitory neurotransmission throughout the brain. This action leads to sedation, a decrease in anxiety, and muscle relaxation, which are particularly beneficial in acute anxiety episodes.
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
These ranges are not recommendations and are just listed for education purposes. You need to consult your licenced medical professional before considering taking any of these medication for anxiety.
However, despite their effectiveness in quickly reducing anxiety symptoms, benzodiazepines are associated with potential issues like dependency, tolerance, and withdrawal symptoms. Therefore, they are usually recommended for short-term management or as adjunctive therapy to SSRIs or SNRIs, especially when rapid symptom relief is necessary, or other anti-anxiety medications are ineffective.
In summary, SSRIs and SNRIs are the primary pharmacological treatments for anxiety disorders, with their specific mechanisms of action targeting serotonin and norepinephrine to improve mood and reduce anxiety. Although benzodiazepines offer immediate relief for acute anxiety situations, their action on enhancing GABA activity comes with a higher risk of dependency and withdrawal issues, thus their use is carefully considered and typically limited to specific, short-term circumstances. The choice of the best medication for anxiety is highly individualised, taking into account the specific anxiety disorder, user preferences, and the potential for side effects.
While SSRIs and SNRIs anxiety medication Australia are the first-line treatments for anxiety disorders, Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) serve as secondary options. These classes are often considered when patients do not respond adequately to first-line treatments, despite their potential for more significant side effects and tolerability issues.
Mechanism of Action for TCAs: TCAs work by inhibiting the reuptake of norepinephrine and serotonin in the brain, which increases the levels of these neurotransmitters. This action can help alleviate symptoms of depression and anxiety. However, TCAs also affect other neurotransmitter systems, which can lead to a broader range of side effects.
Common TCAs include:
Amitriptyline (Elavil)
Clomipramine (Anafranil): Particularly used for OCD.
These ranges are not recommendations and are just listed for education purposes. You need to consult your licenced medical professional before considering taking any of these medications.
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Mechanism of Action for MAOIs: MAOIs increase levels of norepinephrine, serotonin, and dopamine by inhibiting the activity of the enzyme monoamine oxidase, which breaks down these neurotransmitters in the brain. This can improve communication between brain cells and enhance mood. However, MAOIs can interact with certain foods and anti anxiety medications, leading to potentially dangerous increases in blood pressure.
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
These ranges are not recommendations and are just listed for education purposes. You need to consult your licenced medical professional before considering taking any of these anxiety medications.
For individuals with treatment-resistant anxiety disorders or those who have not benefited sufficiently from first-line medications, anticonvulsants and atypical antipsychotics may be considered as best medication for anxiety disorder for adjunctive treatments.
Mechanism of Action for Anticonvulsants: Anticonvulsants are primarily used to treat epilepsy, but some also have mood-stabilising properties. They can modulate neurotransmitter release and neuronal excitability, which may help in managing anxiety symptoms. Their exact mechanism in treating anxiety is not fully understood but is thought to involve the regulation of GABA and glutamate levels.
Common Anticonvulsants include:
Pregabalin (Lyrica): Also used for fibromyalgia and neuropathic pain.
Gabapentin (Neurontin): Off-label use for anxiety disorders.
These ranges are not recommendations and are just listed for education purposes. You need to consult your licenced medical professional before considering taking any of these anxiety medications.
Mechanism of Action for Atypical Antipsychotics: Atypical antipsychotics act on various neurotransmitter receptors, including dopamine and serotonin receptors, which can help in treating anxiety, especially when it is part of a complex clinical picture with psychotic features or severe mood disorders. They are called “atypical” to distinguish them from older antipsychotics, as they generally produce fewer extrapyramidal side effects.
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
These anti anxiety medications are used to treat a range of psychiatric conditions, including schizophrenia, bipolar disorder, and sometimes off-label for other uses. Dosing can vary widely based on the condition being treated, patient response, and side effects. It’s crucial to follow a healthcare provider’s instructions for dosing and use of these medications.
In conclusion, TCAs and MAOIs serve as second-line treatments for anxiety due to their effectiveness but have more significant side effect profiles. Anticonvulsants and atypical antipsychotics offer additional options for treatment-resistant cases, with their use tailored to the individual’s specific needs and response to previous treatments. The choice to use these medications involves careful consideration of the benefits versus potential risks and side effects.
Recent research has expanded into novel pharmacological targets for anxiety disorders, exploring the therapeutic potential of glutamate modulators, GABAergic medications, neuropeptides, and cannabinoids. These emerging treatments offer hope for individuals who have not found relief with traditional anxiety medication.
Glutamate Modulators: Glutamate is the primary excitatory neurotransmitter in the brain and plays a key role in neural activation. Modulating glutamate activity can potentially rebalance neural circuits involved in anxiety. Ketamine, a well-known NMDA receptor antagonist, has shown rapid antidepressant effects in treatment-resistant depression and is being explored for anxiety disorders due to its potential to modulate glutamatergic neurotransmission rapidly.
GABAergic Medications: Enhancing the activity of GABA, the primary inhibitory neurotransmitter in the brain, can produce anxiolytic effects. Research is focused on developing agents that can modulate GABAergic activity with fewer side effects than benzodiazepines.
Neuropeptides: Neuropeptides such as neuropeptide Y (NPY) are under investigation for their role in stress response and anxiety. Targeting neuropeptide systems may offer a novel approach to anxiety treatment by directly influencing the pathways involved in stress resilience.
Cannabinoids: The endocannabinoid system plays a significant role in modulating mood and anxiety. Compounds targeting cannabinoid receptors or enhancing endocannabinoid activity are being studied for their potential anxiolytic effects. Cannabidiol (CBD), a non-psychoactive component of cannabis, has garnered interest for its potential to reduce anxiety without the psychoactive effects associated with tetrahydrocannabinol (THC).
The exploration of drugs like ketamine, riluzole, and xenon focuses on their ability to modulate the glutamatergic system, offering new hope for treatment-resistant cases. Ketamine has gained attention for its rapid-acting antidepressant effects, with research expanding into its efficacy for anxiety disorders. Riluzole, traditionally used in the treatment of amyotrophic lateral sclerosis (ALS), modulates glutamate release and has shown potential benefits in anxiety disorders by targeting glutamatergic neurotransmission. Xenon, an inert gas with anaesthetic properties, is being explored for its potential to modulate the NMDA receptor and its role in neuroprotection and anxiolysis.
When treating anxiety disorders in children and adolescents, Selective Serotonin Reuptake Inhibitors (SSRIs) are typically the first choice due to their favourable balance of efficacy and safety. However, this population requires careful monitoring for side effects of anxiety medication and interactions, as young patients may respond differently to anti anxiety medications than adults. Side effects can include changes in mood, weight, and sleep, and there is a need to vigilantly watch for any signs of increased suicidal ideation, particularly when initiating treatment. Regular follow-ups and close communication with patients and their families are crucial to adjust dosages and ensure the safe and effective use of these medications.
Individuals with anxiety disorders often present with comorbid psychiatric conditions, such as depressive disorders, which can complicate treatment strategies. The presence of comorbid conditions necessitates a comprehensive approach to medication management, often requiring adjustments to standard treatment protocols. It’s essential to choose the best medication for anxiety that can address multiple symptoms or conditions without exacerbating any of the existing issues. SSRIs and SNRIs, for example, can be effective in treating both anxiety and depressive symptoms. In cases of more complex comorbidities, such as anxiety coupled with bipolar disorder or psychosis, atypical antipsychotics or mood stabilisers may be considered in addition to or instead of traditional anxiety medications.
The management of anxiety disorders in individuals with a high risk of dependency, particularly regarding the use of benzodiazepines, requires careful consideration and strategy. Benzodiazepines, while effective for short-term relief of acute anxiety symptoms, carry a significant risk of dependency and withdrawal. To minimise these risks, healthcare providers should limit the duration of benzodiazepine treatment and consider lower dependency-risk alternatives, such as SSRIs or SNRIs, as first-line treatments. For patients who require the anxiolytic efficacy of benzodiazepines, prescribing the lowest effective dose for the shortest duration necessary is advisable. Additionally, exploring non-pharmacological interventions, such as cognitive-behavioural therapy (CBT), can provide long-term benefits without the risk of anxiety disorder medication dependency.
In summary, treating anxiety in children and adolescents, individuals with comorbid conditions, and those at a high risk of dependency necessitates a tailored and cautious approach. Monitoring, adjusting treatment plans as needed, and considering both pharmacological and non-pharmacological interventions are key to achieving effective and safe outcomes.
The evolving landscape of anxiety disorder treatment underscores the critical need for ongoing research into novel therapeutic options. Despite the advances in pharmacotherapy and psychotherapy, a significant proportion of people either do not respond adequately to existing treatments or experience burdensome side effects. Consequently, the exploration of new pharmacological targets, including glutamate modulators, GABAergic medications, neuropeptides, and cannabinoids, remains a priority. The validation of these emerging therapies hinges on the execution of large-scale clinical trials designed to rigorously assess their efficacy, safety, and tolerability across diverse patient populations. (Sartori and Singewald 2019) emphasise the importance of such research efforts to uncover more effective and faster-acting treatments, potentially revolutionising the management of anxiety disorders.
The field of personalised medicine—tailoring medical treatment to the individual characteristics of each individual—holds great promise for the future of anxiety disorder treatment. Recognizing that anxiety disorders manifest differently among individuals, with varying symptoms, severity, and responses to treatment, personalised medicine approaches aim to consider genetic, phenotypic, and environmental factors that could influence treatment outcomes. (Birmaher, Yelovich, and Renaud (1998) highlights the potential for genetic testing to play a crucial role in predicting a patient’s response to specific medications to treat anxiety.
Thereby allowing clinicians to select the most appropriate and effective treatment from the outset. Furthermore, understanding phenotypic variations among patients can guide more targeted and individualised treatment plans, reducing trial and error in anti anxiety medication selection and minimising side effects.
The integration of personalised medicine into clinical practice requires not only advancements in genetic and biomedical research but also the development of comprehensive databases that can inform treatment decisions. Additionally, there is a need for healthcare systems to adapt to support personalised treatment approaches, including training for clinicians in genetics and the implementation of decision-support tools in clinical settings.
The future of anxiety disorder treatment is evolving at the intersection of groundbreaking research and personalized medicine. With advancements in clinical trials and tailored treatment strategies, patients now have more options than ever to manage their anxiety effectively. As we continue to understand the genetic and environmental factors influencing anxiety, the potential for better treatment outcomes and highly personalized care is rapidly expanding.
While medication plays an important role in anxiety management, many people find that therapy provides lasting, drug-free solutions. If you’re looking for personalized anxiety treatment in Sydney, our clinic specializes in evidence-based therapies that help you develop long-term coping strategies without relying on medication.
👉 Learn more about our Sydney-based Anxiety Therapy services here